Why Egg Freezing Is an Impossible Choice

http://prime.nautil.us/issue/22/slow/why-egg-freezing-is-an-impossible-choice

by dnetesn • 11 years ago

97 100 11 years ago

prime.nautil.us

jkot• 11 years ago

Instead of this, Apple or Facebook could pay $20,000 to their partners, if they stayed at home with a kid.

nsxwolf• 11 years ago

My college educated wife chose to stay home. Some of her friends and family view this as a deliberately provocative anti-feminist choice, and we're in the midwest. I can only imagine those sentiments would be even more common in SV.

knicholes• 11 years ago

My wife is also college educated and stays home. I don't see how this is anti-feminist, though. The way I see it, it's a woman choosing to live the way she wants to live. It had never occurred to me that this could be anti-feminist.

Then again, I live in Utah where a sizeable portion of the college-educated women major in Family and Consumer Sciences at BYU. Seriously, though. http://registrar.byu.edu/catalog/2011-2012ucat/departments/F...

My wife graduated in marketing and has worked and is fully able to work as a professional. I kind of view it as noble for her to bear the responsibility of full-time child rearing. It's undoubtedly a more difficult task than my sitting around on a computer all day occasionally going to meetings with catered lunches. ;)

Domenic_S5• 11 years ago

My college educated wife also chose to stay home! She knew that's what she wanted to do before college.

I think it's hard to disparage when any partner chooses to stay home -- and isn't choice a core tenant of feminism?

blhack• 11 years ago

Something more important that working? Blasphemy!

danielweber• 11 years ago

Her friends can suck it. It's your family, you make the decisions, because you live with the consequences.

It's cliche, but: if someone stops being your friend because you leave the job market for personal reasons, they were never your friend.

needacig4• 11 years ago

I don't agree this is an anti-feminist choice, but I think people might see it that way because genuinely anti-feminist people like to claim that a woman's place is in the home and that women's brains aren't really suited for tasks that aren't nurturing. So women staying home to take care of the children, on a surface level, supports this traditional anti-feminist argument and this is why it could be seen as anti-feminist.

Dewie• 11 years ago

They think that a woman making a non-traditional[1] choice is anti-feminist? They think that woman should fall in line and do what is expected of her (out of ideology)? How wonderfully ironic.

[1] staying at home might as well be the new non-traditional choice. Feminism is now the old guard.

msoad• 11 years ago

In many cases the partner is a professional himself and $20k don't get you anywhere with that situation.

s73v3r• 11 years ago

Or allow more remote work.

bentcorner• 11 years ago

$20,000 is roughly the cost of childcare for the year. It would be better spent on letting parents use that money towards that, allowing both partners to work.

With a large enough population you could probably open an on-site care facility for children, which buys you better employee satisfaction, since you could integrate it with their workplace IT.

That said, the $20k is a one time cost to freeze eggs, whereas the $20k you would give (to a partner or other childcare) would cover just one year. The egg freezing seems like the more economical choice, from Apple/FB's point of view.

zelos• 11 years ago

There seem like lots of other options that aren't so invasive. Better childcare, flexible/part time working hours, decent maternity/paternity leave, not expecting your employees to dedicate their entire existence to the Company.

sjg0072• 11 years ago

Or offer day care, life balance, work from home etc.. Honestly, having a kid puts you out of the office but not necessarily out of work, especially tasks amenable to remote work.

throwaway03951• 11 years ago

Funny thing about using the $20,000 benefit for IVF: a clinic charges a lot more, like 2.5 times more, for the same service when going through insurance than when self-paying. With the $20,000 benefit you will end up out-of-pocket paying 50% of the self-pay amount. That is better than nothing but the service is not covered in full.

golemotron• 11 years ago

Similarly, Noyes’ team, surveying 183 egg-freezing patients on why they were delaying childbirth, found that just 24 percent cited professional reasons, while 88 percent cited lack of a partner.

Are they more likely to find a partner as they get older? That bet could be as large as a bet on the viability of the frozen eggs. Finding a partner and raising a child on one's own both become harder as time goes on. My bet is that most eggs frozen will by younger women for themselves later in life will not be used.

toomuchtodo7• 11 years ago

I feel like I'm uniquely qualified to comment on this, as I'm going through the IVF process with my wife currently.

