January 21, 2015

By Jane Hoback, Health News Colorado

Marie was 27 when a hormone test revealed she had an extremely low egg count that could make it difficult for her to get pregnant, particularly if she waited a few years. But Marie (who asked that her full name not be used to protect her privacy) wasn’t ready to start a family.

“I’ve always wanted kids – always,” said Marie, a nurse who lives in Denver. “The timing just isn’t right yet.

“But in my mind at that moment, (the test) was telling me I can’t have kids. I’m going to have to have egg donors.”

Now a relatively new egg-freezing technology has allowed Marie to be her own egg donor and gives her a better chance of getting pregnant when she’s finally ready.

Called egg vitrification — essentially flash-freezing a woman’s eggs — the process is becoming increasingly popular. As more women decide to wait to have children until they are in their late 30s or early 40s while they pursue their careers or find the right partner, with egg freezing they don’t have to worry about their fertility declining as they age.

Recent announcements by Apple and Facebook that the companies would pay up to $20,000 for female employees to freeze their eggs has sparked even more interest in the procedure.

“After the invention of birth control, this is the most significant (development) in giving women reproductive freedom,” said Dr. William Schoolcraft, founder and medical director of the Colorado Center for Reproductive Medicine in Lone Tree. “It maintains the opportunity to have a baby like men have later in life. Men could get their MBA, take on some giant career path and say at 42, ‘I think I’d like to settle down, find a wife and have kids’ with no ramifications. If women did that, most of them found themselves childless. It’s not for everybody. But for women who want that career path, they’re not sacrificing completely having their own child.”

That’s because in general, women are at their optimal reproductive age when they’re between 20 and 30 years old, said Dr. Serena Dovey, assistant professor at the University of Colorado Division of Reproductive Endocrinology and Fertility. “We see mild declines starting in their early 30s and then the chance of pregnancy drops pretty quickly in their later 30s, early 40s.”

Women who are 35 or younger are ideal candidates for egg freezing. Dovey said the average age of U.S. women who freeze their eggs currently is late 30s. The upper age limit for women to freeze eggs is about 50.

Schoolcraft said women in their early 30s usually don’t worry about fertility issues. “They aren’t thinking that far ahead,” he said. “Then they say, ‘Oh my gosh, I’m 36. I’m single. I don’t even have a relationship.’ Suddenly this urgency kicks in.”

But that could have been too late for Marie, who said many of the women in her family had difficulty getting pregnant when they were in their late 20s. She decided to see an obstetrician, who recommended she go to a fertility specialist after the results of a simple hormone test showed she had what she called a “really low, really crappy egg supply.”

An appointment with Schoolcraft at the CCRM and subsequent tests confirmed the initial results.

“I basically had the lab values of a 38-year-old,” Marie said.

She and her boyfriend met with Schoolcraft to discuss options.

“The thing that convinced me that I needed to do something sooner rather than later was that I asked him if I was his daughter and these were her labs, what would he tell me to do if I wanted to have kids of my own. And he said, ‘I would absolutely tell you to freeze your eggs right now. I would tell you that you need to do something to preserve your fertility.’ ”

Her other option was to consider in vitro fertilization, “but that would be actively trying to get pregnant.”

Marie and her boyfriend have been together more than five years and have discussed having children in the future, “but we’re not ready to do it just yet. We decided that egg freezing was the way to go.”

Thus began a complicated process of several rounds of various medications, hormone injections, blood tests and ultrasounds – all laid out in a precisely detailed calendar — to help “create this perfect environment for hopefully more healthy eggs,” Marie said.

It was a sometimes stressful, difficult period. “Particularly the shots,” said Marie with a laugh. “I’m a nurse. I give shots to people all the time. I do CPR, very emergent things. But poking your own body with a needle is really hard to do.”

Throughout it all, she said the team at CCRM was “great. They were so supportive.”

