In a November episode of The Mindy Project, a pajama-clad Dr. Lahiri told an auditorium of bright-eyed college students that their baby days were numbered.
“Your body does not care if you are dating the wrong guy, or [if] the guy you’re with is also sleeping with the rest of your dorm,” she said. “Your body and your eggs just keep getting older, which is why freezing them is actually a pretty smart idea…it gives you a little more time to find that one diamond in the crap-heap of American men.”
The talk is part of a larger attempt to save her failing fertility clinic by cashing in on a new demographic of egg freezers—healthy young women likely to have kids before they’re 40, but willing to shell out thousands in case they don’t.
That may seem like a stretch, but elective or “social” egg freezing is an increasingly appealing option for young women who want to extend their childbearing window.
Cryopreservation banks host egg freezing cocktail parties to convince women it’s a good insurance policy for the future.
They highlight alarming numbers about how the quantity and quality of a woman’s egg supply declines as she ages, with a steep drop-off after age 35. Silicon Valley companies even offer insurance packages that cover the costly procedure.
With prices starting at $10,000, egg freezing is prohibitively expensive for those of us who don’t work at companies like Facebook or Apple.
But as of today, Extend Fertility—a new private clinic in Manhattan—offers the procedure at half market price. It’s the first standalone egg freezing practice in the U.S., meaning it doesn’t offer IVF (in-vitro fertilization), embryo freezing, donor eggs, or infertility surgery.
Women who freeze their eggs generally do so in infertility clinics for an average of $10,000-$12,000 per cycle compared to Extend Fertility’s $4,990 for up to four cycles (20 percent of women do not retrieve enough eggs in one cycle). While initial office consultations at infertility clinics run up to $500, they’re free at Extend Fertility.
The process of extracting eggs isn’t that different from a typical clinic—the procedure takes 15 minutes (patients usually undergo twilight anesthesia) and an embryologist freezes them.
From there, they’re transferred to an egg bank in New England and stored until the patient decides to thaw them. In the end, Extend Fertility is a glorified (and pricey) middle man. “We’re the custodians of your eggs, you’re the owner,” said Dr. Joshua Klein, co-founder and Chief Medical Officer of Extend Fertility. “You tell us what you want to do, or with whom.”
They bill themselves as a “premier egg freezing service” with a focus on patient comfort, but Extend Fertility isn’t exactly the luxury, spa-like clinic you’d think it would be. Their equipment is state-of-the-art and the office is squeaky clean, but where’s the mint tea and plush couches? Where are the trickling waterfalls and health-and-wellness accoutrements?
“We’re obviously a medical facility, but we’ve made a conscious choice to make the entire experience unlike a traditional medical experience,” said Klein during a tour of the facility earlier this week.
Indeed, the clinic itself looks more like an Ikea-outfitted workspace than a gynecologist’s office or family planning center. Initial consultations and meetings throughout the process are conducted at round tables in small, vitrine-like rooms with light blue walls.
Klein spent years as a reproductive endocrinologist at Reproductive Medicine Associates of New York before co-founding Extend Fertility.
He noticed the atmosphere at his prior practice wasn’t conducive to women who wanted to freeze their eggs simply to buy themselves time. “The traditional IVF clinic was an awkward, weird place for that to happen,” said Klein.
Imagine a waiting room filled with anxious patients and their partners, both of them either desperate to have a baby, or grieving previous IVF failures.
Extend Fertility, by contrast, is tailored specifically to these healthy, working women who aren’t ready to have a baby but know they likely want one (or more) down the road.
Like other clinics, it determines a woman’s ovarian reserve from a transvaginal ultrasound and hormone testing. Unlike other clinics, it does this for a reasonable price.
Without the overhead costs of running an IVF clinic, Extend Fertility—by making the service more affordable—hope to appeal to a younger demographic of women who want to preserve the age of their eggs until they’re ready.
Then it’s the patient’s responsibility to find an IVF clinic and arrange to have her eggs transferred there. From here, she’ll pay anywhere from $12,000 to $40,000 for IVF treatment alone.
Extend Fertility wants women to feel like customers rather than patients (they’re paying top dollar, after all). That means quick and efficient appointments prior to the actual egg retrieval, so that women can drop in before work and be out the door in twenty minutes; a designated “fertility advisor” who guides patients through each step of the process, answering questions in non-medical speak and taking phone calls at odd hours; and a team of experts trained in the “essentials of hospitality,” according to their website.
While most doctors meet patients post-exam in private offices decorated with degrees and diplomas, Dr. Klein sits with them at a round table in one of the clinic's sterile rooms.
Dressed in a light blue button down shirt and tweed tie, he seems more like an affable bank manager than an exceptionally qualified fertility specialist.
But Klein is at once unassuming and authoritative while explaining how he determines patients’ hormone doses (“it’s as much an art as a science”) and the ideal age at which women should freeze their eggs (under 35).
“Women aren’t here to get a ticket to a baby, per se, but to achieve a certain peace of mind that comes with the idea of preserving your options,” said Klein, noting that the clinic’s target demographic is women aged 27-35.
Extend Fertility hopes to make egg freezing mainstream, but the practice dates back to the 1980s—and sperm freezing 30 years before that. Some test tube babies born from frozen embryos are now in their early 20s.