Are they more likely to find a partner as they get older?

Possibly. Maybe not, but you're essentially paying for insurance.

That bet could be as large as a bet on the viability of the frozen eggs.

Frozen embryos are extremely viable, as long as you were able to observe their cellular division 3-5 days after fertilization. As long as you can confirm they're viable before freezing, you're almost assured they'll be viable when thawed at a later data in the future (this isn't only from my pubmed research, but also from the top fertility doctor in the Chicagoland area we're using).

Finding a partner and raising a child on one's own both become harder as time goes on.

Disagree. In most cases, you're further advanced in your career when older, giving you more income, thereby more purchasing power. You may not find a partner, but daycare is easier to afford, or a part time nanny. Delaying childbirth most likely affords you opportunities not available to those who cut their career prospects early to have children (or who left their career entirely because they had a partner to rely on).

Also, more resources available to you means you can be more discerning about your partner selection.

My bet is that most eggs frozen will by younger women for themselves later in life will not be used.

Its possible, but like I said above, its insurance. My wife is 30. Whatever eggs we freeze now that we don't use, they are essentially her eggs at 30, and could be used by her at any date in the future. She even has the option to use those eggs with someone else if we're not together at some point in the future (life is long).

TL;DR Freezing your eggs is an insurance policy against the future.

EDIT: Due to reasons I'd rather not make public beyond what I've shared above, I've contacted institutions who are doing research in coercing stem cells into egg or sperm cells. I expect in the next 10 years for this to be a solved problem, and the egg retrieval process to be deprecated in favor of a quick blood draw and incubation period to coax stem cells to reproductive cells. But unfortunately, this isn't solved yet.

fluidcruft• 11 years ago

Frozen embryos are extremely viable

Well, eggs aren't embryos... They're not fertilized and they're not dividing so I'm not sure how you propose checking viability before freezing... The stats cited in the article are that only 2000 frozen eggs have ever been successfully used world-wide.

technotony• 11 years ago

This research on coercing stem cells into eggs/sperm is hugely important and significant. It's the key bottleneck holding us back from safe, effective, affordable genetic modification of ourselves: http://www.technologyreview.com/featuredstory/535661/enginee...

Domenic_S5• 11 years ago

daycare is easier to afford, or a part time nanny.

OP said raising a child, not paying others to raise a child in your stead.

Balgair• 11 years ago

So, my brother works in one of those labs. Whatever they have told you, don't bet on it. Making totipotent stem cells (SCs) is a lot different than multipotent SCs. The tragedy of the Sasai incident [1] I think highlights the difficulty and the false hopes in that field. There are a LOT of issues that are very difficult to get us to totipotency [2]. For instance, in regular development, we do not yet know how cells communicate exactly. Is Wingless or SonicHedgeHogg transferred extracellularly (in Brachet's cleft) or via thin processes in the 'bucket-brigade' manner. How do the cells move during gestriculation? Etc. You may think these are pedantic, but if it is bucket-brigade mechanism, then having other cells is required to develop and return SCs to totipotency. And before you think that these are solvable issues, look into embryology [3] a bit more. For example, it is unknown what role the direction of the sperm's entrance has on the development of a chordate embryo. Just waving hands and saying 'they'll figure it out' isn't the best way to think about this. These biological systems represent 4.5 billions years of hacking and tinkering that we are just now starting to understand.

TL;DR: The body is incredibly fascinating and complicated, is a series of cells going back 4.5 Gy, and is very expensive to research.

[1]http://www.nature.com/news/stem-cell-pioneer-blamed-media-ba...

[2]https://en.wikipedia.org/wiki/Induced_pluripotent_stem_cells

[3]http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/F/Fro...

EDIT: Not to scare you or your wife away though. Anyone thinking of IVF should go for it, it is your right. Best to you and yours. If your writing like this on HN, you sound like you will make a great parent!

rwallace• 11 years ago

In most cases, you're further advanced in your career when older, giving you more income, thereby more purchasing power.

