Yes, the stars are doing it! 40-year-old Sofia Vergara revealed in the April issue of Vogue that she has to watch what she eats because she’s seeing a fertility specialist and taking pills and hormone injections to prepare for egg retrieval, in order to freeze them for use at a later date.
The Modern Family star explains:
They want to get as many eggs as they can because usually you produce them but they're not good. They have to be perfect, perfect perfect ones. My boyfriend [Nick Loeb] is 37, younger than me, never had kids.Vergara isn’t the only celebrity embarking on “social egg freezing,” which is now being promoted as a way for women to pursue a career and delay childbearing until a more convenient time. Kim Kardashian (32) and Coco Austin (33), wife of rapper Ice-T, have also gone through the procedure, and talked about it publicly.
What’s next? I can imagine an egg-freezing reality TV show, with 24-hour-a-day cameras chronicling women injecting themselves with hormones, detailing every emotional reaction and trip to the clinic. The climax: an announcement of who produced the most “perfect” eggs.
But egg extraction isn’t really a laughing matter. The hormones that “shut down” the ovaries can cause long-term debilitating symptoms. The hormones used to stimulate the ovaries to produce multiple eggs can also have serious side effects, though they are fortunately rare; several women have died from complications of ovarian hyper-stimulation. The egg extraction procedure itself, in which a needle is inserted into a woman’s reproductive organs to suck out eggs, can also be risky and can lead to scarring and ovarian damage.
When women are facing medical procedures that can cause infertility, such as chemotherapy for cancer treatment, they may find these risks worthwhile. Extracting and freezing eggs for social reasons – so that a woman could pursue her career or wait for Mr. Right to come along before defrosting – raises a different set of ethical considerations. In short, social egg freezing is nothing to be taken lightly.
In other “egg-related news,” scientists say they are developing the capability to turn human eggs into powdered form, skipping the inconvenience and cost of storing them in expensive cryo-preservation facilities. A woman could conveniently store her egg sachet in her lingerie drawer, or in her kitchen cabinet next to her cinnamon and other spices. Simply add water, sperm, find the turkey baster in the kitchen drawer, and voila. Ahhh…the modern conveniences of reproduction without all the mess and fuss! Just be careful which spice you reach for when cooking up that romantic breakfast for two.
Posted in Arts & Culture, Assisted Reproduction, Diane Tober's Blog Posts, Egg Retrieval
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Comment by Diane Tober, PhD, Apr 10th, 2013 5:14pm
Thank you for your comments and for acknowledging the importance of addressing the ethical issues. As mentioned in the blog, yes, there is definitely a difference between freezing eggs to preserve fertility for medical purposes (e.g., in the case of cancer treatment), and freezing one's eggs for social purposes. We, too, are concerned that women may see these technologies as a convenient way to delay childbearing in order to enhance careers, find the right partner, etc., and potentially put themselves at medical risk for the sake of convenience. We also realize that for women facing chemotherapy and radiation, for whom this procedure may be the only option for preserving their future fertility, this technology can help provide at least some emotional relief during very a very difficult time.
For other women, using these technologies out of convenience however, this is more problematic. As you mentioned, Lupron is used to suppress ovarian function. However, it is not FDA approved for this purpose. Accurate data is still not available on the short and long-term health risks of synthetic hormones. At least four women world-wide have died from OHSS; others have been rendered infertile from ruptured ovaries, or complications during extraction. Findings from the HFEA in the UK reported 30,000 cases of OHSS between 1991 and 2007. A recent HFEA inquiry into maternal deaths in the UK showed that OHSS is none one of the biggest causes of maternal mortality in IVF patients. Unfortunately, there is no reliable, accurate data on the incidence and prevalence of OHSS among IVF patients or egg donors. It is highly likely that the occurences of OHSS are under-reported. There is also a paucity of research exploring long-term health risks, like increased cancer rates, among women who have used these drugs during IVF or egg donation cycles.
Another concern, beyond social egg freezing, is the use of egg donors--both for fertility practices and some practitioners/researchers calling for egg providers to be paid as research subjects. Do women who provide eggs for others experience increased risks because of the desire to get as many eggs as possible. If the egg is a commodity, and a donor is being paid, isn't there an interest for the practitioner/researcher to get more for their money, and thus a greater tendency to cause OHSS?
