
Why Egg Freezing Is an Impossible Choice - dnetesn
http://prime.nautil.us/issue/22/slow/why-egg-freezing-is-an-impossible-choice
======
dougmccune
This has been a huge topic of conversation for my wife and I for the past few
years. Our entire social circle is the exact target demographic: early
thirties, highly educated, career focused, etc etc. We got married earlier
than nearly all our friends (age 28). We've had two kids before most of our
friends are married. Our friends are now closing in on 35 and now thinking
about how to have a family is becoming a serious concern. We were a generation
raised being told consistently that a woman should be career focused, pursue
as much education as possible, and that you don't have to ever worry about
finding a partner and having kids until you're ready. And now we have friends
freezing eggs, considering how to start a family without a partner while they
can still easily have kids, etc. It just feels like the pendulum has swung too
far in terms of my generation's expectations (or maybe naiveté). You can't
change biology. It will be interesting to see what kind of advice I give my
daughter when she's an adult, but I'm hoping her generation has a bit more of
a middle-ground approach to thinking about the balance between career and
starting a family.

~~~
rayiner
If you want to get married and have kids, you should just do it. My wife and I
had our daughter while we she was still in law school and I had just
graduated. Taking care of a kid is a lot of work while both working long hours
at big firms, but why that's what grandparents are for. There is no good time
to be sleep deprived for months doing night feedings. At least in your 20's
you have the energy and your parents are young enough to help out!

~~~
M8
_" that's what grandparents are for"_

Yeah, luckily they are guaranteed to be alive in your twenties.

~~~
liotier
> Yeah, luckily they are guaranteed to be alive in your twenties.

And guaranteed to live in the same city. And guaranteed not to be busy with
other pursuits. Of course !

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patmcc
The hugely surprising fact of the article, for me, was:

"Just 2,000 babies have been born from cryogenically frozen eggs in the world"

That's crazy to me; this all sounds like a huge bet on complete unknowns.

I also wonder if this is going to be the end of grandparents in affluent
circles - if people wait until their 40s for kids, and their kids do the
same...not much time to hang out with grandma and grandpa.

~~~
chriskanan
This issue has been weighing heavily on me. My Dad was 36 when I was born and
is now 70 years old. My fiance and I are both professionals and have our kids
planned for 2018 when she is done working 80 hour weeks. By then my Dad will
be around 74. Considering my grandfather died at 85, that doesn't leave a
whole lot of time left to have a big impact. Plus, that likely means I won't
have much time with my potential grandchildren either if my children also
don't have kids until their late 30s and assuming _quality_ lifespan doesn't
increase dramatically.

~~~
patmcc
I'm in a very similar boat - my parents were 48 and 38 when I was born (I'm
29), so they're really starting to get old.

My wife and I decided screw it, we're going to have kids now, despite not
being in the best places professionally. It might be tough, but we're still in
a much better place than ~75% of people when they start having kids, and we
think we'll figure it out.

And so, this morning, we got to hear our kid's heartbeat for the first time.
It's scary, and the idea of not being in the "ideal" job is worrying, and
doubly so for my wife (who still needs some more experience to get her
professional designation), but kids/pregnancy is sadly not something that can
be put off indefinitely without consequences. So we bought the bullet, and
we're going to make it work.

~~~
tezzer
Congratulations!

My wife and I decided there was never an ideal time, possibly never a good
time, to have kids, so we jumped in (at 30 for her and 40 for me) to have 2 in
2 years. I have superiors with kids who have been very understanding on the
days when I've been a zombie from no sleep, when I have to take sick days
because my wife is overwhelmed, etc. etc.

It's hard for both of us but I'm really glad we did it now, not when we were
older and less flexible/energetic/fun. She's starting to think about career
again, and will take her time figuring out what she wants to do in a couple of
years when we're OK with the youngest, an infant now, going into day care.

Good luck!

~~~
omilu
Yep, no time is the right time (except maybe waiting until after college). It
will be hard no matter what. All you can do is hold on and enjoy the ride.
Good luck. Father of 3 speaking.

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jpatokal
> Female fertility declines sharply at 37

This, by the way, is largely a myth. Obviously fertility decreases with age,
but it's a gradual tapering off until menopause, not a cliff at 37 (or 35 or
40 or any other red line). ~80% of women aged 35 to 40 can still conceive
within a year.

[https://en.wikipedia.org/wiki/Fertility#Female_fertility](https://en.wikipedia.org/wiki/Fertility#Female_fertility)

~~~
Domenic_S
The risk of defects is more salient and does indeed cliff.

