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Diana Kapp | February 4, 2008
The next big fertility treatment promises to let you get pregnant with your own eggs into your 50s—maybe. Will freezing the biological clock finally make it possible for smart, gutsy Bay Area women to kiss the work/guy/baby craziness good-bye? Tick . . . tick . . . tick . . .
Susanne Goldstein and her friends agree: The perfect date is divorced and already has a couple of kids' soccer games occupying his Saturday mornings. That way, "he's not obsessed with spreading his seed because he's done it," she says. This may seem like an odd statement coming from a 38-year-old single gal who wants kids of her own. But the dynamics of the San Francisco dating scene make it more understandable.
"Most people I meet think I'm 26 or 27," Goldstein explains, so no-bullshit she verges on intimidating. Fresh from a workout, she's still in black tights, her thick hair pulled back in a ponytail; she has too much on her to-do list to bother with a shower. "After a guy hears my life story—eight years doing this" (working in film) "and fifteen years doing that" (running a consulting business) "—he figures out I couldn't possibly be the age he thought. And then that's the end of it."
She's been keenly aware of the age issue since she and Sam,* seven years her junior, split two years ago. "He wants to have kids. But he's nowhere near ready. He figured, by the time he was ready, I'd be too old." It's a common story in the Bay Area, Goldstein says, not that she blames him. And for a woman of her age, achievements, and ambitions, it's one of life's most painful Catch-22s.
So it's not surprising that what's obsessing Goldstein today, instead of her grad school application, due next week to Harvard's John F. Kennedy School of Government, is her ovaries. Yesterday she had lunch with her friend Gloria. Between bites of Tower burgers, the two got into a conversation about egg freezing—the next big fertility technology, an offshoot of in vitro fertilization (IVF) that promises to prolong a woman's chances of having a baby until she's good and ready by putting her eggs (which begin deteriorating rapidly at around the age of 27 and are almost kaput by 42) on ice. The focus of intense research since the 1980s, egg freezing has suddenly reached the point IVF was at ten or fifteen years ago: still experimental, but feasible—at least for a certain privileged class of highly educated, financially well-off, make-it-happen women who don't mind betting on long shots. In a flash, Goldstein thought she'd found the solution to her quandary.
She'd scarcely said good-bye to Gloria before she was on the phone to Lynn Westphal, M.D., assistant professor of obstetrics and gynecology and director of Stanford Medical Center's egg donor program. Barely 24 hours later, Goldstein found herself sitting in Westphal's office, staring at what looked like a TV set missing its antennae. The "white noise" on the screen was an ultrasound of her ovaries, which Westphal and a resident scrutinized for little black dots—aka antral follicles, which contain maturing eggs (or oocytes or ova). "In a young woman with healthy ovaries," Westphal told her, "you'd find about 20 specks on each ovary." For egg-freezing candidates, the number of follicles is critical, since any individual ovum has only a 1 to 2 percent chance of surviving the freezing and thawing process, being fertilized in a petri dish and transplanted into a womb, and the pregnancy itself. Westphal considers anything fewer than 12 to 15 eggs a bit dicey, given their fragility, plus the cost of stimulating, "harvesting," and freezing them for who knows how long. Goldstein's final follicle count: way fewer than that.
Finding out that her ovaries were already in serious decline would seem to violate the first of Goldstein's two life rules: Above all else, avoid being stressed and avoid being cold. But the news had an unexpected calming effect. "All I kept thinking was, ‘Thank God I know the results of this,'" she says. Right there in Westphal's office, she decided to plunk down $10,000 for a procedure that has resulted in a mere 200 births around the world, none in the Bay Area. "I really feel like the age of my eggs is something I get judged for," she says. "I want to be able to say to someone when I'm 42 that I have 38-year-old eggs.
"I have money tucked away," she adds. "I own a home already. This rises to the top of the list as the most important use of my money. You only get one shot." Speeding back up 280, armed with a needle to practice injecting her tummy with fertility drugs and a treatment calendar geared to the start of the fall semester in Cambridge, Goldstein called her mom: "Do you still love me even though I'm crazy?"