I agree that these technologies can offer some people hope and there is also potential for misuse. I'm curious how physicians balance these issues in their daily practice. I also think there is a tremendous need for more research in these areas, so that women who do undergo these procedures can truly give informed consent. Please feel free to contact me directly if you'd like to discuss further.
Comment by Craig R. Sweet, M.D., Apr 4th, 2013 6:29pm
There are a number of reasons why one would want to consider freezing eggs. Cancer is an excellent example. There are other instances wherein women will be placed on medications that may also impair their fertility. Some severe benign gynecologic illnesses often result in the removal of an ovary, such as endometriosis, cryopreserving oocytes before the last remaining ovary has to be removed certainly makes some sense. Women that are also at risk for premature menopause may also benefit from the egg freezing (oocyte cryopreservation) process.
I am also concerned that freezing oocytes as a type of "reproductive insurance policy" for social reasons is of potential concern. I worry that a woman may become too choosey waiting forever for "Mr. Right" if she thinks she has all the time in the world to reproduce because her eggs are on ice. Waiting indefinitely may really not be a good idea.
Remember, many of the eggs may not survive the warming process, fertilize, grow or eventually even implant. The number of eggs one has to freeze in order to have come out with a child in the end is dependent on the age of the patient. The older the patient, the smaller the number of normal eggs available. As a result for the older patient, two retrievals may be needed in order to secure an adequate "clutch" of eggs that is likely to result in a live born child. One must let the older patient know of this concern.
It is also likely that the patient may never use the frozen eggs. Unless specific blood tests are obtained within 30 days of the egg retrieval procedure, the patient won't be able to donate the frozen eggs to a patient in need. What a waste so careful planning is needed to cover numerous potentialities.
To keep perspective, though, if men's sperm counts dropped off so severely and as early as women's ability to conceive, everyone would be freezing their sperm. Fortunately, that is not the case.
Your comment about the medications that shut down the ovaries (oral contraceptives) is not accurate and they do not cause "long-term debilitating symptoms." A second medication is also added that temporarily suppresses the pituitary gland for anywhere from two weeks to just a few days. All of these medications leave the body fairly quickly and are absolutely gone by the time the women menstruates. I'm afraid your source on this issue may be a bit off. If these medications are given for months, then symptoms consistent with sudden menopausal symptoms may occur, but these medications are not maintained outside the short window of treatment when using them to retrieve eggs.
The egg retrieval procedure itself has a complication rate of <1%. There is a risk but it is very, very small, especially in seasoned hands.
Especially for the young, the risk for ovarian hyperstimulation syndrome (OHSS) can reach 10% and can be dangerous if left unrecognized or untreated. Fortunately, the use of a process called a "Lupron trigger" is now used to trigger the final egg maturation process thankfully drops the OHSS risk to about 1-2%. In the past, this was a real worry for the very young or those women with polycystic ovarian syndrome who would try to produce large quantities of eggs at once. Still, the risks need to be discussed and the entire cycle cancelled before retrieval if the patient is at significant risk.
Having just performed oocyte cryopreservation on a patient a couple weeks ago before her chemotherapy and radiation treatments were scheduled to start, I am familiar with the process. I agree that careful counseling is needed regarding what is to be done with the eggs should the patient not survive is also very important. Who will inherit the eggs? For these women, however, after they hopefully survive their disease and thrive, they may often be sterile and oocyte cryopreservation is an amazing option for them to fulfill their life's dream of having a child. They don't just want to survive, they want to live life as fully and as normally as they can and oocyte cryopreservation may indeed help them reach that goal.
For others who are wanting to delay childbearing so they may climb the corporate ladder without delay, careful counseling is again needed regarding all of their options. Personally, I would like to see corporate America a little more forgiving and allow women to have it all including the CEO spot while having a wonderful daycare nearby. If men were consistently raising children, we would have figured out how do combine these to worthwhile endeavors long ago.
So, counseling regarding the true risks is absolutely needed. Counseling regarding long-term consequences of having a "reproductive insurance policy" is likewise necessary since there is no absolute guarantee that the eggs will eventually produce children. I really don't want to see women put "their eggs in one (cryo) basket" without thinking the whole process through.
Oocyte cryopreservation has tremendous potential but also has the potential for missuse. Balancing the two is a challenge and you are right to call out the ethical issues that we all need to think carefully about.
Craig R. Sweet, M.D.