The sharp rise in egg freezing

The pandemic prompted a rise in women freezing their eggs. But fertility preservation is more than just a Covid craze.

When Shara Seigel went through a break-up in the summer of 2020, she didn’t just have to deal with heartbreak. Finding herself single at 35, and in the height of Covid-19, Seigel, who lives in New York, now had to worry about whether the end of the relationship would also mean losing the chance to become a mother.

“Given that it was still the peak of the pandemic, I knew it was going to be hard to meet someone new anytime soon,” she says. “Even when I do meet someone, I don’t want to feel rushed or pressured to try and get pregnant because of my age.”

Then, Seigel spotted something on Instagram – an influencer she followed documenting her experience of egg freezing. As Seigel scrolled through the posts demystifying the egg-freezing process, something that once felt daunting and unattainable started to seem within reach. “I felt like this was a way to buy myself some time and give myself a back-up plan,” she says.

Within a month, Seigel had started her first cycle of egg freezing. She repeated the process in December 2020, in order to improve her chances of retrieving viable eggs. Although she has yet to move forward with fertilisation and implantation, Seigel says she now feels more relaxed about her fertility: “I have peace of mind.”

During the pandemic, many fertility clinics saw a huge jump in interest in egg freezing procedures. Some data suggests that in the US, egg freezing retrievals increased by 39% from pre-pandemic levels, and in the UK, enquiries rose by as much as 50% in the summer of 2020, compared to the prior year.

For women who found the pandemic disrupted their timeline to begin a family, or couples who decided to delay having a child amid the resultant economic uncertainty, fertility preservation has likely felt like a lifeline. It is not without its nuances, however: technologically-aided pregnancy comes with challenges – and no guarantees. Yet, with increasing take-up, it stands poised to change the way some women think about their autonomy and plan their families.

A mostly privileged position

Developed in the 1980s, oocyte cryopreservation – more commonly known as egg freezing – was originally designed to help women with serious medical conditions requiring treatment that could harm fertility improve their chances of having a baby post-treatment.

The series of procedures involves collecting a women’s eggs, freezing them and then thawing them later on for use in fertility treatment. In recent years, egg preservation has moved from a process of medical necessity to an elective treatment, and women can now choose to freeze their eggs to improve their chances of having children at a later date.

Bat-Sheva Maslow, a reproductive endocrinologist who has performed more than 2,000 egg-freezing procedures, says egg freezing gives women who are currently not in a position to have children a chance at motherhood further down the line, when their natural fertility might be declining.

As a college-educated single woman in her mid-30s employed at a knowledge-work company, Seigel is a typical candidate for the procedure in most respects. Research from 2021 suggests women who undergo elective egg freezing are commonly single, between 36 and 40 years of age, Caucasian, with higher education and employment.

Many of these candidates are also in privileged positions. “Unfortunately, egg freezing isn’t cheap,” says Elizabeth King, a certified fertility coach based in Los Angeles who helps to support women through infertility, miscarriage and pregnancy. With the self-funded egg freezing process costing an average of £7,000 to £8,000 ($8,520-$9,740) in the UK, and $10,000 to $20,000 in the US, the procedure is generally only accessible for well-paid individuals, or people working within particular industries.

Some of these women also work at companies that provide egg-freezing as an employment perk, but these employees are overwhelmingly high-status white-collar workers, often in the tech-sector. “There are quite a few start-ups and tech companies that are offering egg freezing as a benefit to draw in the younger generation and keep them working harder, without the distraction of stepping out to build a family,” says King. “This means that generally most women who are freezing their eggs are within a higher-income bracket.”

But King says the group of people exploring egg freezing has broadened. With a growing global cost of living crisis, a sharp rise in people changing jobs and fears about the lasting impact of the pandemic, she’s observed people in long-term partnerships are putting off pregnancy. Through her practice, she’s also noticed more women in their late 30s and early 40 seeking out egg-freezing guidance, and an increase in black and Latina women through the past few years.

This interest in egg freezing comes amid a trend towards older motherhood and technologically-aided pregnancy. In the UK, the average age to become a first-time mother has been increasing since the 1970s, and is now at a record peak of 30.7; in the US, the number of women giving birth older than age 40 is at an all-time high.

The reasons for this are complex. The rise in effective contraception, alongside improved education and labour-market participation, have given women more opportunities and choices. On the flipside, poor family policies, such as a lack of state-funded childcare, increasingly unaffordable housing and growing economic uncertainty mean that many women feel unable to have children, even if they are otherwise ready for motherhood.

Amid this broader trend, experts say there are several reasons why the pandemic prompted a spike in egg-freezing interest.

Data from an April 2022 Pew Research Center study showed that three-quarters of US daters reported meeting someone was harder than ever in the pandemic era, and many, like Seigel, have heightened concerns about finding a partner.

