Egg freezing is not all it's cracked up to be

It's sold as a procedure that can empower women, but freezing eggs is costly, time-consuming and not guaranteed to be a success.

That hasn't dented its popularity in Australia, where use of the treatment has skyrocketed.

The number of Australian women freezing their eggs tripled over the five years to 2020. Egg freezing for non-medical purposes also increased by 56 per cent in just 12 months between 2020 to 2021 as COVID lockdowns, which made dating difficult, drove more women to the procedure.

As women's fertility decreases with age, freezing eggs can buy time for those who want to preserve their fertility for later.

But, as a growing number of young women say they feel pressured by fertility services who use social media influencers to advertise egg freezing, it's important women be made aware that egg freezing is expensive and may not deliver all that it promises.

Egg freezing involves the woman self-injecting fertility drugs for a couple of weeks to grow as many eggs as possible. When the eggs are mature, they are retrieved in an ultrasound-guided procedure under light anaesthetic. The eggs are then stored in liquid nitrogen until the woman returns to use them.

While some women freeze their eggs to advance their career or to improve their financial circumstances before having children, the most common reason is they don't have a partner or have a partner who is "not ready" to have children.

While egg freezing can be a useful and necessary procedure for some, the process is not a failsafe insurance policy.

The chance of a baby depends on the woman's age at egg freezing. Of the women who froze their eggs at age 35 years or younger, 52 per cent had a baby but this dropped to 34 per cent for women aged 36-39 years and 19 per cent for women aged 40 years or older when they froze their eggs.

It's also pricey. Each egg retrieval process costs between AUD$5,000 and AUD$10,000, although there's a Medicare rebate of about half of the cost if the procedure is for medical reasons.

Usually, more than one hormone stimulation and egg-retrieval is needed to collect enough eggs, meaning women often pay AUD$16,000 to AUD$60,000, depending on age, to have enough eggs stored for an 80 per cent chance of having a baby.

On top of that, egg storage costs around AUD$500 a year. Then there is the cost of the IVF procedure for those who decide to use the eggs down the track.

Research also shows that very few women come back to use their eggs. On average, only about one in 10 women (11.1 percent) return to use their eggs and of those 28 percent have a baby.

In Australia and most other countries, assisted reproductive technology treatments, including egg freezing, are delivered by private IVF clinics. Some of these are now corporatised and deliver healthy profits for shareholders.

Commercial interests can affect clinical practice in a range of ways, according to participants in one study about the potential for conflicts of interest that can arise due to commercialisation of the IVF industry.

Doctors might offer treatments to patients who don't need it, or report high success rates based on women who do not represent the average patient, for example.

Another study of patients' views on the pros and cons of the commercialisation of the IVF industry cautions that it might lead to misleading marketing and advertising. These concerns apply to egg freezing, too.

On clinic websites, egg freezing is promoted as an empowering option that offers "peace of mind" and allow women to stop "worrying about their biological clock".

However, studies of the content on IVF clinic websites highlight several areas of concern regarding the quality of information about egg freezing.

They include the websites downplaying or not mentioning that egg freezing is costly and not risk-free, that it may require multiple rounds to get the number of eggs that give a reasonable chance of success, that eggs may not survive thawing, that embryos may not form, and that if they do, there is no guarantee of a baby.

Deciding what to do with unused eggs can be challenging, especially for those who still want but have not had children.

Some clinics have also begun using social media and influencers with huge followings in their marketing strategies.

These partnerships have sparked debate about their ethical, social, commercial, and legal implications. They include that when influencers promote the clinic's egg freezing services, they may present biased, incomplete, or misleading information, which can affect followers' decision making. This may mean that a decision to freeze eggs is swayed by personal stories rather than objective, comprehensive information.

Many of these social media posts use feminist language around increasing women's autonomy to suggest that egg freezing is empowering — a way of taking control of one's own body.

But as journalist Micaela Mackenzie has written for Bustle, "promoting egg freezing through the lens of a certain brand of ‘you can do anything you put your mind to' Instagram feminism can be misleading."

And as Cambridge researcher Katie Hammond has written, "egg freezing is not necessarily an empowering option. It is a risky, intrusive procedure for which there is still little research. It is shortsighted, and simultaneously fails to challenge the very conditions that produce its need."

Online marketing on egg-freezing has a lot in common with promotion of the anti-Mullerian hormone (AMH) test as a way to learn about your future fertility potential: both examples of how commercialisation of reproduction is letting women down.

AMH levels are a measure of the number of eggs remaining in the ovaries — but there is no evidence that this predicts chance of pregnancy now or in the future, and studies show no difference in chance of achieving pregnancy between women with high and those with low AMH levels.

Despite this, advertising on clinic websites and by online companies selling AMH tests direct- to-consumers often have false and misleading claims about the utility of the test and suggest it can help women ‘take charge of their fertility'.

Women deserve factual and realistic information about what is possible with egg freezing to allow them to make informed decisions and manage their expectations.

A new Decision Aid, free of commercial interests, that details all the pros and cons of egg freezing might help women make the best decision given their cicumstances .

While a Decision Aid is a start, and early research suggests most women using the tool found it useful, more is needed to ensure women can access trustworthy and impartial information about egg-freezing.

This should include tighter regulation around social media marketing of egg freezing and AMH testing to make sure women make reproductive decisions based on facts rather than on spin.