Risk of having a child with Down Syndrome:

At age 20, 1 in 1,441

At age 25, 1 in 1,383

At age 30, 1 in 959

At age 35, 1 in 338

At age 40, 1 in 84

At age 45, 1 in 32

At age 50, 1 in 44

[http://en.wikipedia.org/wiki/Advanced_maternal_age#Risk_of_b...](http://en.wikipedia.org/wiki/Advanced_maternal_age#Risk_of_birth_defects)

~~~
cjbprime
It's a different kind of risk, though. In the last few years "cell-free DNA
tests" \-- sequencing fetal cells that are circulating in the mother's
bloodstream -- have become common (and paid for by health insurance), and they
detect chromosomal abnormality as early as 8 weeks into the pregnancy. If you
aren't ethically opposed to abortion, the risk of Down's can be the "well,
damn, guess we'll try again in a few months" sort of risk.

~~~
differentView
>If you aren't ethically opposed to abortion, the risk of Down's can be the
"well, damn, guess we'll try again in a few months" sort of risk.

You say that as if there is no emotional, psychological, and physical costs to
an abortion. The costs is often to both partners and marriage/relationship.

~~~
kabouseng
GP also states it very non-challantly as a go-no go decision. Usually you get
a result stating the child have a 1 in 200 chance of down syndrome considered
a high risk. But in 199 cases you will have a normal healthy baby. Do you now
abort or not?

Also you might have taken a while to get pregnant, lets say 5 or 6 months, so
aborting means you get to wait another 5 months before getting pregnant again.

~~~
cjbprime
As with the poster below, you're not understanding the advancement of the
cell-free DNA test I described. It is >98% accurate at detecting Down's in the
first 10 weeks, is non-invasive, and is now commonly used.

~~~
Domenic_S
Some misconception here.

Medical tests are either screening tests or definitive tests. Screening tests
return the odds that what you're screening for is found, and at some
indicative threshold the more invasive definitive test is performed.

Cell-Free Fetal DNA Testing is a screening test. It's a _fantastic_
advancement, no doubt, and interestingly the false-negative rate is almost 0.
However, amniocentesis is still the gold standard for definitive DNA testing
(i.e., if the cell-free screen came back as 'elevated risk', the mother would
still have an amnio).

Further, insurance coverage for the cell-free screen is not at great levels.
The screen is not yet standard-of-care. Even with high-quality Silicon Valley
big-tech-company insurance, our out of pocket was several hundred dollars.
Worth it imo, but again not standard-of-care.

Moreover, cell-free screens are not available to women carrying multiples or
who used egg donors, both situations that are much more common in the advanced
maternal age/IVF segment.

It's a truly revolutionary technology, but we still have a way to go.

------
jarjoura
Are couples so egotistical that they can only imagine having a kid that is
genetically theirs? If you want to delay family life and work on your career,
why is it not an obvious option to adopt when you're ready?

Also, I do think companies need to start offering 6-month packages for
parents, both the father and mother. There's too much wealth floating around
for this to still not be a thing.

~~~
irremediable
You make a good point, although you phrase it very provocatively. Genetics can
be a big deal, for many reasons. At the basic level, the desire to have
children is a desire to promulgate one's genes.

I agree with you in that I don't care, myself; but I don't think it's fair to
judge the people who do care.

~~~
restalis
"I agree with you in that I don't care, myself; but I don't think it's fair to
judge the people who do care."

And through natural selection, those kind of people (who care, that is) will
dominate the human genetic pool, while the ones susceptible to falling into
the provider role will systematically be weeded out, like it or not!

~~~
irremediable
Haha, not necessarily so. For one thing, memetics might trump genetics.
Cultural changes might heavily outweigh any genetic selection effect. If
enough people adopt children and then encourage those children to adopt when
they're older, it could easily outweigh genetic effects.

For another thing, people who care might be less reproductively successful on
average. This is a bit more fanciful, but IMO is more plausible than it
sounds. Perhaps people who care about that stuff won't have as many children
because they're more picky, for example, or for any other reason that might
correlate with that preference.

~~~
restalis
"If enough people adopt children and then encourage those children to adopt
when they're older, it could easily outweigh genetic effects"

And that will only provide a more fertile ground for proliferation of a
specific kind of genes, don't you think? (Of course, for that you must have to
believe at least a little bit that genetic behavior is not entirely
replaceable by parental education.) Currently, if having a harsh life as an
abandoned child is something of a lesson to prevent a similar experience in
one's offsprings (which are cared for), then through each adoption we're just
preventing/affecting a natural homeostasis.

------
jkot
Instead of this, Apple or Facebook could pay $20,000 to their partners, if
they stayed at home with a kid.

