Fertility Preservation: Hope for the Future.
The six words jump off of the large screen in front of us. Around me, 30 or so people sit in plush leather chairs nibbling on catered tea sandwiches. It’s 6:30 p.m. on a Wednesday night, and we’re in the dark “Screening Room” of one of California’s most highly respected fertility clinics, Southern California Reproductive Center, located on the sixth floor of a building just off of Rodeo Drive in Beverly Hills. It’s a fancy establishment, the kind of place with gold curtains and a bold painting of the sun on the ceiling.
Like me, most of the people at this free “Fertility 101” information session appear to be women in their thirties, and we are all here to learn one thing: whether this place can save us from our rapidly and inevitably declining fertility.
On the screen, a Powerpoint slideshow shuffles through “fun facts” that signal all will be okay. We learn about the doctors we’ll be hearing from this evening (Dr. Chang loves karaoke) and look at photos of children born through in-vitro fertilization, known here as #Hopenators. The center informs us that what we’re all dealing with is normal—one in six couples face fertility issues—and provides us with inspirational quotes to further soothe us. Never give up on something you really want, the center tells us. It’s hard to wait, but it’s harder to regret; what isn’t today, might be tomorrow. The center also requests that we leave a review on Yelp.
“Fertility Preservation” can mean any one of many things, we learn. It can mean sperm freezing or in-vitro-fertilization, in which an egg gets fertilized in a lab and not a uterus. But critically for the purposes of centers like this, it also can mean egg freezing, or “oocyte cryopreservation,” a process in which a person injects hormones to stimulate ovulation, which allows eggs to be extracted, frozen and stored for later use.
Free “information sessions” like this one have become increasingly common at U.S. fertility clinics over the past five years, primarily thanks to two developments related to egg freezing, according to Rene Almeling, a professor of sociology at Yale University and the author of Sex Cells: The Medical Market for Eggs and Sperm. The first occurred in 2012, when the American Society for Reproductive Medicine stopped labeling egg freezing as an “experimental” process, which allowed fertility clinics to market the process more broadly and aggressively. Then, in 2014, Facebook and Apple announced their employees would receive full egg-freezing coverage for non-medical purposes.
Media coverage of the tech giants’ shiny new employee benefit led to broader public knowledge of and discussion around the egg-freezing process, which was often depicted as an empowering means toward female career advancement. Bloomberg Businessweek ran a story in 2014 with the headline “Freeze Your Eggs, Free Your Career.” TIME published one titled “Company-Paid Egg Freezing Will Be the Great Equalizer.” Hal Danzer, a reproductive endocrinologist and co-founder of Southern California Reproductive Center, or SCRC, told me that the women who come in are "really excited about doing this for their careers.” But one 2018 study found the primary reason people decide to freeze their eggs is lack of a partner.
Whatever the reason, egg freezing has become the fastest-growing fertility preservation service in the business. In recent years, the number of U.S. egg freezing cycles has more than doubled—from around 5,000 in 2013 to almost 11,000 in 2017. While data is not yet available for 2018, the founder of the New York-based egg freezing clinic Kindbody recently told The New York Times that she expected that number to jump to nearly 76,000. Danzer said that SCRC used to be involved in 20 to 30 egg freezing cycles annually. This year, the center expects that number to hit 300.
But the aggressively optimistic and inarguably swanky information sessions like the one I attended can mask some of the more complicated scientific realities surrounding egg freezing. What has been marketed as an empowering insurance policy for career-minded woman is in reality a complicated and expensive medical procedure with questionable outcomes and significant unknowns—one that is leaving many patients frustrated.
Almeling, for one, is particularly irritated by the marketing tactics.
“This is still a fairly new technology that has a fairly low success rate; this means that people in the fertility industry are aware that it’s not at all an insurance policy, but I think that language is still sometimes used in an effort to sell this to women,” she said. Instead of an insurance policy, she added, egg freezing is more akin to a “very expensive lottery ticket.”
Though the process is being marketed as a smart career choice for those hoping to slow their biological clock, it remains a luxury service limited to very few. On average, a single egg-freezing cycle that includes medication and storage costs between $15,000–$20,000, according to Fertility IQ, an online hub for fertility information. Often, people need more than one cycle to get their desired number of eggs. If the patient ever wants to use the eggs through in-vitro-fertilization, that will cost an extra $22,000. The vast majority of people who undergo the process have to pay most of that themselves. In 2017, only 20 percent of people who sought fertility treatment had all services covered by insurance, according to Fertility IQ. Seventeen percent had limited coverage, and 63 percent had no fertility coverage at all.
The high costs make free information sessions a critical component of the process. No one likes to fork over $15,000. As a result, reproductive endocrinologists have begun to find a myriad of ways to market their services and make women believe the process will be easy and fruitful. In the Bay Area, one such reproductive endocrinologist named Aimee Eyvazzadeh has come to call herself “The Egg Whisperer.” Through her YouTube show, Eyvazzadeh racks up as many as 92,000 views with videos like “How to have the best Egg Retrieval Experience” and “How to Give Yourself a 100% IVF success rate.” She also holds bi-monthly webinars she calls “egg-freezing parties,” where potential clients can “ask questions about their options.” Earlier this year, Kindbody, the New York-based fertility clinic, raised $15 million from venture capitalists for its “Fertility Bus,” a mobile clinic that does free testing for anti-Müllerian hormone, which can help assess someone’s ovarian egg reserve but isn’t a conclusive determinant of fertility. Once you have the results of that, a prospective client can head to Kindbody’s Manhattan clinic for a more comprehensive $250 fertility test. In truth, it’s all marketing for Kindbody’s primary business: egg freezing.