ITEM: A few years back, Dr. Eldon Schriock and his wife, Beth, also a physician, were the featured speakers at a brown-bag lunch for UCSF students on couples juggling dual careers and kids. But in a nanosecond, the discussion veered from putting family in balance to putting family off. "It ended up being a bunch of young doctors pressing me on how they could preserve their fertility," says Schriock, now medical director at the city's tony Pacific Fertility Center.
ITEM: At Stanford earlier this year, 100 or so students and alum ponied up $55 each for "Career, Babies, and Biological Clocks," a talk sponsored by Stanford Professional Women. "I'm doing the math," confided a biz school second-year who attended. She was agonizing over an offer from a hot private equity firm. "I'm 28. It takes five years to make partner. If I take this job, and I want kids, I'm pretty much guaranteeing I won't make partner." At a corner table, a gaggle of sorority sisters stopped planning an upcoming bash to stare worriedly at a graph showing how miscarriage increases and fertility decreases over time. The line of women with questions for G. David Adamson, a doctor at Fertility Physicians of Northern California in Palo Alto and San Jose, wound out the door.
ITEM: A well-known local OB-GYN, still single in her late 30s, is rumored to have frozen embryos (her own eggs, anonymous donor sperm), "just in case." Soon after, she met a guy, married him, and—using fertility drugs—finally got pregnant. The embryos, it's said, are still in the freezer.
Attention, trend watchers: The Bay Area has a new obsession. When it comes to women under 40 and their fertility, the ignorance-is-bliss era couldn't be more over. Blame Sylvia Ann Hewlett's 2002 book, Creating a Life: Professional Women and the Quest for Children, which piles on enough scary stats about declining fertility and unhappily childless overachievers to cave in the roof at Berkeley's Boalt Hall School of Law. Or those Newsweek and Time cover stories pushing the panic button even harder. Blame the Charlotte and Miranda story lines on Sex and the City and the egg donor ads on the back of the Bay Guardian, which suggest that if you're over 30, "your shriveled-up eggs are good for nothing," as one 33-year-old San Francisco woman, newly split from her longtime beau, ruefully says. It's a Zeitgeist thing: Along with the Atkins diet and the Davis recall, the hot topic at dinner parties has become how to pick a sperm donor or ask your sister for her eggs if yours get too old. "The thirtieth birthday is a big trigger," says newly pregnant 34-year-old Andrea Leszek, a manager at a dot-com, who, like a lot of her friends, was starting to stress out about the state of her ovaries. "We're the first generation that's really dealt with this. It's a sociological phenomenon."
Yet for all the heart-to-heart conversations and ticking-time-bomb jokes, no one seems to know how to solve the love-work conundrum that has plagued liberated go-getters at least since Gloria Steinem arrived on the scene. Life for many under-40 Bay Area women is still careening—not to mention careering—in the what-would-I-do-with-a-kid-now direction: so many degrees to earn, so many companies to get off the ground, so many frogs to kiss before finding the One. Then there's the all-too-common lament that when a gal is finally ready to hop on the mommy track, all the good guys her age are taken. "The ones that aren't are single for a reason," says one unmarried San Francisco doctor. "My biggest fear is ‘settling'—ending up in five years with some guy sitting on my couch drinking beer." One result: In the largest market for Match.com in the country, 45 percent of adult San Franciscans have never been married (even accounting for gays and lesbians, that's huge).
No surprise, then, that the typical San Francisco mom is almost 30 when the stork pays her first visit, the Census Bureau reports—five years older than the national average, eight years older than the typical new mom circa 1970. Among Bay Area professionals, the average first-time mother is probably a good bit older, judging by all those graying heads bent over breast-feeding babies at Peet's. And because of their advanced age, many of those moms conceive the 21st-century way: in a neon-lit doctor's office, tended by an entourage of fertility specialists, with Daddy down the hall watching a porn video while he spills his seed into a cup. In 2001, according to the Centers for Disease Control, women here were two and a half times more likely than those in the rest of the country to give birth through IVF. Just count all the twin strollers navigating the sidewalks of upscale neighborhoods from Petaluma to Morgan Hill. ART—assisted reproductive technology—is the way large segments of the Bay Area make babies now.
