My uterus is being targeted by ads.
For years now, I've been part of the demographic for Facebook, Instagram, and TikTok ads promoting egg freezing. Egg freezing is a medical procedure which allows doctors to freeze and preserve unfertilized eggs for future use. Eventually the person can thaw their eggs, fertilize them, and then transfer the embryos to the uterus at a later date when they want to become pregnant. Since the number of eggs and their quality both decrease as a person ages, it's advertised as a way to extend fertility — despite the American Society for Reproductive Medicine (ASRM) warning that this positioning could give "false hope." But at least the thinking is that "younger" eggs may be implanted in the uterus of an older person, or a person who may have undergone medical procedures like chemotherapy, and may not have viable eggs left when they want to have a baby.
Some ads I'm served are incredibly vague: "Know your options," or "Learn about egg freezing," read many of them, next to a photo of a woman gazing off into the distance. Some are more promotional: There are sales for egg freezing just like there are sales for products that aren't medical procedures. Refer a friend! Black Friday! US$1,000 off! Certainly, none of them warn about the "false hope" potential of egg freezing to extend fertility.
As with ads for other women's health services, like fertility hormone tests, coming across these posts while idly scrolling Instagram can feel jarring. But whether these ads feel invasive, or helpfully informative, either way they are getting the option in front of more people. They usually don't contain much information, and so might prompt questions. Egg freezing is also a for-profit procedure, that can be a moneymaker for established clinics and fertility startups alike, whether or not it's covered by insurance. That's why many organic social media posts from influencers about egg freezing are actually posts from paid partners of egg freezing clinics advertising their services. So clicking through an ad for this "product" might not be the best way to find answers.
Mashable spoke with two OBGYN fertility experts who have seen hundreds of egg freezing clients: Dr. Nicole Noyes, an early pioneer of egg freezing, and Dr. Sigal Klipstein, a Reproductive Endocrinologist in Chicago and chair of the Ethics Committee of the American Society for Reproductive Medicine. While ads frequently invite their targeted audience to "learn more," they don't actually say much until you're hearing the sales pitch from the company trying to sell you this procedure. Given the for-profit nature of egg freezing, and the plentiful, opaque ads getting the word out about the procedure, here's what doctors want people who come across egg freezing ads to know — things the ads rarely discuss.
It's a very personal decision, not a blanket "just in case" insurance policy for everyone
When discussing egg freezing options with patients, Dr. Noyes asks them a question: Can they "see it?" Meaning, can they see the circumstances of their life coming together in a way that would make them ready to get pregnant in the near future? If not, they might be a good candidate for egg freezing.
"I think the best age is 25 to 39," Noyes said. "And I don't mean all 25 year olds. I mean 25 to 39 year olds not in a position conducive to childbearing in the near future."
But what makes one person ready for a baby could be very different from another person. Having support and community is an important part of egg freezing. But the individual choice component of deciding to freeze your eggs is what makes some ads promoting, for example, specials where you get discounted procedures if you freeze with a friend, especially galling.
A person's individual circumstances are all part of what Dr. Klipstein describes as a "social decision" that makes opting to freeze your eggs unique from undergoing other medical procedures.
"It's somewhat of a medical decision, but it's very much a social decision," Klipstein said.
Egg freezing is sometimes presented as a way to hedge against the march of time, an "insurance policy" for your uterus if your job, finances, relationships, and other life factors don't all come together at the perfect moment for you. But it's not right for everyone, and certainly not a guarantee that you'll be able to get pregnant at the exact moment you want to.
"Is it an insurance policy? No," Noyes said. "But definitely more women can have children when they're ready because of egg freezing."
The data on success rates is in flux
There are multiple datapoints to measure the success of egg freezing procedures. How many eggs did an extraction yield? How many patients returned to thaw their eggs? Of the patients who thawed, how many implanted and became pregnant? Of the people who got pregnant, how many carried their fetuses to term? How many live births resulted from a frozen egg?
The answers to these questions are more complex than you might think. A big part of the reason why is because the procedure really only took off in the last two decades, so the data on people who froze their eggs, and then returned years later, is limited. The data also varies because in the 2000s and early 2010s, the average age of egg freezing patients was 38, according to Noyes.