~~~
nsxwolf
My college educated wife chose to stay home. Some of her friends and family
view this as a deliberately provocative anti-feminist choice, and we're in the
midwest. I can only imagine those sentiments would be even more common in SV.

~~~
Domenic_S
My college educated wife also chose to stay home! She knew that's what she
wanted to do before college.

I think it's hard to disparage when any partner _chooses_ to stay home -- and
isn't choice a core tenant of feminism?

~~~
needacig
See my theory here:
[https://news.ycombinator.com/item?id=9236049](https://news.ycombinator.com/item?id=9236049)

EDIT: Please, and if you want.

------
mindfulgeek
I was offered egg-freezing before beginning one of those "sterilizing"
chemotherapy treatments. While it was great to have the option, the last thing
I wanted to put my already dying body through was hormone therapy and
surgery...

Years after treatment, I was in "menopause" and not a candidate for fertility
treatment (fsh > 50 AMH = .17). My only hope was a donor egg.

My husband and I naturally conceived in July and our baby boy is coming in a
few weeks.

I share this not because I think every woman can have babies, but because our
science is still limited in understanding conception. There is a lot more to
creating life than what we can "see" at the moment.

------
Domenic_S
Ctrl+F "pain" \- nothing. Egg retrieval hurts, and OHSS is severely
underreported. REs for whatever reason do NOT like to officially diagnose
OHSS.

------
golemotron
> Similarly, Noyes’ team, surveying 183 egg-freezing patients on why they were
> delaying childbirth, found that just 24 percent cited professional reasons,
> while 88 percent cited lack of a partner.

Are they more likely to find a partner as they get older? That bet could be as
large as a bet on the viability of the frozen eggs. Finding a partner and
raising a child on one's own both become harder as time goes on. My bet is
that most eggs frozen will by younger women for themselves later in life will
not be used.

~~~
toomuchtodo
I feel like I'm uniquely qualified to comment on this, as I'm going through
the IVF process with my wife currently.

> Are they more likely to find a partner as they get older?

Possibly. Maybe not, but you're essentially paying for insurance.

> That bet could be as large as a bet on the viability of the frozen eggs.

Frozen embryos are _extremely_ viable, as long as you were able to observe
their cellular division 3-5 days after fertilization. As long as you can
confirm they're viable before freezing, you're almost assured they'll be
viable when thawed at a later data in the future (this isn't only from my
pubmed research, but also from the top fertility doctor in the Chicagoland
area we're using).

> Finding a partner and raising a child on one's own both become harder as
> time goes on.

Disagree. In most cases, you're further advanced in your career when older,
giving you more income, thereby more purchasing power. You may not find a
partner, but daycare is easier to afford, or a part time nanny. Delaying
childbirth most likely affords you opportunities not available to those who
cut their career prospects early to have children (or who left their career
entirely because they had a partner to rely on).

Also, more resources available to you means you can be more discerning about
your partner selection.

> My bet is that most eggs frozen will by younger women for themselves later
> in life will not be used.

Its possible, but like I said above, its insurance. My wife is 30. Whatever
eggs we freeze now that we don't use, they are essentially her eggs at 30, and
could be used by her at any date in the future. She even has the option to use
those eggs with someone else if we're not together at some point in the future
(life is long).

TL;DR Freezing your eggs is an insurance policy against the future.

EDIT: Due to reasons I'd rather not make public beyond what I've shared above,
I've contacted institutions who are doing research in coercing stem cells into
egg or sperm cells. I expect in the next 10 years for this to be a solved
problem, and the egg retrieval process to be deprecated in favor of a quick
blood draw and incubation period to coax stem cells to reproductive cells. But
unfortunately, this isn't solved yet.

~~~
technotony
This research on coercing stem cells into eggs/sperm is hugely important and
significant. It's the key bottleneck holding us back from safe, effective,
affordable genetic modification of ourselves:
[http://www.technologyreview.com/featuredstory/535661/enginee...](http://www.technologyreview.com/featuredstory/535661/engineering-
the-perfect-baby/)

~~~
aorloff
Exactly what about that could possibly be "safe" ? Even if it were medically
safe, how would you make sure that people used it in societally acceptable
ways and that it didn't imperil the long term genetic pool of the human race ?

~~~
toomuchtodo
> Even if it were medically safe, how would you make sure that people used it
> in societally acceptable ways and that it didn't imperil the long term
> genetic pool of the human race ?

You can't. That's both the beauty and fear of it. We'll either have
immortality, or extinction.

------
gcr
It's a lot easier to sell something when you frame the issue as one of loss
avoidance.

"You should do X, because if you don't do X right away, then this bad thing
may happen in the future! By the way, it only costs $N0,000... But your baby's
life is on the line!"

I can't think of a much more convincing sell for this target market than that
if I tried.