Except when it doesn't work. Twenty-five years after the birth of the first "test-tube" baby (in England) stunned the world, ART breakthroughs have come so fast and furious that many of us have been lulled into thinking that virtually any old ovary can be coaxed into fecundity with a syringeful of hormones. News stories about famous older moms—Madonna, Geena Davis, that 60-something Italian woman who had a baby after her 17-year-old son was killed in a road accident—have created the illusion that 40 is a perfectly normal age to get pregnant. (The number of California women who had their first child in their 40s surged by 700 percent from 1980 to 2000.)
Yet for every delirious couple celebrating a positive pregnancy test by sending a case of champagne to their Pacific Heights fertility specialist, at least two others—stressed to the max, mired in debt, wracked with heartbreak every time they pass a Baby Gap—give up trying, with nothing to show for their efforts but a pile of referrals to infertility support groups and adoption agencies. Too-old eggs are often their problem. "The analogy I use is fruit at the supermarket," says embryologist Barry Behr, director of Stanford's In Vitro Fertilization and Assisted Reproductive Technologies Lab. "The delivery is made on Monday. By Sunday it's all rotten bananas and bruised plums. Eggs after 40 are like weekend fruit." Only not very fruitful: Of the 4 million women who gave birth in the United States in 2001, just 2.5 percent were 40 or over, and a mere one-tenth of 1 percent were 45-plus. Even with IVF, the chances of giving birth over age 42 using your own eggs are less than 6 percent per attempt.
Couple these grim stats with the strange reality of the local dating scene, and it's easy to see why egg-freezing advances at Stanford and a handful of other fertility clinics have scientists buzzing—and growing numbers of independent, frustrated, determined women dipping into their 401(k)s. Here, at last, could be the solution to what guys have been known to call "Newsweek syndrome" ("stressy, freaked-out women pressuring them to commit," one single explains). With a stash of still-fertile eggs in the bank, the Ironwoman challenge of synchronizing career, love life, and biological clock might become a game someone could actually win.
The potential implications of egg freezing—personal, commercial, and societal—are profound. As the technology improves, it could transform the assumptions, expectations, and destinies of men and women as dramatically as the Pill and legalized abortion did a generation ago, Behr believes. "Now," he says, "you can have your cake and eat it, too."
But first, there are a few kinks to work out.
Lynn Westphal's plans for a two-week getaway to the coast of Spain just turned into a couple of days at Disneyland. Which is hugely disappointing, since she's at the Stanford Reproductive Endocrinology and Infertility Center seven days a week and hasn't had a day off in nearly three months; unfortunately, women's ovulation cycles don't pause for weekends and holidays. The relentless nature of fertility treatment is hell on family vacation plans but great for her bond with patients (Westphal has been known to dance around the lab when someone who has tried everything finally gets pregnant, though it's hard to imagine this reserved, preppy blonde kicking up her heels). The bond goes deep. Like most of her patients, the 42-year-old fertility specialist has been to the brink of infertility.
Westphal got into the field as a Stanford medical student in the mid-1980s. Clawing her way into "the old boys club of medicine," she recalls, "I wanted to finish my fellowship, then my subspecialty boards. Then I wanted to get my practice going. Fifty [for kids] sounded about right." Instead, she had her first baby at 34, scared into it by five close colleagues who were all experiencing fertility problems. But when she wanted to try again at 37, she tested high for a key hormone, making the likelihood of a baby low ("I bawled for a week"). In the end, with fertility drugs, she got pregnant. "I realized what a miracle it was. I really beat the odds."
After three years in private practice as a reproductive endocrinologist, she was recruited back to Stanford in 1998 to establish its donor egg program. Just a few months into her new job, she received a call from a desperate local dad whose 21-year-old daughter had just been diagnosed with cancer. He'd phoned fertility centers around the country looking for someone to save some of her eggs before chemotherapy destroyed them. At that point, it was fairly common to freeze embryos, usually "extras" left over from a standard IVF round. But only a few labs internationally and on the East Coast were experimenting with preserving unfertilized eggs, with minimal success. "He pleaded with us to do it," Westphal recounts. She consulted with Behr, who told her he thought his staff had the technical skills to succeed. The young woman and her father were thrilled.