The flexibility of remote working has also made the process logistically easier for some women. Seigel says the shift meant she was able to fit the multiple appointments needed for successful egg retrieval around her more flexible work life, making fertility preservation a realistic prospect for the first time.

More fundamentally, Anisha Patel-Dunn, a psychiatrist and chief medical officer at US-based LifeStance Health, a behavioural healthcare company, points out that the pandemic was a time for reflection, when many people seriously reconsidered their life choices.

“The pandemic brought on an existential crisis for many people that is bringing up questions such as ‘what is the value of my life? Is my work meaningful? Is my partner really the right person for me?’” she says. “Whether you want to accomplish a life or career goal first, or if you are reconsidering your romantic partner, all of this introspection that we are seeing may add up to people not feeling ready to have kids right now.”

King agrees both the uncertainty and instability of the pandemic were a major factor in the spike. “People have had a lot of time in isolation to think about their future,” she says. “Women who were single realised that egg freezing was a good opportunity to ‘buy time’ in the event that they didn’t meet a partner. Couples have also been freezing embryos with the intention of having a family when the world is more stable, or their financial situation is better.”

Many of these factors were highly present for Laura Pommer when she chose to freeze her eggs. Texas-based Pommer and her ex decided to divorce just a month before the start of the pandemic. Living alone for the first time, in a period of mass isolation, gave Pommer, 37, the chance to consider what she wanted from her newly-single life.

“I had a lot of time to think about what is important in life,” says Pommer, whose parents helped subsidise the costs of the process. “I used this time to really consider what life experience is, how I wanted to live it and how to get the future I desired. That is when I decided that I was sure that I wanted children, preferably biologically, and that I would freeze my eggs.”

The proliferation of egg freezing has distinct upside. However, there are complexities around the procedure that candidates have to consider.

Both Pommer and Seigel experienced how physically and emotionally taxing the initial egg-freezing process can be. Seigel describes the weeks leading up to the procedure, when patients have to inject themselves with a mixture of medications, as stressful, noting that her physical and mental health were impacted as a result of being unable to exercise during this timeframe.

Pommer says she struggled through a month of appointments and hormone shots, and recalls how “nerve-wracking” the last injection, which had to take place at midnight a couple of days before the extraction of follicles, was. “A few days later, I went in for the eggs to be harvested. The process went smoothly, but I was uncomfortable for a few days after, and the hormones certainly impacted me,” she says.

More significantly, the process comes with no guarantees. Some experts are concerned that the chances of successful pregnancy using frozen eggs could be being oversold by some clinics, and are warning that women shouldn’t see fertility preservation as a fail-safe insurance policy.

The age at which women freeze their eggs is a factor in success: Women who are younger than 35 have a 18% chance of having a baby when five eggs are frozen, but this falls to 7% if the woman is over 35 at the time of freezing.

Outcomes are influenced by how many eggs patients freeze; to truly have a strong chance, clinicians generally recommend going through multiple cycles of egg freezing (the number of eggs retrieved in each cycle is highly individual, with averages as high as 15 for women under 35, to as low as 6 for women over 42). However, this ratchets up costs and can be prohibitive for many people. (The BBC has a more detailed breakdown of egg-freezing success rates here.)

Consequently, the high cost of egg freezing combined with the relatively low success rate mean that some women may be paying significant sums for a so-called guarantee that only marginally increases their chances of motherhood. 

There are concerns that some clinics may be taking advantage of women who are anxious about their fertility, without adequately explaining how realistic a successful pregnancy after egg freezing really is.

“I think that there is a false sense of security that women with frozen eggs will get a healthy embryo or live birth,” says King. “I do think that clinics should do a better job of explaining the reality of the journey, not only from a physical standpoint, but an emotional one as well.”

‘I can let life come to me’

Based on current trends and anecdotal reports, however, interest in the procedure is still high even as the pandemic wanes, something which, in the long term, could change how some people plan and expand families.

“If, when, how many and with whom we have children has significant implications for pretty much every aspect of our adult lives – where we live, where we work, how we spend and save our money as well as our physical and emotional wellbeing,” says Maslow, of Reproductive Medicine Associates in New Jersey, US. “Reproductive planning is part of our life planning.”

Maslow says we are likely to see more mothers in their late 30s and early 40s. King adds that some women will experience a growing sense of freedom around work and how they plan their future, as they increasingly feel that they have the kind of control over their fertility that previous generations missed out on.

King caveats, however, that this sense of agency may largely be constrained to upper-middle class individuals, who are more likely to be able to afford the procedure. Another caveat, of course, is that not everyone who chooses to freeze their eggs will be successful and have their plan play out as they’d hoped.

In Pommer’s case, the procedure has made her feel less pressure to find a new partner or push her career in a certain direction. She can now focus on her growing business, with the longer-term goal of having a child once things have “calmed down” a bit. “I can be flexible in where I live now and let life come to me, instead of trying to control for a certain outcome,” she says.