When I decided to apply to medical school, a question nagged at the back of my mind: If I ever decided I wanted kids, would my eggs be any good?
I was daunted by embarking on a career path so notoriously toxic for female practitioners who want to raise children. Some 40 percent of surgical residents who are pregnant or mothers consider leaving their program due to difficulties balancing career and family. Paid family leave for faculty at top medical schools is, ironically, 3.4 weeks shorter on average than the American Academy of Pediatrics recommends.
They are selling a sense of control that doesn’t really exist. To say that egg freezing stops time is a gross oversimplification.
Egg freezing seemed like it might offer a solution. Icing my oocytes would cost a hefty sum, but at least I’d be able to start a family when it made sense to conceive rather than when my body was telling me I had to. Even if I couldn’t fix gender discrimination in health care, medical students like me could buy ourselves time during our intense years of school and residency to have more options down the road.
Now that I’m in my first year of training, though, I’m not so sure that freezing my eggs will provide the fecundity insurance plan I want. Instead, I’ve found that the fertility industry — expected to burgeon to $41 billion by 2026 — is dangerously glossing over what science tells us these treatments can and can’t offer.
Assisted reproductive technology is a potent tool for empowerment for some, and can bring a peace of mind that I don’t take lightly. Yet the industry is increasingly exploiting anxieties about reproduction without addressing the urgent inequities, unfounded promises and disregard for medical best practices in the field. Instead of allowing this opaque industry to persist as is, it’s time to establish an independent government body that can regulate industry practices and ensure women get the information they need to make fertility decisions that are right for them.
Today, some 500 clinics scattered throughout the U.S. provide fertility treatments, including egg freezing (the part of the process that preserves a woman’s eggs) and in vitro fertilization, or IVF (a way to combine a thawed or fresh egg with a sperm cell and implant it in the uterus). Until 2013, egg freezing was considered “experimental” by the American Society for Reproductive Medicine. That year, it lifted the label, a move that normalized the use of egg freezing as part of infertility treatment.
Importantly, the committee’s report that removed the experimental label didn’t recommend the procedure’s use for delaying childbearing. There wasn’t enough evidence, the committee wrote, that the benefits of this type of egg freezing outweighed potential financial and emotional risks, and it warned that “marketing this technology for the purpose of deferring childbearing may give women false hope.”
Nonetheless, companies like Facebook and Apple began offering egg freezing as a perk to their employees. This and a host of other factors — the increase in the average age of marriage and childbearing, technological advancements in egg freezing and the legalization of same sex marriage — have pricked the ears of venture capital funds and private equity firms eager to cash in.
The assisted reproductive technology business used to be focused on the infertile. About 10 percent of women ages 15-44, or 6.1 million women altogether, have difficulty conceiving and carrying a baby to term. In the last decade or so, though, that has shifted. Investors today are changing the game. They’re not only buying up existing clinics, but also pumping money into new fertility companies and standalone egg-freezing centers catering to people like me: those who aren’t necessarily infertile but want the ability to decide when to have children without worrying about declining fecundity. Doctors know that while the uterus doesn’t age, eggs do — a leading reason why females over the age of 35 often have trouble getting pregnant. Egg freezing allows people to keep their eggs young while they get older.
But with a profit motive mixed in, new companies are often downplaying the medical and financial complexities of egg freezing. Instead, gimmicks and convenience seem the order of the day. Kindbody, a fertility start-up with locations in New York, Los Angeles and San Francisco, raised $15 million in venture capital last year and regularly hosts cocktail-party-style information sessions to attract clients. Out of a company van, they offer free hormone tests that indicate how many eggs a woman has left, though not her overall fertility.
The American College of Obstetrics and Gynecologists doesn’t endorse this test as a reliable predictor of reproductive ability in people who are fertile. But the fact that their directive is being ignored is a sign that some level of additional oversight is needed, because self-regulation isn’t cutting it.
The U.S. currently regulates the fertility industry in a fragmented fashion. State governments handle physician medical licenses; the Centers for Disease Control and Prevention track the success rates of centers offering assisted reproductive technology; the FDA oversees drugs, devices and donor tissues involved in these procedures; and professional societies set guidelines and ethical standards. Yet there’s no cohesive regulatory agency to supervise fertility centers and the treatments they provide.
Unlike the U.S., the U.K. has one — the Human Fertilization and Embryology Authority. This body regulates the entire gamut of assisted reproductive technology from sperm banking to IVF and inspects all clinics providing fertility treatments. If the U.S. took the wise step of establishing an analogous agency, it could also require that clients be educated on the effectiveness of tests and procedures offered at these centers — and even ensure that clinics follow standards of care.
This body could address regulatory gaps in the advertising arena, too. Only half of IVF center websites in a 2019 study adhered to the Society for Assisted Reproductive Technology guidelines for online advertising. Meanwhile, advertisers are flooding social media with slogans like “Fertility meets freedom.” A competitor to Kindbody called Extend Fertility has populated Instagram with ads claiming: “When you freeze your eggs, you #freezetime.” Research presented at an American Society for Reproductive Medicine conference last September found that this flavor of marketing is common among top egg-freezing companies.
African Americans have double the rate of miscarriage of white individuals undergoing IVF.
But they are selling a sense of control that doesn’t really exist. To say that egg freezing stops time is a gross oversimplification, as rates of successful live births often run well under 50 percent for a single round of IVF, which usually costs around $23,000. (“An expensive lottery ticket,” as one reproductive endocrinologist and infertility specialist put it.)
There are also pricey drugs and disruptive side effects that often accompany the egg-freezing process. The hormones used to prompt the ovary to spit out several eggs at once can trigger nausea, fatigue and, in severe cases, dehydration, vomiting and blood clots. Although these complications should already be discussed as a matter of course when the patient is first receiving information about fertility treatments at her clinic, having a regulatory body could require this information — as well as success rates for individual centers and financial considerations for egg-freezing — be disclosed.
This is not to mention other issues that already plague the assisted reproduction services arena. We’ve recently learned that many fertility doctors offer extra and unnecessary procedures that do not boost success rates but pad the bill. Add-ons such as “endometrial scratching” tack on thousands of dollars to IVF treatments that already reach five figures, but offer no benefit when it comes to the chances of having a baby. Only a handful of states mandate insurance coverage for IVF, meaning that most patients must bear the brunt of these costs themselves. Fertility clinics in the United Kingdom are required to disclose the effectiveness of these add-ons — a rule that would improve access to information about these procedures if implemented in the U.S.
Furthermore, certain groups face vast disparities in fertility treatment access and outcomes. African Americans have double the rate of miscarriage of white individuals undergoing IVF, and patients who have obesity report experiencing weight-related stigma while seeking fertility treatment. Heteronormative definitions of fertility as the inability to conceive after a year of sex between a man and a woman exclude many LGBTQ individuals from insurance coverage for egg-freezing and IVF. It’s clear we have a long way to go before fertility treatments are accessible to all who want or need them.
If you factor in the possibility that I might have kids without IVF, freezing my eggs before I’m 30 will likely only improve my chances of having a baby minimally, by 3-7 percent. So for now, I won’t be. But that calculus might change down the road; icing eggs in my mid-30s could increase that probability by as much as 20-30 percent.
Should the day come when I seriously consider egg freezing, I want to have a complete picture of what my options and chances are; what the technology can and can’t do for me; and reassurance that whatever provider I use is properly monitored. Given the current incentive structures in the industry, I’m skeptical I’ll get that full picture unless we reform how fertility centers are regulated.