That call launched the first program in the country dedicated to preserving the fertility of cancer patients. Today, Stanford houses 34 such women's unfertilized eggs, loaded into cocktail-sized straws and stored indefinitely in a tank of steaming liquid nitrogen at minus 196 degrees Celsius. (For an explanation of the process, see "Six Things You Should Know If You're Thinking About Egg Freezing," at left.) Another dozen patients have chosen to cryopreserve embryos—a much safer bet, since these have a longer track record and result in pregnancies a respectable 25 percent of the time. The problem is that embryos require a partner or sperm donor—something patients may not have or be ready for.
Lindsay Nohr, diagnosed with recurrent tongue cancer two years ago at age 24, fell into this category. "I could handle the cancer," she says. "The thought of being infertile I could not handle." Thanks to the Stanford program, she was on fertility hormones just days after her tumor was removed. Now, with 29 eggs in safekeeping, Nohr runs Fertile Hope, a nonprofit that helps other cancer patients in a similar predicament. In late September, the group held a glitzy fund-raiser in San Francisco with the Lance Armstrong Foundation (Armstrong's three kids come from sperm he banked the day before beginning chemo for testicular cancer). Lynn Westphal ("my angel") sits on Nohr's medical advisory board.
What Westphal and Behr never expected was how much time they'd have to spend fending off hordes of perfectly healthy, mostly single women who wanted to bank their eggs, too. At first, the docs reacted to these pleas with an emphatic no. It was one thing to offer an experimental procedure as a last-ditch option for someone who would become infertile fighting a potentially fatal disease, quite another to encourage a healthy woman to undergo an expensive, sometimes grueling course of treatment, replete with potential complications and general anesthesia, to possibly—only possibly—become pregnant many years down the line. At this point, back in the late nineties, researchers had yet to prove they could reliably freeze eggs at rates that consistently lead to babies. (Even now, none of the Stanford cancer patients has taken the ultimate step: actually trying to thaw and fertilize an egg.) "Women may count on it and not get pregnant when they should," Westphal says. "If the eggs don't thaw well, they've lost their opportunity to get pregnant."
Once again it was a persistent caller—a divorced software exec edging toward 40—who turned them around. When Heidi Flaherty was married, kids never moved to the front of her agenda. "I always thought I would wake up one morning and feel, ‘Now is the time to have a baby.' And I never did." In the six years since she and her husband split, none of the guys she's dated has made her want to elope to Las Vegas and start a family. Intent on having a mate and children ("I'm not ready to accept that whole spinster thing"), she was looking to buy a little more time.
She'd already been looking into egg freezing when she happened to attend a 1999 performance of the play Immaculate Misconception, at San Francisco's Eureka Theatre. The drama—penned by Stanford chemistry professor and writer-gadfly Carl Djerassi, best known as the "father" of the birth control pill—prophesied a world (a little bit Orwell, a little bit Huxley) in which women routinely freeze their eggs, men bank their sperm and have vasectomies, and reproduction is divorced from love and the biological clock. By chance, Djerassi, who often attends performances of his plays, was in the audience that night (in fact, he was sitting right behind her). When she figured out who he was, Flaherty introduced herself and asked him how futuristic his vision really was. His answer sealed her resolve.
"She made a very good argument," says Westphal. "She'd obviously given it a lot of thought." Still, it took two years to wear down Westphal and Behr. Late last year, the clinic finally received permission from a Stanford medical review board to take egg freezing mainstream. Flaherty signed on as the first healthy patient.
Barry Behr has been trying to figure out the most effective way to freeze human eggs since he was a grad student at the University of Nevada in the mid-eighties, when it had hardly ever been done. In his quest, he focused on several species of fish and amphibians that he believed might hold the key because they literally freeze solid in winter and thaw out in spring. Eventually, by comparing these animals to their warm-blooded cousins, he identified a sugar and an amino acid abundant in the ones that freeze. Nearly 20 years later, despite recent reports that the sugar, trehalose, may indeed increase the survival rates of frozen human eggs, Behr still is trying to come up with the perfect freezing protocol. So are a lot of other researchers. All of which underscores just how experimental egg freezing still is—and how much of a gamble it may be for women to bank their oocytes now as a hedge against an infertile future. Leaning back in his cramped office, Behr, a spirited South African, sighs heavily. "[Egg freezing] is more profound than almost anything else we do. The responsibility is huge."
