Alicia Trapini is now 30, ‘but my eggs will always be 29,’ she likes to say.
Last year, Alicia made the decision to shell out thousands of dollars to freeze her eggs as a measure to protect her chances of having children – when she is ready to.
She is one of some 20,000 women in the US that have elected to freeze their eggs or embryos – and their numbers are growing every day.
It has been 40 years since the first baby conceived by IVF was born. And now, countless frozen eggs and embryos make up future generations of babies made possible by medical technology.
Since rapid, extremely low-temperature freezing was introduced became the widespread practice in 2012, the freezing process itself has become a widely standardized low-risk procedure.
But even as the technology stabilizes and more and more women spend thousands to go through IVF treatments and egg extraction and freezing, questions and misconceptions continue to swirl around the cryogenic technique.
The reality, however, is that even without unforeseen tank failures, freezing your eggs is more like hedging your bets than it is purchasing a fail-proof insurance policy.
After hormone therapy and egg retrieval, eggs are frozen and stored in cryogenic tanks like this one for up to 25 years at a storage cost of about $100 a year
WHAT WE KNOW: RETRIEVAL IS SAFE (IF PAINFUL) AND 90 PERCENT OF EGGS SURVIVE THAWING
Alicia’s six frozen eggs nestled in a cryotank in New York are not, in her mind, her only hope for children. Instead, they are more like a plan B.
Recent cryotank mishaps at fertility clinics in Cleveland, Ohio, and San Francisco, California, cost more than 1,000 families some of their most precious assets, thawing and destroying their frozen eggs and embryos.
Alicia Trapini, 30, decided to freeze her eggs last year at the age of 29 but hopes they will just be a back up plan for a future pregnancy
For those families, the technology that had seemed to serve as a safeguard became instead a devastating set back.
When egg freezing first became commercialized, it was still mostly offered to women with medical conditions, particularly those who had been diagnosed with cancer and would need to undergo chemotherapy which could damage or destroy their eggs and render them infertile.
But Alicia is one of a newer wave of women who know two things for certain: they want to have the option of becoming mothers someday, but they don’t want children just yet.
Earlier in the history of cryopreservation technology, embryos seemed to be far more resilient to the the process of freezing and thawing.
Many women had to either choose to fertilize their eggs with their current partner or donor sperm without knowing what (or who) their future would hold by the time they wanted to have that embryo implanted.
‘I’m single and I do plan on hopefully having a husband one day to make embryos with,’ says Alicia, but she doesn’t know who that person will be.
‘I was young [when I decided to do it] and I didn’t know anyone else that had frozen their eggs in their 20s, besides people with health issues.’
I’m single and I do plan on hopefully having a husband one day to make embryos with
Alicia Trapini, egg freezing patient
Luckily for Alicia and single women like her, survival rates for unfertilized eggs are now nearly as good as those for fertilized embryos, at 90 percent versus 95 percent.
The improved resilience of frozen eggs was brought about by the advent of vitrification, a rapid freezing process by which the temperature of an egg or embryo plummets by thousands of degrees per minute.
Cells frozen this way take on a smooth glass-like structure, rather than developing the crystalline structure of ice, which is less stable and more fragile. By 2012, vitrification was the preferred method for egg and embryo freezing.
WHAT TO EXPECT: MONTHS OF INJECTIONS AND DOCTORS VISITS ARE NOT FOR THE FAINT OF HEART
Her eggs may have been frozen ultra-rapidly, but the preparation process Alicia had to go through was long, and arduous.
Once Alicia was ready to pull the trigger, Dr John Zhang and his team at New Hope Fertility Center began monitoring her hormones and health immediately.
‘They put you on hormones to stimulate your body to produce more eggs, take your blood almost every day and start watching you really really closely,’ she says.
HOW ARE EGGS FROZEN?
Egg freezing dates back to 1986 when the first pregnancy from a frozen egg was reported in the Lancet Journal.
Collected eggs were preserved in cryogenic tanks after being frozen ‘slowly’ for many years.
In the early 2000s, scientists began experimenting with an ‘ultra-rapid’ freezing technique called vitrification.
Using this process, the temperature of an egg plummets thousands of degrees per minute, resulting in a glass-like cell structure that is stronger than other crystalline ice forms.
They are then stored in cryogenic tanks, for up to 25 years.
In preparation for having her eggs retrieved, a woman must undergo the first stage of an IVF cycle, which uses hormones to stimulate more eggs into maturity, then another set of hormones to trigger the eggs’ release.
Patients inject these drugs at home and are usually closely monitored by their doctors.
There are many different forms of these hormone treatments, ranging in cost from about $800 to $6,000 per cycle, and six to 10 weeks in duration.
Then, the eggs are surgically retrieved in a minimally-invasive procedure.
‘It’s exhausting, it takes a lot of time and it’s important to stick to taking your medications on time. They give you explicit information about what you have to do on a daily basis and you’re constantly going to the pharmacy.’
All of those drugs are expensive. Depending on the particular treatment and extent of monitoring, the price can run somewhere between $800 and $6,000, per treatment cycle.
The total cost of the process varies depending on what type of IVF a woman opts to use in preparation for egg retrieval, but Alicia says to be prepared to shell out several thousand dollars, plus $100 a year to store your eggs.