In practice, when people get 'further advanced' in a career over the years, their spending typically drifts up to match any increases in income (or to match the spending of their peers, which typically amounts to the same thing) so they don't really end up with more money. You can always plan on being an exception, to be sure, but I think it's a good idea to be very wary of planning on being an exception.

differentView2• 11 years ago

Also, more resources available to you means you can be more discerning about your partner selection.

More discerning from a much smaller pool.

kabouseng2• 11 years ago

Hi, we also went through this process recently (Successful IVF and we froze the spare eggs).

I am not sure what statistics you were quoted, but our doctor quoted us:

~70% chance of successfully thawing an egg with observed cellular division.

~30% chance of successfully thawing an egg without observed cellular division.

~55% chance of successful pregnancy from an implanted egg, thats why they implant two in many cases, making it roughly 25% chance of twins, 50% chance of one and 25% of none.

If you have got enough eggs the thawing isn't really a problem, but most harvestings only get around 5 - 8 eggs of which 2 - 3 are good. We were extremely lucky in harvesting 21 eggs off which 8 were grade A quality.

Just another perspective.

aetherson• 11 years ago

I disagree that finding a partner is harder as you get older -- at least in the upper third or so by income of white-collar workers, which is the demographic that is being targeted here.

I mean, past a point, sure. Probably it's a lot harder to find a partner at age 45 than it is at 30. But I think it's easier at 30 than at 25.

needacig4• 11 years ago

My intuition (and cultural tropes) tells me this varies depending on whether you are male or female. You can look at the age differentials of married couples and see that women will marry men who are older than them (or men will marry women who are younger) meaning that as women age they should likely have a harder time finding a partner.

restalis4• 11 years ago

"Are they more likely to find a partner as they get older?"

Even if not, it's still a good thing to hope for. It is a psychological effect that gave birth (no pun intended) to a market. After finally acquiring wealth in exchange for one's prime years of life, there aren't many further things worth exchanging those gains for but another dream.

Domenic_S5• 11 years ago

Ctrl+F "pain" - nothing. Egg retrieval hurts, and OHSS is severely underreported. REs for whatever reason do NOT like to officially diagnose OHSS.

jpatokal2• 11 years ago

Female fertility declines sharply at 37

This, by the way, is largely a myth. Obviously fertility decreases with age, but it's a gradual tapering off until menopause, not a cliff at 37 (or 35 or 40 or any other red line). ~80% of women aged 35 to 40 can still conceive within a year.

https://en.wikipedia.org/wiki/Fertility#Female_fertility

Domenic_S5• 11 years ago

The risk of defects is more salient and does indeed cliff.

Risk of having a child with Down Syndrome:

At age 20, 1 in 1,441

At age 25, 1 in 1,383

At age 30, 1 in 959

At age 35, 1 in 338

At age 40, 1 in 84

At age 45, 1 in 32

At age 50, 1 in 44

http://en.wikipedia.org/wiki/Advanced_maternal_age#Risk_of_b...

cjbprime4• 11 years ago

It's a different kind of risk, though. In the last few years "cell-free DNA tests" -- sequencing fetal cells that are circulating in the mother's bloodstream -- have become common (and paid for by health insurance), and they detect chromosomal abnormality as early as 8 weeks into the pregnancy. If you aren't ethically opposed to abortion, the risk of Down's can be the "well, damn, guess we'll try again in a few months" sort of risk.

Maakuth• 11 years ago

I wonder if the Down probability is connected to the age of eggs or the womb? I mean, does using frozen eggs make the effective risk comparable to the age when the eggs were harvested?

civilian• 11 years ago

Yup! My brother and I were born when my mom was 44 and 42, respectively. Apparently my mom had made an appointment with her OB-GYN to talk about fertility treatment options. At that appointment they also did a routine pregnancy test and she discovered that she was pregnant with me. :D

refurb• 11 years ago

"Conceive" doesn't equal "healthy child born". Plenty of pregnancies end in miscarriage and that rate increases with age.