The technical challenge relates to the nature of the egg. The width of a human hair, it is the largest cell in the body and very watery, with an extremely fragile "shell." This exterior is important because sperm need to bind to it to penetrate the egg. Freezing causes the water inside to expand, often damaging the shell. Other factors increase an egg's fragility—a woman's age, the approach of ovulation (when the DNA inside is in an especially delicate state, and even slight changes in temperature can disturb the vital maturation process). The goal isn't to make frozen eggs as "good" as fresh ("Frozen will never be the same as fresh," Behr says; "it's not in fish; it's not in veggies") but to greatly improve their viability once thawed.
Still, the process has improved to the point where higher pregnancy rates are expected to be announced at the American Society for Reproductive Medicine annual meeting in San Antonio, Texas, later this month. Ironically, though, "the real advance in egg freezing hasn't been in freezing," Behr says. It's been something called ICSI (intracytoplasmic sperm injection), which allows individual sperm to be injected directly into the cytoplasm of the egg, thus bypassing the problematic outer membrane. First performed in 1992, this little-touted technique has catapulted IVF success rates, especially for over-40 women, and it's largely solved male infertility. Now, according to researchers at the University of Bologna, where 35 (or nearly 20 percent) of the world's frozen-egg babies have been born via their freezing, thawing, and ICSI protocol, the pregnancy rate has jumped to about 20 percent, nearly as good as with frozen embryos. Los Angeles fertility doctor Thomas Kim, pioneering a "flash freezing" process, has reported a 21 percent birth rate with ICSI. At the San Antonio meeting, he plans to present new data about five patients whose excess eggs were frozen after a first IVF round; in later IVF cycles using the thawed eggs, three of the five women took home a baby—a stunning 60 percent success rate.
Those kinds of numbers have gotten the attention of fertility docs everywhere and ignited an entrepreneurial boom. Last year Kim opened CHA Fertility Center on Wilshire Boulevard in L.A., which offers egg freezing and storage for healthy women under 37. (The cost: $8,000, not including drugs.) He's frozen the eggs of 23 patients and turned away about 400 more who didn't meet age and other criteria. Meanwhile, the Florida Institute for Reproductive Medicine, in Jacksonville, which claims it can deliver a baby to any woman from whom it can harvest 12 to 19 eggs, is franchising its system to other clinics. (It has never published its protocol, but admits its results are based mainly on eggs from women 33 and under.)
Locally, however, Stanford's ambivalence is shared by other top clinics. "In 1983, we were doing IVF at UCSF with initial success rates of 10 percent," says Schriock, who was part of the UCSF team that performed the first IVF procedure in Northern California."Egg freezing is already realizing greater success than that." Even so, his Pacific Fertility Center, the city's busiest fertility clinic, doesn't plan to offer egg freezing until the results are more reliable. At UCSF, the director of the Division of Reproductive Endocrinology and Infertility, Marcelle Cedars, says: "Early on in IVF, women were doing something where they had no other option. With egg freezing, you are doing this for a contingency." Still, UCSF has started freezing the eggs of patients with cancer or other extreme circumstances.
In the hypercompetitive, extraordinarily lucrative fertility business, top clinics no longer have a choice, says Behr. "If you take the high road and try to do the right thing—are you really accomplishing anything?" he asks. "You're not changing the outcome for this patient. Because they'll just go elsewhere."
The usual Bistro Aix crowd is somewhere else this evening, which suits this handful of single, thirtysomething women just fine. They socialize occasionally, but tonight they've gathered in this Marina hot spot to talk to Christy Jones, a '91 Stanford grad who launched the now $150 million Trilogy Software before even leaving "the Farm" (for which Ernst & Young named her 1999's Entrepreneur of the Year in the young persons category). They're here to vet her latest endeavor: a chain of egg-freezing centers catering to women like them. Jones's current plan is to open the first Extend Fertility clinic in California by the end of the year. (Her first idea, for a clinic with a "spalike" atmosphere, has given way to something less girly-girly, more medical-serious.)
Not surprisingly, Jones is invested in her idea well beyond its bottom-line potential (though she is financing the start-up costs from her own fortune—no venture capitalists involved). She spent much of the last decade building Trilogy. "It was intoxicating—I was having a blast. And work was all I did." At 30, single, barely having dated, she finally looked up. "I always thought I'd gun for my career in my 20s. Then I'd be ready to have a family. But it doesn't quite work that way," she says, laughing.