But now, thanks in part to the addition of egg freezing insurance benefits at companies like Apple and Meta, younger people are freezing their eggs, too. These younger eggs might have different outcomes than the eggs harvested from people in their late 30s, according to Noyes.
There are some knowns that can help you decide whether egg freezing might be right for you. For example, one study Dr. Klipstein referenced estimated that if you're under 35, you'll need to retrieve 10-20 eggs to have an 85 percent chance of at least one live birth using those eggs, and that number goes up the older you are. What that means is, if you freeze when you're older, you are more likely to have to do multiple rounds of egg freezing to increase your chance of having a baby using those eggs.
"The older you are, the less eggs you get, and the less likely each egg will [result in] a baby," Klipstein said. "And so the older you are, the more eggs you need in order to have a chance of having a baby."
What about the amount of people who actually use their frozen eggs? One study of 231 people (where the average age was 38), also referenced by Klipstein, found that just under 40 percent of those people who have frozen come back to retrieve and thaw their eggs. Of those 88 people who thawed, 27 had live births. That's a 34 percent success rate among people who thawed.
That rate is consistent with what Dr. Noyes has found in her own research of NYU patients, that one in three patients who froze (with an average age of 38) had a child.
"I think that's good," Noyes said. "But that means two out of three didn't, but one out of three more women got a baby that wouldn't have."
According to Noyes' own experience, if people freeze earlier, she puts the chance at one out of two.
Clinics vary
Noyes cautions that those data points refer to outcomes from "good clinics," or places with lots of experience that know what they're doing. But not all companies and doctors offices that offer egg freezing are created equal. It's especially difficult to discern differences in quality when all the information you have to go on is an Instagram ad.
"About one in three women will get a live birth in a good egg freezing program," Noyes said. "But not all programs are good, and it's really hard for the consumer to know that."
Rather than be attracted by gimmicks or sales, Noyes says to make sure to ask questions about how many procedures a company has done and success rates before choosing an egg freezing provider.
There are multiple costs involved
A huge factor in a decision to freeze your eggs is cost. The amount of money you'll spend varies from clinic to clinic and geographically. But generally, one round of egg freezing will cost between US$6,000 - US$20,000, according to Business Insider. Then, after you actually freeze your eggs, you also pay a storage fee — you're basically paying rent for your eggs at an egg freezing facility. And beyond that, there is a cost of thawing, fertilizing, and implanting. All of these costs vary from clinic to clinic and state to state. Meanwhile, ads gloss over the long financial process that's involved.
"There's a second part of the fee that I think is important to keep in mind," Klipstein said.
It's a medical procedure
While the decision to freeze is both medical and social, the process itself involves a medical procedure. That includes two weeks of giving yourself injections, and then a procedure that requires undergoing anesthesia.
"It involves some small injections, it has a risk of over stimulating your ovaries causing something called ovarian hyperstimulation syndrome, and it does require anesthesia and it does require you to have someone to drive you home on the day of anesthesia," Klipstein said. "Those are the things I would want people to know."
It can be emotionally challenging
Many social media videos depict people's "egg freezing journeys." These usually involve time-lapse videos of people giving themselves injections. But Dr. Noyes thinks the emotional component — both surrounding the act of egg freezing, and heightened by the fact that you're injecting yourself with hormones that can impact your mood — cannot be ignored in weighing a decision to freeze.
"It's a huge commitment for two weeks," Noyes said. "It's not easy, because you have to do shots. You have to go to the clinic. Your ovaries are growing, so you feel kind of funky. You're scared, and you have all the anticipation surrounding it. That anticipation is very wearing and causes a lot of anxiety."
It's about odds, not assurances
The decision to freeze your eggs is one that involves money, time, and medical and emotional risk. Whether those costs are worth the potential benefit of one day thawing your frozen eggs and having a baby is entirely up to you. But it's important to go into the decision with a clear understanding that you are getting increased odds of one day having a baby at a later date, and not a guarantee.
"One of the things that is really important when you're looking at freezing your eggs, is what are you buying?" Klipstein said. "You're spending good money. You're going through a procedure that has some risk, what are you getting on the other end of it? And what you're getting, I think, or what you hope to get, is an increase in the chance of having a baby down the road. Not a guarantee, but increased chances of having a baby when you're ready to have one."
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