Podcast Review: Today in Focus – Should you freeze your eggs?

Social egg freezing (that is, egg freezing pursued by healthy, fertile women) has only been commercially available for the last decade or so, but the way it is marketed might have you believe it's a tried-and-tested, sure-fire approach to extending your fertility. 'Why your New Year's Resolution should be to freeze your eggs', a post by the Fertility Institute of San Diego states under a stock picture of cheerful partygoers. But as this podcast, 'Should You Freeze Your Eggs?', by the Guardian's Today in Focus makes very clear, egg freezing is by no means the safe fertility insurance policy it is so often promoted as.

This podcast is an illuminating discussion around the science and practice of egg freezing. Hosted by Hannah Moore, the episode features interviews with Alexandra, who underwent commercial egg freezing aged 37, Dr Zeynep Gurtin, lecturer at the Institute of Women's Health, University College London, and Beth Follini, a life coach who specialises in helping women decide whether or not they want to have children. Together, the personal, scientific and sociological perspectives provided by these women make for an engaging and sometimes surprising discussion around fertility and egg freezing.

At the centre of the discussion – and the centre of popularity of social egg freezing itself – is why healthy, fertile women are choosing to freeze their eggs. This is clearly not addressed by a one-size-fits-all answer, but the reason given by Alexandra is perhaps common to many women. If, for whatever reason, the traditional narrative of getting married or having a long-term partner before having children hasn't played out by their mid/late 30s, being confronted by a decline in fertility is a major factor in women choosing to freeze their eggs.

As Dr Gurtin confirms, the most common age for women to pursue social egg freezing is 37/38 years old, which might also be influenced by the cost associated with egg freezing. Alexandra totals the cost of the procedures she underwent: £400 for an initial fertility assessment, £1000 on drugs that needed to be injected daily for over a week (in a process she describes as 'shockingly DIY'), and over £3500 on the egg retrieval procedure. On top of that, monthly or yearly payments need to be made to keep the eggs in deep freeze. For Alexandra, this process resulted in the retrieval of eight eggs, six of which could be frozen.

Many women require more than one cycle to have enough eggs frozen to give a reasonable chance of a successful pregnancy. Having ten-15 eggs frozen increases the chances of a sufficient number of eggs surviving the freezing and thawing processes. As such, Alexandra's clinic recommended that the entire cycle of drug injection and egg retrieval would likely need to be performed three times. That would mean a total cost of over £10,000 for invasive medical procedures, which Alexandra repeatedly said were not fully explained to her along the way or discussed in the context of her lifestyle.

If you do have the money and time to spend on egg freezing, you'd hope that the financial outlay would be a worthwhile investment. Certainly, many posts make egg freezing sound like the best way of prolonging your chances of having a biological child or taking the pressure off dating. In reality, egg freezing is quite complex – the high water content of eggs makes them much harder to freeze than sperm – and the number of viable eggs likely declines with each step in the subsequent IVF process. In a fairly shocking statistic from Dr Gurtin, we learn only one in five women who freeze their eggs choose to pursue IVF at a later date, and of those women, just one in five of them will ultimately have a healthy pregnancy and baby: a four percent success rate on an expensive and emotionally taxing procedure.

It is worth noting that this low usage rate might in part be attributed to the ten-year limit that was, until recently (see BioNews 1111), in place for eggs frozen for non-medical related reasons, and for the relatively short amount of time that commercial egg freezing has been around for. With the ten-year limit having recently been removed, perhaps more women will ultimately use their frozen eggs – but this could also result in irresponsible advertising targeted towards even younger women, including teenagers.

Is egg freezing really the answer to women facing fertility conundrums? Follini, a fertility-focused life coach, thinks not. Instead, Follini suggests, egg freezing is commonly used as a way of deferring decision making around having children to an indeterminate date, with no certainty around the outcome of IVF using frozen eggs. While Follini is not against women freezing their eggs, I found what she said about deciding now as opposed to hedging your bets on an uncertain procedure very interesting, especially if that means re-examining what you think motherhood looks like. And, as Dr Gurtin says, perhaps we need to look at motherhood and childcare in society more broadly as a way of addressing why women are increasingly choosing to freeze their eggs to postpone having children.

What was clear to me from this podcast episode is the emotive messaging around egg freezing. Women have been sold the 'have it all' lifestyle, and I do think egg freezing is a direct consequence of that – certainly with the headline stories of big tech firms offering egg freezing as an employee perk through the 2010s. But making decisions around motherhood is such a personal and emotional experience that it's difficult not to view marketing and employee benefits related to fertility as exploitative.

Dr Gurtin describes the language used by clinics on their websites as being overwhelmingly positive, and sometimes completely misleading, with little acknowledgement of the risks and success rates of egg freezing and subsequent IVF. Perhaps better regulation around commercial egg freezing and the language used in adverts would allow women to make better informed decisions going forward, but it's difficult to get away from the desire or emotional connection some women have towards having their own biological children. Indeed, Dr Gurtin, who provides a balanced and informational narrative throughout the podcast, concludes her interview by saying that the time and heartache of her own IVF journey was overwhelmingly worth it to have her son.

It is difficult to know how – perhaps impossible - to detach the scientific facts of egg freezing, or any fertility procedures, from a hope for motherhood. However, this episode made it clear that knowing the facts, and not relying on persuasive marketing, is key to making informed decisions. If you're considering freezing your eggs, I'd really recommend listening to this podcast, and also checking out the HFEA website on egg freezing for reliable information.