Now, though, instead of concentrating on relationships, the 33-year-old is jetting across the country, lining up a team (Behr has just signed on as her chief scientific adviser). Instead of a baby, she's giving birth to yet another business—one that taps into the deep reluctance of other educated, ambitious women to choose personal lives over professional dreams.
Sara,* a consummate fast-tracker ("in high school I was voted most likely to make a million and most likely to succeed"), first heard about egg freezing a couple of years back from Jones, a friend. At the time, the concept struck her as strange; now, nearing 32 and single, she can "totally relate." "I'd just appreciate not having to think about it. Then I'd go about figuring out what I want to be when I grow up. And having fun with my single friends going to parties."
"My three best guy friends—they're all having relationships with 27-year-olds," vents Aimee,* grabbing her red bag to shut off her ringing cell phone. Her monthly trip to Hong Kong—she's a management coach for a global tech company—was canceled at the last minute, which is why she was able to make it. "They're 40, went to Harvard Business School, and they won't date a girl over 35." Not that she entirely blames them. "For guys that age, there's a lot of pressure. They perceive anyone over 35 as looking for a father."
"So many guy friends who hear about my business idea say, ‘Men will love you. It takes the pressure off. Market this to men,'" Jones blurts out. Everyone laughs.
And then, she leans in and asks, "So, would you guys freeze your eggs?"
"One of my friends at work was all set to do it—she'd done all the research," says Sara. "Then she had this dream about her eggs sitting there all alone. And she abandoned the whole thing."
It does seem lonely, Aimee agrees. Divorced four years ago at 30, the outspoken brunette never anticipated being in this position. "If it's not going to happen the traditional way, I'd adopt."
Another friend who considered it "decided instead to go find a husband," Sara says. "She did Match.com like a maniac—went on two to three dates a day for a couple months. And it worked. She found a guy and married him.
"I'm not quite there yet," she adds, munching a fry. "I could see doing egg freezing a year from now. But there is some sense of ‘giving up' with it. That you've had to resort to this."
"It's exciting," chimes in Lily, 33, a strikingly attractive physician in her first year of practice. "I wouldn't want people to know, though. It's very narcissistic."
"Egg freezing reminds me a lot of plastic surgery," Aimee responds. "In the beginning there was total stigma. Now if you want Botox or a boob job, you just go do it. Soon it'll be, ‘I'm not freezing eggs because there's something wrong with me. I'm a liberated woman doing what liberated women do.'"
The conversation confirms most of Jones's hunches. Women in her target market can see the benefits of egg freezing and can imagine themselves doing it—eventually, if they run out of options. For this fast-lane group, at least, cost doesn't seem to be a factor—it never even came up. Even so, there's a big hurdle to overcome. By the time the sense of urgency hits, it's often too late. If a gal really wants to hedge her bets, she ought to freeze her eggs in her 20s or early 30s, instead of waiting until she's pressed up against the wall at 38. But how many still-young women want to imagine themselves ten years later, ready to settle down but completely alone? How many women, at the start of their careers, can fork over $10,000-plus for something they may not need and that may not work? Jones's fundamental challenge is really not, If they make it, will they come? But rather, Will they come soon enough?
These are big questions—for Jones, too. She's planning to freeze her eggs as soon as she opens her first clinic.
For a woman who spends her life making babies, it's ironic that University of Bologna's Eleonora Porcu spent so much energy hiding her pregnancy from colleagues (she was 35 and kept it a secret for seven months). "You're viewed as less efficient," she complains, "though it [pregnancy] has nothing to do with your efficiency." That experience, as well as her years as a top researcher at one of the leading fertility clinics in the world, has prompted her to think a great deal about the feminist and social implications of ART. She's more ambivalent than you might assume.
