As women enter the workforce in larger-than-ever droves, millennial women face burgeoning student loan debt and the cost of living continues to inflate, many are putting off pregnancy. But the risk of fertility complications increases in tandem with age. According to 2016 population data from the Center for Disease Control and Prevention, the number of births fell one percent from the year prior, bringing the general fertility rate to 62 births per 1,000 women ages 15 to 44; the birth rate in America is at an historic low, and women aren't all that well educated on infertility.
In Vitro Fertilization (IVF) — the process of fertilization in which an extracted egg and retrieved sperm sample are manually combined in a laboratory dish and the embryo(s) is then transferred to the uterus — is a relatively new procedure to treat infertility. The number of egg-freezing cycles however, has increased 15-fold in 10 years as evermore women consider IVF.
But for women who do make the decision to cryopreserve their eggs in an effort to preemptively avoid concerns surrounding reproductive aging, they’re offered little to no counseling. In an aptly titled review recently published in the Journal of Women's Health, “Need for Comprehensive Counseling in Women Requesting Oocyte Cryopreservation,” researchers examined medical literature to determine current counseling practices for women undergoing elective oocyte cryopreservation; they found no uniform guidelines and, now, they’re calling for some so women can make more informed decisions.
“Given the increasing use of oocyte cryopreservation, data supports that women be extensively counseled at the time they are requesting elective oocyte cryopreservation for future use in the same manner that they are counseled when requesting ART for pursuing an immediate pregnancy,” the study concludes.
The researchers emphasized that it’s particularly critical for women to understand the potential risks involved with later-in-life pregnancies. Previous research suggests that women — and especially millennial women — are largely unaware of the conception complications that arise with age, so counseling could be key.
A Healthline’s State of Fertility Report 2017 finds that more than half of millennial women and men are delaying parenthood for career security and financial reasons, but they’re not mindful of the odds of conception challenges and the cost impact of postponing parenthood. Just 32 percent of millennials realize that half of the population over the age of 35 will need medical intervention to have a baby, and there’s no guarantee that it’ll be successful.
Dr. Shapiro, M.D., reproductive endocrinologist at Prelude Fertility told Sexual Health Magazine, that the general population isn’t aware of the significance of aging on infertility because of “social messaging” most celebrities with children born in their 40s, he says, used better-quality eggs from much younger donors, but that truth is rarely disclosed. The chance of getting pregnant per month at age 40, is only seven percent, compared to 23 percent at age 27; this number drops to just one percent per month by age 44.
“Young women need to think about family building in their mid- to late-30s while they are still most fertile in their 20s,” he explained. “Women who seek to preserve fertility after age 35 are more likely to be freezing ‘infertility’ than freezing their fertility.”
That said, even those who do consider building families later in life aren’t promised success if these freeze their eggs now.
A study published in the journal Human Reproduction in 2010, confirmed the effectiveness of oocyte cryo-storage and suggested that eggs are indeed of the same quality after being frozen for some time as they are if they’re fertilized and used in an IVF cycle immediately — but a woman’s body might not be of the same “quality” to carry those eggs as she gets older.
In other words: Even if a woman is young and healthy when she decides to freeze her eggs, she may develop risk factors with age, which increase the chances of pregnancy-related maternal and fetal mortality and morbidity like preterm delivery, low birth weight babies, preeclampsia and labor and delivery complications. A wealth of research that spans decades also shows that women's chances of facing chromosomal abnormalities and miscarrying significantly increase with age.
In a 2010 Clinic Report National Summary, researchers reported IVF success rates (in terms of the percentage of IVF cycles that resulted in live birth) by age: 41.5 percent for women under 35, 31.9 percent for women 35 to 37, 22.1 percent for women 38 to 40, 12.4 percent for women 41 to 42, five percent for women 43 to 44 and just one percent for women 45 and older.
Just how many eggs a woman decides to freeze is also a factor in her success. Another study analyzed the outcomes from almost 1,500 women who froze their eggs at age 35 or younger; the chances of a live birth increased from 15 percent for women who froze just five eggs, to 61 percent for women who froze 10 eggs and 85 percent for women who froze 15 or more eggs.
Findings are always changing, of course, as maternity and medical care evolve. That's why women of all ages have evermore questions about the nuances involved with freezing their eggs and IVF, and more research needs to be done.
As of 2013, the American Society for Reproductive Medicine still considered egg freezing for nonmedical reasons an experimental procedure; while that’s no longer the case, is still doesn’t currently recommend elective egg freezing for the sole purpose of combating reproductive aging, which it refers to as “social freezing,” because of the lack of data surrounding it.
Egg freezing has nonetheless become so mainstream that even some companies as big as Apple and Facebook offer is as a medical benefit. But while cryopreservation might be covered, the cost of a basic IVF cycle ranges from $12,000 to $15,000 on average — that’s a pretty penny to pay without totally understanding the risks involved.
“When a woman of any age chooses to undergo egg retrieval and cryopreservation, she should have access to the knowledge and counseling available to be able to make a truly informed decision,” Dr. Susan G. Kornstein, editor-in-chief of the Journal of Women's Health, said in a statement. “The scope of that information should not differ depending on the age of the woman at the time of oocyte cryopreservation, reason for the procedure or plans for future pregnancy.”
AnnaMarie Houlis is a multimedia journalist and an adventure aficionado with a keen cultural curiosity and an affinity for solo travel. She's an editor by day and a travel blogger at HerReport.org by night.