Alicia opted to do mini-IVF, a form of the treatment that uses lower doses of hormones but has to be administered over a longer period of time – 10 weeks, instead of the six weeks of traditional IVF.
For that entire time, ‘you have to inject yourself with drugs every day, or, in my case, I had my sister do it,’ Alicia says.
‘I am not someone who is comfortable with needles but it’s less of a big deal than you think, you get used to it. I think that deters a lot of people from even thinking about it, but if I can get used to it, anybody can.’
When her body and hormones were otherwise ready, Alicia got a final dose of a drug to make her ovaries release the carefully cultivated batch of eggs to be extracted.
For all the medical interventions they use to encourage the development of these eggs, doctors still only have so much control over when they will come, so egg retrievals don’t exactly comply with nine-to-five work schedules.
‘It happens in a very specific time window. It could be midnight. Mine was on a Sunday,’ Alicia says.
Retrieval procedures are short, only lasting about 20 to 30 minutes, and patients can elect to be awake for the procedure or under general anesthesia.
Alicia decided to stay awake so she wouldn’t have to worry about finding someone to drive her home and ‘was being an independent woman about it,’ she says.
‘It wasn’t great. It was pretty painful and uncomfortable and I kind of wish I had opted to go to sleep.’
If I’m a single woman and I’m young and I have the money, go for it, the younger the better
Dr Zaher Merhi, New Hope Fertility Center
Because she had had mini-IVF instead of the traditional form, Alicia knew to expect she would have a relatively small harvest of eggs, but that they were supposed to be higher quality.
Still, ‘at first [the surgeons] only had four eggs, they couldn’t get the other two out, and you’re in the room as they’re communicating this. It was very emotional,’ Alicia recalls.
In the end, her team got all six. Alicia even plans to do another cycle in the next year or so, before her egg quality starts to deteriorate, which typically begins around age 35.
‘One of the reasons I’ve become more involved with New Hope,’ says Alicia, who now speaks at the clinic’s regular information sessions on egg freezing, ‘is that just because you don’t have that decline yet doesn’t mean you shouldn’t freeze your eggs while your life is not focused on trying to find someone to have children with.’
Though generally speaking, 35 is the ‘scary age,’ as Alicia puts it, the number and quality of her eggs varies from woman to woman.
There’s a 90 percent chance each of her eggs survive thawing and they can stay frozen for about 25 years. But beyond that there is no guarantee the eggs will yield children for Alicia, and no good way to estimate the odds.
What we don’t know: How to accurately tell an egg’s fertility without fertilizing it
WHAT WE DON’T KNOW: WHETHER OR NOT A FROZEN EGG WILL LEAD TO A SUCCESSFUL PREGNANCY
Doctors test fertility by measuring levels of two hormones: anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH).
These help to estimate the number of eggs a woman has in her ovarian reserve, but really tell us nothing about the quality of those eggs.
Sperm can be observed under a microscope for motility, or how well they swim, which gives a good indication of their quality.
‘We use donor sperm to kind of test eggs,’ says Dr Zaher Merhi who works at New Hope Fertility Center but did not treat Alicia.
But that means fertilizing precious eggs, and some women are not ready to make that commitment.
The best doctors like Dr Merhi can do is look at the extracted eggs under a microscope for very obvious and basic imperfections like a ‘cracked shell,’ he says.
If the eggs don’t look good, they are disposed of.
‘If we were able to find a marker that tells us whether or not an egg is good by testing the fluid or something, that would increase egg freezing a lot compared to IVF,’ which is still the go-to infertility treatment, he says.
Many women seem unaware that a frozen egg is not a guarantee of a pregnancy down the line.
If we were able to find a marker that tells us whether or not an egg is good by testing the fluid or something, that would increase egg freezing a lot compared to IVF
Earlier this month, the journal Fertility and Sterility published a study on women’s perception of egg freezing revealed that many believed there was a 100 percent chance that their frozen eggs would result in a child.
To date, more than 5,000 babies have been born from frozen eggs, but there is no national registry counting how many eggs have been frozen, and therefore no way of knowing what percentage have been fertilized successfully or unsuccessfully.
Dr Merhi says that this uncertainty should not dissuade young women from doing it any way: ‘If I’m a single woman and I’m young and I have the money, go for it, the younger the better. So once a patient starts to think about it, she should do it, but at 35 you shouldn’t wait any longer.’
Yet women may not even be aware that freezing their eggs is an option.
Alicia found out about egg freezing through her work in medical sales for a fertility company. She met Dr Zhang who told her ‘you should definitely do it now if you don’t have concrete plans to have children in the next five years and a meaningful relationships with somebody you want to have kids with,’ she recalls.
Alicia agreed, and went ahead with egg freezing, but her own OBGYN had never mentioned the option.
‘I had an appointment with her a couple of months after I started the process and I let her know about it. She was like “oh, that’s good, good call,”‘ Alicia says.
Now that she’s frozen her eggs, ‘it gives me peace of mind,’ she adds.
‘I still might not to have to use them. Honestly, my plan is to donate them to science and have kids the old fashioned way.’
‘But I think a lot of women end up saying “I wish I’d known about it” when they are, like, 40,’ and Alicia is relieved not to be one of them.