On the positive side, she thinks egg freezing could offer a way around ethical issues involving embryos and the definition of life (plenty of people believe destroying unused embryos, for example, is akin to abortion; destroying unfertilized eggs doesn't provoke the same angst). But unlike the women at Bistro Aix, Porcu doesn't see banking eggs as the solution to the work-family dilemma. "I think women should change society," she says. Instead of more years to synchronize career and kids, she adds, what women really need is a social structure (subsidized child care, more flexible hours, and so on) that allows them to raise families and pursue meaningful work. She also frets about what might happen if egg freezing becomes as prevalent as, say, Botox. "We risk transforming reproduction into a laboratory matter," Porcu says. "If we separate reproduction from the human relationship between a man and a woman, this will make us poor from an emotional point of view."
Indeed, as egg freezing hits the mainstream, it's starting to create plenty of skeptics, including prominent feminists like Berkeley-based Peggy Orenstein, author of Flux, a widely read look at the difficulties of juggling marriage, family, and career. She thinks egg freezing is "overstated, oversold, overdone." Especially since, for most women, assisted reproductive techniques don't produce a baby. "I've been through the ‘fertility mill,'" says the 41-year-old, referring to her own multiple fertility treatments. "And I never got pregnant, not even a little bit." The two-month-old daughter she's now toting in a sling happened the old-fashioned way: a romantic weekend with her husband.
Other difficult issues arise: Is it a good thing for women (or men) to be lulled into thinking, even more than they already do, that it's OK to put off love and family until the time is "right"? As anybody who's ever had a kid can tell you, the timing is never perfect. Will women (or men) in the full flower of their careers really be better able than younger people to drop everything to start a family? What kinds of new parents will grandparent-age people make?
It's the job of Arthur Caplan, Ph.D, chair of the Department of Medical Ethics and director of the Center of Bioethics at the University of Pennsylvania, to raise provocative questions about the long-term impact of medical technology, and he has some doozies when it comes to egg freezing. "If social pressure leads to everybody doing this, is that really the best use of our resources?" he asks. "When is it irresponsible not to freeze eggs—is it the obligation of a parent whose young daughter is undergoing surgery? How long is too long for an egg to be frozen and still used—20 years? 100?" Then there's the most obvious of all: Will the babies be healthy? (So far so good, but the truth is, no one knows. The technology is too new. Some recent studies, however, suggest that babies born through ICSI may be more likely to suffer from certain chromosomal abnormalities, a fact that rarely comes up in the discussion. Other studies have found no such problems.)
These are all issues that society should be grappling with, says Noel Schwerin, who explores the topic in her recent PBS documentary Bloodlines: Technology Hits Home. She's concerned that so far this hasn't happened. "These decisions are being made behind closed doors, in doctors' offices."
Orenstein is worried, too. The fertility industry is a big business, she says. "Our vulnerability is being preyed upon. There's a lot of money to be made."
Susanne Goldstein, of course, did get accepted to Harvard. This summer she headed east to reclaim that sense of possibility that comes only from being back in school (and from hanging around the kind of cute, smart, single guys most often found on a college campus). While she'd hoped to leave a stash of eggs behind, her story didn't go that way.
When Goldstein heard Westphal on the answering machine ("Give me a call; I want to discuss next steps with you"), she knew instantly the news wasn't good. There was something about the doctor's tone of voice. When they finally spoke, Westphal said that Goldstein's tests had come back borderline—borderline not good. They'd need to be extremely aggressive. But even jacked on twice the typical hormone dose (at twice the cost), there was still a good chance she wouldn't produce enough eggs to warrant harvesting and freezing.
Still, Goldstein was willing to see how her body responded to the first phase of treatment. After a bluesy, bloated few days, "I tried to access my gut," Goldstein recalls. "It was saying ‘Don't do it.'" So in the same take-charge way that she'd decided to give egg freezing a try, she opted to pull the plug. "It's devastating," she said at the time. "Even right now I'm sitting here wondering, ‘Did I just make the biggest mistake of my life?' I'll never know."
Heidi Flaherty, the woman who persuaded Stanford to open up its egg-freezing program, ended up in pretty much the same boat. Elevated levels of a key hormone that should be low. Just three eggs produced on the first attempt and four when she tried again. At that point, Flaherty decided, enough. "Well, at least now I don't have to worry about birth control," she says.
A couple of months later, Goldstein has moved on. She's staying up late studying econ and socially responsible business, engaging in policy wonk discussions "with some of the smartest people I've ever been around." Harvard guys think she's in her 20s. She's not looking forward to the cold but is otherwise very happy.