Something about this feels off to me. When viewed in the right light, this
almost looks like blackmail, or extortion.

------
davidf18
Seifer, et. al. 2014 - Putting 'family' back in family planning
[http://www.ncbi.nlm.nih.gov/pubmed/25406182](http://www.ncbi.nlm.nih.gov/pubmed/25406182)

A lot of people who do not understand fertility (female fecundity -- the
ability to conceive) and others give wrong info from comments I've seen here.

The Amerian Society for Reproductive Medicine (ASRM) the doctors orgninzation
of fertilty doctors (called Reproductive Endocrinologists) says that women are
most likely to conceive in their 20's to early 30's. Elite egg donor agencies
that offer $20,000 for donor eggs in Ivy League student newspapers want donors
under 29 or 28. Studies show that 3 out of 4 men and women overestimate by
five years the rapid decline in fecundity believing that it is 40 when it is
in fact 35.

The ASRM does not yet recommend egg freezing for delaying childbirht but
rather for situations such as chemotherapy for cancer which would destroy the
eggs in the ovaries.

Fertility speicalists (S. Silber and others) recommend that if women expect to
wait beyond 30 to have children they should have an antral folllicle count
ultrasound at age 25. Other fertilty speciialsts have recommended other tests
at age 25 (eg, FSH, or anti-Mullerian hormone).

There are no non-invasive tests to test for ovarian reserve which varies from
woman to woman. Unfortunately, studies shiow that doctors (include those
internetists that might write birth control medication perscriptions) don't
have any better understanding of ages of female fertilty than the general
public. Obstetricians _do_ know but they don't always discuss the age issues
with their patients.

In summary, women should consider getting a test for their ovarian reserve
(antral follicle count ultrasound or above mentioned laboratory tests sooner
rather than later) so that they can make informed decisions. The article
listed above and its references will provide a lot of information. __* Consult
reproductive endocrinologists for correct information about fecundity. __ _

------
EdSharkey
The intensity of pain and grief one can feel when they or their spouse have
fertility issues is tough to convey. Most people have no idea what a hell this
fertility thing can be. It's such a lonely condition, no one wants to talk
about it, and no one wants to hear about it.

And when someone makes a juvenile joke about eggs, wombs, etc. around me and
my wife or if we get some dumbass comment like "when are you going to have
another kid?", I can tell you that that person is PERMANENTLY tainted with the
#asshole hashtag and we're probably going to have a tearfilled conversation
that night. If you fancy yourself a comedian and you want to make some jokes
about procreation, don't be shocked when friends fall away from you.

I don't know if egg freezing should be recommended, whether it might lead to
birth defects or developmental issues, etc. But, if it were available to me
and my wife early in our marriage and we knew we might have troubles, I think
we might have sprung for it.

Here's my PSA: age 35 is when egg quality and quantity starts to decline
precipitously for most women. If you're interested in doing this egg freezing
or embryo freezing thing, plan to get it done well before age 35 (like age 30,
just to be safe.)

------
cinquemb
Makes me wonder if/when the market for this grows, if we'll start to see
financial products built on this (maybe to help offset the costs of such, or
to hedge risks for a company that may solicit in relatively financially risky
behaviors?) à la egg futures[0] concept Hanson discuses?

[0] [http://www.overcomingbias.com/2014/10/why-not-egg-
futures.ht...](http://www.overcomingbias.com/2014/10/why-not-egg-futures.html)

------
shin_lao
Reproduction is not just a biological act where a male gamete meets a female
gamete.

The hardest part of the process is finding the person with whom you want to
have a child and who will be your partner in life for this incredibly complex
challenge that is raising children.

I question the ethics behind relieving thousands of dollars to affluent women
while making them believe it will somehow solve their existential need.

There is no way around balancing work and life if you want to have children.

~~~
M8
_" There is no way around balancing work and life if you want to have
children"_ \- it's probably more about being picky.

~~~
restalis
"it's probably more about being picky"

Yes and... not only. Being picky is only natural. Being unrealistic about it
is more of the issue here.

------
sjg007
Nobody talks about this but fertility rapidly declines in your 30s especially
after 35. Egg freezing should be done as early as possible, aka in your 20s,
even then the odds that you will have a live birth after thawing are low. That
being said, there is the viable alternative of using an egg donor which relies
on fertile young women.

~~~
needacig
Are you joking? Everyone talks about this.

~~~
M8
He means nobody is suddenly procreating just because of that fact.

------
tiatia
It is an outstanding idea.

Do you know the best thing about having a kid in your 50ies?

You don't have to worry about college costs since you will be dead....

------
Sophistifunk
Goddammit, I thought this was about cooking.