“For fertility clinics, this is a money-making enterprise,” Almeling said. “There are clinics that put on fairly fancy events with cocktails and swag and these free vouchers. There’s a reason that so much effort is being put into these marketing events, and it’s because it’s a great source of revenue for fertility clinics.”
But fertility clinics often downplay the cost of egg freezing in their information sessions. At my SCRC event, discussion of money was minimal and vague. The only time it was mentioned explicitly was at the top of the presentation, when a doctor went over the tech giants that pay for fertility services and the types of insurance the center will accept, while also noting insurance companies vary in what they will cover. Attendees were handed free fertility consultation vouchers, which had a link to download a free “Egg Freezing Cost Guide,” but that wasn’t very informative either. The “What Will It Cost To Freeze My Eggs?” page says that the average was “somewhere around $10K per cycle,” but that it “can vary from clinic to clinic” and didn’t specify if that was the cost there. While they noted that the medications usually run between $3,000-5,000, there was no estimate for the anesthesia or storage, even though the eggs are stored at SCRC. When I later asked Danzer about the center’s cost more directly, he said that he tells people to budget $10,000 for the process, excluding two things: anesthesia, which can cost between $500 and $1,000 if not covered by insurance; and storage costs, which Danzer said costs “a couple hundred dollars” per year at SCRC.
That money is paying for a procedure with significant medical unknowns. According to Almeling, no one in the pharmaceutical industry ever undertook a longitudinal study on the long-term effects of fertility drugs. What we do know is that egg freezing is anything but a sure bet. A 2018 study from the Human Fertilisation and Embryology Authority in the U.K. found that the use of a patients’ own frozen eggs resulted in a live birth only 18 percent of the time per cycle. A 2015 study referenced in a Canadian Fertility and Andrology Society report estimated that for people 35 and under, success rates ranged from 15 to 61 percent. For people over 35 that rate was between 5 and 30 percent. The Mayo Clinic summarizes it this way: “The chances of becoming pregnant after implantation are roughly 30 to 60 percent, depending on your age at the time of egg freezing.” (It’s possible the technology has improved in the years since this data was collected, but this is the most recent reputable information available.)
Danzer took issue with these numbers when I brought them up, saying that the live birth rate is closer to 80 percent nationally and 90 percent at SCRC. When I asked where I could find such data, he instead emphasized SCRC’s experience and skill.
Almeling believes that fertility clinics need to not only be more transparent about the “really, really, really high” failure rates, but provide more information about the physical difficulties involved in the egg stimulation and retrieval process too.
“It’s been gleefully marketed as this easy, breezy technological solution to your biological clock, when, in fact, freezing one's eggs requires self-injecting fertility medications at least once a day for several weeks and going through outpatient surgery,” she said.
Dina, an attorney in her mid-thirties who asked that VICE not use her real name, attended an SCRC information session in 2016. As a child, she’d had to have an ovary removed and was at the information session less for information and more for the free consultation. “I wanted to know if I was dealing with a half deck of cards or not,” she says.
“It was very strange,” Dina said. “They gave us champagne, which seemed weird for a fertility event.” In addition to a similar version of the slideshow I watched, Dina said her event included a “baby playlist.” As Dina watched the pre-presentation, baby-heavy slideshow, music played from the surround-sound speakers. “Every song had the word ‘baby’ in it,” Dina said, “everything from The Supremes ‘Baby Baby’ to Britney Spears’ ‘Baby One More Time.”
The message couldn’t have been clearer to Dina, who felt as if the center was saying, “We’re going to get the job done. You’re going to have kids this way.”
In contrast to the pre-presentation, Dina describes the presentation itself as “a heavily fear-based campaign.” As she looked at slide after slide that addressed her declining fertility, Dina found herself wondering: “Is this really necessary?” Sitting in the same room, I felt the same way. I have no desire to have kids, and even I found myself starting to wonder about the number and quality of my eggs. After all, I am 35. Listening to a 30-minute presentation about how my body was decaying exponentially every day, week, and month was anxiety-inducing. I didn’t even want to freeze my eggs, so why would it matter if I didn’t?
Dina went to the consultation anyway, understanding that she’d have to pay for the lab work and ultrasound. SCRC called her a few weeks later and said that there’d been a problem with the blood sample and she needed to come back in for another one. “As the phlebotomist is drawing my blood, he tells me that they need more predictors and wants to do a full workup,” she told me. Dina signed a document okaying the tests but was shocked when she received a bill for nearly $2,000. “They line item charged me for every individual test: $150 or $200 for my Vitamin D count, $150 or $200 for everything.” Dina refused to pay and SCRC stopped spending her bills after about a year.