Her current take on kids, aging eggs, and the future: She'll just see where life leads her. "I decided not to fight fate. Whatever happens happens," she says, with the confidence of someone for whom things always seem to work out. But then, in the next breath, a bit wistfully, "You kind of have to look at it this way."
Six Things You Should Know if You're Thinking About Egg Freezing
1. Your chances for success are really iffy—at least at the moment.
Not one baby has been born in the Bay Area from a frozen egg. Ever. Around the world, only about 200 babies have ever been born that way. In a handful of clinics, frozen-egg researchers have claimed a success rate of around 20 percent—i.e., only one in five women implanted with previously frozen eggs has carried a baby to term.
Here's another caveat: Most of the reported results are from women under 35, and researchers aren't sure how older eggs respond to the freezing and thawing process. In addition, most findings involve eggs frozen for a few weeks or months at most.
2. Being a fertility patient is a big pain.
A woman is born with a finite number of eggs. Through her life, hormones cycling monthly cause eggs to "ripen" and leave the ovaries. In an old-fashioned pregnancy, an egg is pulled down the fallopian tube to the uterus and is fertilized by a sperm. Ah, the miracle of life.
Here's the miracle of science. Like in vitro fertilization (IVF), egg freezing begins with using hormones to stimulate egg production—more eggs than mature in a natural cycle—and then "harvesting" them from a patient's ovaries. Stimulating eggs invariably involves daily do-it-yourself hormone injections that can cause bloating, mood swings, and weight gain. Perhaps more inconvenient, you need to go to the doctor several times a week for ultrasound monitoring and hormone tests. When enough eggs are mature, a needle is inserted through the vagina and egg-producing follicles on each ovary are drained. (Harvesting is performed using general anesthesia, but most women say it's no big deal.) With IVF, the best-looking eggs are united with sperm outside the body, and after three to five days, the most promising embryos are transferred to the woman's uterus. Egg freezing adds a step, whereby mature eggs are preserved, then thawed before they're fertilized.
3. Freezing technology is still a work in progress.
Human eggs, like human beings, are mostly made of water. When an egg is frozen, ice crystals form inside that can tear its outer membrane and the tethers that hold DNA inside. Researchers are experimenting with a number of methods to reduce damage from freezing and thawing. At Stanford, before the eggs are frozen, they are dipped in an alternating series of baths containing a chemical called Propanediol and a mixture of sucrose and water. Dipping the eggs in increasingly concentrated sugar solutions forces water out gradually, Propanediol replaces the water, and the eggs can be safely stored at minus 196 degrees Celsius. But that's just at Stanford. Other clinics have different approaches (for example, flash freezing instead of slow freezing), and even Stanford docs are constantly tweaking their method. The point: The approach your clinic chooses may not stand the test of time.
4. It's a lot to pay for a long shot.
Total cost for a patient for one attempt at egg freezing is $8,000 to $10,000; the biggest expense ($3,000 plus) is for hormone shots. On top of this, you need to do IVF to implant the eggs (another $10,000 or so per attempt; it often takes more than one). Most insurance companies don't cover any type of fertility treatments; the ones that do may not cover egg freezing.
A cost you may not have bargained for: Because multiple thawed and fertilized eggs are implanted to increase the chances of pregnancy, you may go home with twins or triplets. IVF pregnancies have a 36 percent chance of resulting in multiple births.
5. Science still doesn't understand the long-term risks.
There is no conclusive evidence on the rates of birth defects in frozen-egg babies, and data on IVF babies is highly inconclusive. (With all pregnancies, risk levels for both miscarriage and certain birth abnormalities go up exponentially as a mother's age increases.)
6. Your motives are worth a second thought.
Egg freezing has the potential to extend fertility a decade or even longer. Before starting on the path to freezing eggs, consider these questions: What exactly are you waiting for—and will the right time ever come? If the mate of your dreams (or even one you'd settle for) never appears, would you use the eggs to have a baby on your own? Could the money budgeted for fertility treatments and egg freezing be better spent on a matchmaker? On finding the right sperm or egg donor? On adoption? On raising a baby alone? Any fertility doctor should be able to discuss these questions with you.