I think the other states on the wiki page make more sense. 66-44% of 35-40 yr olds will have conception resulting in a live birth within a year.

colomon2• 11 years ago

There may not be a cliff, but if you look at http://www.advancedfertility.com/ivf-age.htm you can see that the IVF success rate is halved going from 30 years old to 40, and then halves twice more by age 44. If you are going to need help with fertility -- and lots of women do -- you are vastly better off discovering it at 30 than at 40.

(Re: the article, the interesting question then becomes how much of that decline is due to reduced egg quality. If that's a major issue, then freezing eggs at 30 might be a huge win.)

dougmccune• 11 years ago

This has been a huge topic of conversation for my wife and I for the past few years. Our entire social circle is the exact target demographic: early thirties, highly educated, career focused, etc etc. We got married earlier than nearly all our friends (age 28). We've had two kids before most of our friends are married. Our friends are now closing in on 35 and now thinking about how to have a family is becoming a serious concern. We were a generation raised being told consistently that a woman should be career focused, pursue as much education as possible, and that you don't have to ever worry about finding a partner and having kids until you're ready. And now we have friends freezing eggs, considering how to start a family without a partner while they can still easily have kids, etc. It just feels like the pendulum has swung too far in terms of my generation's expectations (or maybe naiveté). You can't change biology. It will be interesting to see what kind of advice I give my daughter when she's an adult, but I'm hoping her generation has a bit more of a middle-ground approach to thinking about the balance between career and starting a family.

rayiner• 11 years ago

If you want to get married and have kids, you should just do it. My wife and I had our daughter while we she was still in law school and I had just graduated. Taking care of a kid is a lot of work while both working long hours at big firms, but why that's what grandparents are for. There is no good time to be sleep deprived for months doing night feedings. At least in your 20's you have the energy and your parents are young enough to help out!

madengr• 11 years ago

No, that's not what grandparents are for.

sehutson• 11 years ago

"If you want to get married and have kids, you should just do it."

Most of the women I know who are considering egg freezing would LOVE to "just do it". Not everyone is fortunate enough to meet the right person (who is also willing to commit and settle down) early on.

M83• 11 years ago

"that's what grandparents are for"

Yeah, luckily they are guaranteed to be alive in your twenties.

greggman• 11 years ago

Nice you had family near by at the time. I know plenty of couples that are near none of either of their families. Sometimes they moved, sometimes their families moved, some times their families are no longer around

toomuchtodo7• 11 years ago

I don't disagree with most of your post, except this part: "You can't change biology."

We can already 3D print organs, rewrite DNS using viruses, and just today discovered we can reverse Alzheimer's almost entirely using ultrasound within the brain. It is dangerously naive for us to think we cannot change our own biology. It's simply a matter of time and resources.

scintill76• 11 years ago

OK, but the original implied point still stands IMO: If you're a woman (or man, really) who might ever want to have kids, you probably shouldn't count on being able to reliably and affordably control that biology in your lifetime. And yes, that applies to your "all-natural" chances, too, which probably means it's good to adjust your expectations and "societal norms" as the article says.

P.S. Considering the forum, I got a chuckle out of "rewrite DNS using viruses" -- I assume it's supposed to say DNA.

circlefavshape• 11 years ago

Au contraire, it's dangerously naive to think that the time and resources exist for us to change our own biology in time for it to be useful to you

greendestiny• 11 years ago

The previous generation experienced massive pressure not to return to the workforce after having children, so it makes sense that the pendulum would swing to having career success before children. Hopefully the future actually involves flexibility about career/job breaks required for having children as well as the care situation afterwards.

The biology of the situation doesn't just relate to fertility though, life spans have an impact on the probability of seeing your children and grandchildren reach certain ages.

zaccus2• 11 years ago

Family and career both require massive amounts of time and energy. It should be acknowledged that there is no way to fully commit to one without taking away from the other. So you'll have to make a difficult choice.

patmcc2• 11 years ago

The hugely surprising fact of the article, for me, was:

"Just 2,000 babies have been born from cryogenically frozen eggs in the world"

That's crazy to me; this all sounds like a huge bet on complete unknowns.