The procedure to retrieve her eggs took less than an hour. The results were more successful than Marie had hoped. “Dr. Schoolcraft had told me the best-case scenario was that we might get five or six eggs and about 80 percent would survive freezing.

“But it turned out they retrieved 11 eggs, which all survived.”

Retrieving a sufficient number of eggs in one cycle isn’t the norm. It sometimes takes two or even three cycles.

Schoolcraft said harvesting one batch of eggs usually results in about 10 mature eggs. Of those, eight might survive and of those, doctors might be able to fertilize about six, with about three dividing successfully.

According to Dovey, if a woman freezes 12 eggs in one cycle, her chance of getting pregnant is about 5 percent per egg, so her overall chance of getting pregnant from that one cycle is 60 percent.

Egg freezing had been classified as experimental until studies during the last five years showed successful pregnancies from the process. A large-scale study of young healthy women from a Spanish fertility center showed that pregnancy rates from in vitro fertilization were the same for frozen eggs compared with eggs that had never been frozen, Dovey said.

“But we don’t have a lot of studies of older women – women 37, 38 – freezing their eggs and the chances of getting pregnant and how many eggs you need.”

Eleanor Nicoll, public affairs manager for the American Society of Reproductive Medicine, said the organization has no national data on egg freezing yet. “The procedure is too new to collect significant outcomes data of not only retrievals, but also pregnancies from thawed eggs,” she said.

Schoolcraft estimates that the number of women who are freezing eggs is “in the thousands.”

Retrieval numbers at the CCRM show a steady rise in the past few years: 21 retrievals in 2010, 49 in 2011, 77 in 2012 and 96 in 2013.

Schoolcraft said women are coming to the center from both coasts as the process gains popularity.

Fertility centers in Manhattan and California are even hosting “egg freezing parties” for women to learn about the technology.

The process isn’t cheap, particularly if a woman has to undergo additional retrieval cycles. Dovey said the cost ranges from $7,000 to $15,000 per cycle, and there is usually an annual storage fee to keep the eggs frozen.

The cost to complete the IVF process – thawing and fertilizing the egg, transferring the embryo to the uterus – is additional.

Marie said she paid a total of $15,000. Her annual fee will be about $350. Her insurance covered about $6,000 for various blood tests and lab work. Because of her fertility problems, she said Schoolcraft offered to write a letter of medical necessity to her insurance company, but she hasn’t received word back.

Most insurance carriers don’t cover the procedure.

In a statement, Anthem said, “Egg freezing isn’t covered for most plans. For plans that do offer egg freezing as a covered benefit, it is considered as medically necessary only for females in childbearing age who might face infertility challenges resulting from chemotherapy or radiation therapy.”

Rocky Mountain Health Plans said it “does not provide coverage for the diagnosis and/or treatment of infertility, including testing, medications, surgery and related services.”

Schoolcraft calls egg freezing a “back-up plan. If you get pregnant at 39, great. If you end up struggling, you’ll be glad you had these eggs as a backup.”

But Dovey also cautions that women should understand “this is certainly not a guarantee. A woman may freeze her eggs at 34, 35 and then she doesn’t even try to get pregnant until she’s 42, 43. If she’s unable to get pregnant at that point based on her age and then she tries to use her eggs and is not successful, she’s let herself age out of a time frame where she might have been able to get pregnant spontaneously.”

For Marie, freezing her eggs has “taken the pressure off. I knew I had this weird family history, but now we have this insurance policy in the frozen bank. My boyfriend and I are just happy where we are right now.”

But she also has come to terms with the fact that she might not be able to get pregnant at all, even with her frozen eggs.

“I went through the stages of grief already because I knew I probably don’t get to do this (get pregnant) the normal way, the way I always pictured it,” she said.

“And I know it still might not happen. So if I can’t get pregnant when I’m ready, then I can think about an egg donor or adopting and I’ll take that on with passion.

“But at least by doing this now, I’m giving myself the best chance.”

Katie Kerwin McCrimmon contributed to this story.

Jane Hoback

Health News Colorado