Oktay acknowledges that egg freezing has potential, but he argues that it shouldn’t be made commercially available until there are broad-based multicenter trials, uniform methodologies, and solid success rates. “When we sell a product, we have to have some kind of safety profile and some kind of standard of error for what we stand to get,” he says. “You’re not putting a car on the road if you don’t know how safe it performs after 10,000 miles.”
There are some safety issues with egg freezing, primarily hyperstimulation, which affected one woman in the NYU trial, causing her to produce 55 eggs and become very sick. But Oktay is more worried about psychological complications. The fear is that 30-year-old women will bank a batch of eggs, figure they’re set for life, and come back at 42 only to discover theirs was a bad batch. Or they didn’t save enough. Or the thawing process didn’t work properly. Or they have other health problems. “The end point cannot just be the hope of preserving fertility,” he says. “When someone banks her eggs, we need a certain range of numbers that we can give these women so they can make an informed decision.”
And those numbers are difficult to come by. “You read some papers that say, ‘Oh, of the fertilized eggs, we had this many babies,’ and you get the wrong impression,” says Oktay’s colleague at Cornell, Dr. Lucinda Veeck-Gosden. The question women should be asking, she says, is, “If I walk through the door, what are my chances of taking home a baby?” Veeck-Gosden estimates that chance to be less than 5 percent per frozen egg. (Noyes concedes this is close to the per-egg success rate she’s had at NYU.) This is because not all the eggs harvested will survive the freezing process, not all the survivors will be successfully fertilized, and not all the fertilized eggs will turn into good embryos. If a woman goes through one IVF cycle and manages to freeze ten mature eggs, has she really given herself a good chance at future pregnancy? The Cornell doctors say no.
Complicating matters further is that the debate over egg freezing has gotten personal. Grifo and Noyes both trained at Cornellbefore being wooed away to NYU in the mid-nineties. “They treat us like we moved to India when we moved down the street,” says Noyes. “It’s been strained since we left. Some of what you’re getting is politics, unfortunately.” Grifo agrees. “I think the reason Cornell is so negative is that they aren’t doing it,” he muses, “and they have a vested interest in having something else be a better alternative.” Namely, ovarian-tissue freezing, an experimental—and, Oktay notes, not commercially available—attempt to preserve fertility that would most likely apply to cancer patients.
“You wait,” says Noyes. “In another year, they will all be doing it.” She sees this as a moment akin to the controversial launch of IVF 27 years ago. “I think we’re going to change history.”
In the meantime, Noyes is advising women not to see egg freezing as “a complete safety blanket,” because, she admits, it’s still unclear how many eggs need to be frozen to ensure a pregnancy. Although Noyes advises her patients that they need to have a minimum of ten eggs frozen, she agrees that twenty eggs would be safer—but that’s a number that would send most women in for two rounds of hormones and extraction. Noyes also suggests that a 30-year-old who freezes today should come back by 37 or 38, in hopes of implanting her eggs before she turns 40. That way, if there are problems, she might still have a chance of conceiving with the older eggs in her body. But what do you say to a 37-year-old? If a 37-year-old saves a bad batch and comes back at 42, she may have irrevocably ruined her chance of having biological children.
Still, in all likelihood, the technology will eventually get there. Even detractors see egg freezing as becoming standard practice in the next five years. Someday, one endocrinologist told me, girls will get braces on their teeth when they turn 12, freeze their eggs when they graduate from college, and get pregnant whenever they want.
Which, of course, raises another question: Should egg freezing be the next big thing? Are we looking at a not-so-distant future in which 50-year-olds regularly give birth to their first children and companies forgo barely begun family-friendly policies, expecting that female employees will extend their workaholism indefinitely?
“I’m not sure I’m positive that it’s a great thing,” says Veeck-Gosden. “People don’t think about the long term. Are they going to be around to see grandchildren? It changes what we see as the makeup of families.” Not to mention the fact that “you don’t feel the same at 45 as you do at 35,” she says. And it’s not just energy: Endometriosis increases, uterus and tubal function are compromised, everything suffers with age. “Delaying reproduction just for social reasons,” says Veeck-Gosden, “I think we will probably learn some lessons over the next couple of decades about that.”