I also wonder if this is going to be the end of grandparents in affluent circles - if people wait until their 40s for kids, and their kids do the same...not much time to hang out with grandma and grandpa.

chriskanan• 11 years ago

This issue has been weighing heavily on me. My Dad was 36 when I was born and is now 70 years old. My fiance and I are both professionals and have our kids planned for 2018 when she is done working 80 hour weeks. By then my Dad will be around 74. Considering my grandfather died at 85, that doesn't leave a whole lot of time left to have a big impact. Plus, that likely means I won't have much time with my potential grandchildren either if my children also don't have kids until their late 30s and assuming quality lifespan doesn't increase dramatically.

mjn• 11 years ago

For better or worse, this is more historically common with men, even in previous generations. Both of my parents' fathers were in their late 40s when they were born, in the 1940s. And yes, that left the fathers quite old when their kids grew up, and very old by the time they were or could have been grandfathers. My paternal grandfather died before I was born, and I only knew my maternal grandfather because he lived to a quite old age (he was in his 70s when I was a young kid, and lived into his 90s). There are elevated risks of some diseases with older men, but fertility declines slowly, so it hasn't needed space-age technology for that kind of generational structure to emerge.

patmcc2• 11 years ago

I'm in a very similar boat - my parents were 48 and 38 when I was born (I'm 29), so they're really starting to get old.

My wife and I decided screw it, we're going to have kids now, despite not being in the best places professionally. It might be tough, but we're still in a much better place than ~75% of people when they start having kids, and we think we'll figure it out.

And so, this morning, we got to hear our kid's heartbeat for the first time. It's scary, and the idea of not being in the "ideal" job is worrying, and doubly so for my wife (who still needs some more experience to get her professional designation), but kids/pregnancy is sadly not something that can be put off indefinitely without consequences. So we bought the bullet, and we're going to make it work.

gutnor• 11 years ago

Other problem is that as your parents age, they can require more assistance (illness, death of relatives,...). If you don't have brothers and sisters like my wife and I, the burden is really heavy.

davidf18• 11 years ago

Seifer, et. al. 2014 - Putting 'family' back in family planning http://www.ncbi.nlm.nih.gov/pubmed/25406182

A lot of people who do not understand fertility (female fecundity -- the ability to conceive) and others give wrong info from comments I've seen here.

The Amerian Society for Reproductive Medicine (ASRM) the doctors orgninzation of fertilty doctors (called Reproductive Endocrinologists) says that women are most likely to conceive in their 20's to early 30's. Elite egg donor agencies that offer $20,000 for donor eggs in Ivy League student newspapers want donors under 29 or 28. Studies show that 3 out of 4 men and women overestimate by five years the rapid decline in fecundity believing that it is 40 when it is in fact 35.

The ASRM does not yet recommend egg freezing for delaying childbirht but rather for situations such as chemotherapy for cancer which would destroy the eggs in the ovaries.

Fertility speicalists (S. Silber and others) recommend that if women expect to wait beyond 30 to have children they should have an antral folllicle count ultrasound at age 25. Other fertilty speciialsts have recommended other tests at age 25 (eg, FSH, or anti-Mullerian hormone).

There are no non-invasive tests to test for ovarian reserve which varies from woman to woman. Unfortunately, studies shiow that doctors (include those internetists that might write birth control medication perscriptions) don't have any better understanding of ages of female fertilty than the general public. Obstetricians do know but they don't always discuss the age issues with their patients.

In summary, women should consider getting a test for their ovarian reserve (antral follicle count ultrasound or above mentioned laboratory tests sooner rather than later) so that they can make informed decisions. The article listed above and its references will provide a lot of information. * Consult reproductive endocrinologists for correct information about fecundity.

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sjg0072• 11 years ago

Nobody talks about this but fertility rapidly declines in your 30s especially after 35. Egg freezing should be done as early as possible, aka in your 20s, even then the odds that you will have a live birth after thawing are low. That being said, there is the viable alternative of using an egg donor which relies on fertile young women.

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needacig4• 11 years ago

Are you joking? Everyone talks about this.

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M83• 11 years ago

He means nobody is suddenly procreating just because of that fact.

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cinquemb• 11 years ago

Makes me wonder if/when the market for this grows, if we'll start to see financial products built on this (maybe to help offset the costs of such, or to hedge risks for a company that may solicit in relatively financially risky behaviors?) à la egg futures[0] concept Hanson discuses?