Information sessions like SCRC’s are successful because there’s such a hunger for fertility information in a country where infertility is stigmatized and reproductive health education is often lacking. “People spend most of their lives trying not to get pregnant,” Almeling said, which means “that many people don’t think about their fertility until they’re at the age where egg production and quality has already begun to decline.” At that point, there’s a rush for knowledge.
That was the case with Karissa Chen, a freelance writer. When she was 35, she ended a five-year relationship and, for the first time, started researching information about her fertility and egg freezing.
Chen’s internet research led her to Extend Fertility, a New York City clinic that focuses exclusively on egg freezing. Extend offers free fertility testing, and Chen decided she would “just do it and see,” she said.” I didn’t even know what I was supposed to be looking for. A lot of [the consultation] was having them explain it all to me, like what they were testing, my hormones and follicle count, stuff like that.”
Like most people who consider freezing their eggs, the cost was Chen’s primary concern. She spends half of her time in Taiwan and decided to do the procedure there, where the cost was roughly half of what it would be in the U.S. Egg freezing’s hefty price tag in the U.S. has offered businesses abroad an opportunity to capitalize. Companies are selling “Eggcations,” overseas egg-freezing trips. Ovally sends women to Spain for “the trip of a lifetime, combining relaxation and adventure with taking control of your fertility.” Websites like destinationfertility.com facilitate overseas trips for egg freezing and in-vitro-fertilization. And when the cost of egg freezing abroad can be 50 to 75 percent cheaper than in the U.S., it’s not hard to see why patients would travel elsewhere.
“I’m a writer, I don’t have a really high disposable income. But the more the doctor explained my results to me, what it meant, how my fertility would change exponentially year after year, month after month, it really put the fear and panic in my heart and I decided it was something I wanted to do,” Chen said. That fear lingered, even after she’d made the decision to go forward with the procedure. “It took me about a year to really decide to pull the trigger and by the time I was 30 seconds into doing it, I was so emotional. I was angry and upset with myself, like, Why didn’t I do this sooner?”
But soon after she started the process, Chen started to feel some of the most common side effects of hormone injections, like “mood changes, mood swings, anxiety and depression.” Like Almeling suggested, Chen said she didn’t feel like she had been adequately prepared for any of that. “It was harder than I expected to be. It was emotionally difficult and physically taxing. I was tired and crying all the time.” Chen had read that the procedure was so minor that some people go back to work immediately after. In contrast, Chen was “laid out for [something] like two days. And I got really depressed right afterward.”
No one ever told Chen about the high failure rates of oocyte cryopreservation. She only learned of them while doing her own independent research. The revelation shocked her . “No one misled me,” she said, “but it’s talked about like an insurance policy—and I called it that and it’s what I thought going into it. That you can just put off motherhood, do this thing, and come back to it and it will be fine. It was only when I was doing the really deep research that I realized the actual chances of getting a baby out of this are not that high.”
Considering the lack of a longitudinal test to deduce the long-term ramifications of the processes, Almeling is unconvinced that patients can even give informed consent to fertility clinics if they wanted. It can’t be “true informed consent,” Almeling said, because “we don’t have that long term data to give.” The entire process is leaving many women feeling less than satisfied. One 2018 study conducted by the University of San Francisco’s Center for Reproductive Health surveyed women who underwent elective egg freezing between 2012 and 2016. The researchers found that while 89 percent expected to be happy with the decision to freeze their eggs, roughly half “stopped short of giving a full endorsement of their decision,” and one in six regretted their decision.
Chen, for one, is happy that she froze her eggs. “I got a good number for my age,” she said. She knows it’s not a sure bet, but feels like it gives her “a little bit of a buffer.” Still, she would like to see women receive better education around fertility-related issues, and not from “companies with a vested interest in telling you one thing.” It’s not hard to understand why. Even though the presentation I attended offered largely accurate information about fertility and egg freezing, it also glossed over or outright ignored some of the less appealing realities of the procedure. Yes, the doctors stressed that people over 35 would need more eggs for a better outcome. But they never explicitly stated the failure rates. Nor did they mention the side effects of fertility drugs or the limits of what we know about them. Instead, the center simply told us that the entire process was “safe.”
At times, it felt as if I was attending a timeshare presentation more than a medical seminar. As if I was mostly being sold something. Which, of course, I was. There is no medical need to freeze your eggs. You can just not have kids. Even if I wanted to go through with the process, I could do so for much less money abroad. That leaves centers like SCRC with an incentive to paint egg freezing as a completely carefree and hopeful affair, and to even offer up creative ways to crowdsource the mountains of cash needed to put off your declining fertility just a little while longer. During the presentation, SCRC may have painted fertility preservation as a “hope for the future.” But it more quietly laid on the guilt in the pamphlet I received, informing me that I “may find that parents and family members are more than happy to contribute to an ‘egg freezing fund’ in lieu of birthday or Christmas presents, just because future grandchildren are a high priority.”
The message was clear: You’re not getting any younger. And if you see kids in your future, we might soon be your only hope.
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This article originally appeared on VICE US.