[0] http://www.overcomingbias.com/2014/10/why-not-egg-futures.ht...

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EdSharkey• 11 years ago

The intensity of pain and grief one can feel when they or their spouse have fertility issues is tough to convey. Most people have no idea what a hell this fertility thing can be. It's such a lonely condition, no one wants to talk about it, and no one wants to hear about it.

And when someone makes a juvenile joke about eggs, wombs, etc. around me and my wife or if we get some dumbass comment like "when are you going to have another kid?", I can tell you that that person is PERMANENTLY tainted with the #asshole hashtag and we're probably going to have a tearfilled conversation that night. If you fancy yourself a comedian and you want to make some jokes about procreation, don't be shocked when friends fall away from you.

I don't know if egg freezing should be recommended, whether it might lead to birth defects or developmental issues, etc. But, if it were available to me and my wife early in our marriage and we knew we might have troubles, I think we might have sprung for it.

Here's my PSA: age 35 is when egg quality and quantity starts to decline precipitously for most women. If you're interested in doing this egg freezing or embryo freezing thing, plan to get it done well before age 35 (like age 30, just to be safe.)

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gcr2• 11 years ago

It's a lot easier to sell something when you frame the issue as one of loss avoidance.

"You should do X, because if you don't do X right away, then this bad thing may happen in the future! By the way, it only costs $N0,000... But your baby's life is on the line!"

I can't think of a much more convincing sell for this target market than that if I tried.

Something about this feels off to me. When viewed in the right light, this almost looks like blackmail, or extortion.

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jarjoura• 11 years ago

Are couples so egotistical that they can only imagine having a kid that is genetically theirs? If you want to delay family life and work on your career, why is it not an obvious option to adopt when you're ready?

Also, I do think companies need to start offering 6-month packages for parents, both the father and mother. There's too much wealth floating around for this to still not be a thing.

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irremediable2• 11 years ago

You make a good point, although you phrase it very provocatively. Genetics can be a big deal, for many reasons. At the basic level, the desire to have children is a desire to promulgate one's genes.

I agree with you in that I don't care, myself; but I don't think it's fair to judge the people who do care.

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restalis4• 11 years ago

"I agree with you in that I don't care, myself; but I don't think it's fair to judge the people who do care."

And through natural selection, those kind of people (who care, that is) will dominate the human genetic pool, while the ones susceptible to falling into the provider role will systematically be weeded out, like it or not!

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ido• 11 years ago

12m+ parental leave (that can be divided between both parents) are quite common in continental Europe.

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shin_lao• 11 years ago

Reproduction is not just a biological act where a male gamete meets a female gamete.

The hardest part of the process is finding the person with whom you want to have a child and who will be your partner in life for this incredibly complex challenge that is raising children.

I question the ethics behind relieving thousands of dollars to affluent women while making them believe it will somehow solve their existential need.

There is no way around balancing work and life if you want to have children.

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M83• 11 years ago

"There is no way around balancing work and life if you want to have children" - it's probably more about being picky.

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restalis4• 11 years ago

"it's probably more about being picky"

Yes and... not only. Being picky is only natural. Being unrealistic about it is more of the issue here.

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tiatia• 11 years ago

It is an outstanding idea.

Do you know the best thing about having a kid in your 50ies?

You don't have to worry about college costs since you will be dead....

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Sophistifunk• 11 years ago

Goddammit, I thought this was about cooking.

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mindfulgeek• 11 years ago

I was offered egg-freezing before beginning one of those "sterilizing" chemotherapy treatments. While it was great to have the option, the last thing I wanted to put my already dying body through was hormone therapy and surgery...

Years after treatment, I was in "menopause" and not a candidate for fertility treatment (fsh > 50 AMH = .17). My only hope was a donor egg.

My husband and I naturally conceived in July and our baby boy is coming in a few weeks.

I share this not because I think every woman can have babies, but because our science is still limited in understanding conception. There is a lot more to creating life than what we can "see" at the moment.

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Why Egg Freezing Is an Impossible Choice

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