But eggs frequently didn’t survive the “slow freezing” technique used at the time. It wasn’t until the early 2000s that scientists perfected a breakthrough “flash freezing” technology known as vitrification. Egg survival rates jumped from 50-70 percent to 90 percent.
By 2012, the American Society of Reproductive Medicine (ASRM) deemed the procedure safe and effective, lifting the “experimental” label on egg freezing. But the organization stopped short of endorsing the procedure for healthy women.
Current ASRM guidelines state that “there are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive ageing in healthy women,” nor to support “the safety, efficacy, ethics, emotional risks, and cost-effectiveness” of social egg freezing.
But lifting the “experimental” label allowed clinics to market the procedure to otherwise healthy women. The number of women freezing their eggs skyrocketed from 475 in 2009 to nearly 4,000 in 2013, according to reports from the Society for Assisted Reproductive Technology.
The procedure received its biggest endorsement to date in 2014, when tech giants Facebook and Apple offered egg freezing in employee benefits packages.
To some bioethicists, the decision signaled a disturbing normalization of a procedure that lacked long term safety and efficacy studies. Dr. Marcy Darnovsky, a social scientist and executive director of The Center for Genetics and Society, is one of them.
Darnovsky penned a piece after the 2014 announcement criticizing the companies for the decision. “Getting your eggs frozen is neither a simple nor a safe procedure,” she wrote. “Retrieving multiple eggs involves injections of powerful hormones, some of them used off-label and never approved for egg extraction.”
The short-term risks of the procedure range from mild (cramps, bloating) to severe, such as Ovarian Hyperstimulation Syndrome, a condition in which the ovaries become swollen and painful.
In rare cases (less than 1 percent) OHSS can be extremely dangerous, leading to severe abdominal pain, vomiting, and shortness of breath.
The long-term risks are less certain. Doctors aren’t sure how hormone injections and egg retrieval may affect women and their eggs decades later.
Without a national registry, research on the practice relies on clinics sharing their data, which few do. There are a handful of small registries, including one from Dartmouth University, but the data pool remains small.
According to a January report from the National Center for Health Statistics, the age at which women are having babies has been steadily climbing for thirty years. In 1970, the mean age for first-time mothers was 21.4; by 2014, the number had jumped to 26.3—up from 24.9 in 2000.
Use of assisted reproductive technology (ART) like IVF and egg freezing has risen as well, doubling in the last decade. According to the CDC, in 2013 doctors performed 27,564 egg and embryo freezing procedures. A year later, the number jumped to more than 35,000.
Though she supports IVF and egg freezing for medical reasons, Darnovsky is opposed to the increasing number of women doing it electively. “I think it is very troubling,” she says of a stand-alone egg freezing clinic like Extend Fertility. “A lot of it comes down to misimpressions and a lack of full understanding of just how invasive the procedure is.”
Darnovsky doesn’t think the information void is accidental. “You can only speculate, but I think that this is a very lucrative industry, especially in U.S. where we don’t have insurance coverage and people are paying out of pocket,” she said. It’s a profit-making business and knowing more about the bad outcomes won’t help the business.”
In her mind Extend Fertility is the worst iteration of this: doctors commodifying a medical procedure that’s still too new for scientists to fully understand.
Klein, who spent time carefully going through the risks, is transparent about the lack of research on long-term risks from taking hormones. “At worst it’s an open question,” he said. “Personally my take of data as whole is it’s not something we need to worry about on regular basis.”
What Klein—and the science world—is sure of is that the viability of a woman’s eggs begins to decline at age 35.
“There is not much of a measurable decline before 34, but the curve becomes much steeper at 38,” said Dr. Owen Davis, president of the ASRM and associate director of the IVF Program at the Center for Reproductive Medicine at Weill Cornell Medical College in New York City.
“If a 38-year-old woman doesn’t have any immediate family plans, freezing her eggs seems like reasonable thing to do,” Davis said, adding that the procedure may be less cost-effective for younger women who could easily find a partner and get pregnant the natural way. “At a younger age, it’s important that women understand the unlikeliness that they’ll use these eggs.”
Especially considering the cost of storing those eggs.
Halving the cost of egg freezing alone is great, but the $4,990 “one price” advertised on Extend Fertility’s website doesn’t account for storage, which the company offers in three tiers: $450 for one year, $2000 for five, and $3500 for 10.
With hormone treatments estimated at an additional $2000-$4000, a 27-year-old woman looking to freeze her eggs for a decade is suddenly footing a nearly $12,500 “one price” upfront.
Then there’s the cost of IVF when she’s ready to to thaw her eggs: roughly $12,000 per cycle before hormone medications.
Talia Zapolanski, one of 30 women who froze their eggs with Extend Fertility during the clinic’s soft-launch, isn’t put off by the costs involved.
“I’m going to be honest and say that I hope that I don’t need to use these eggs,” said 33-year-old Zapolanski, who works at a real estate investment firm in New York City. “I’m trying to give myself as many options and possibilities for having children. If I can’t have kids naturally when the time is right, I may even decide to adopt.
“I don’t know what that answer is. But you buy a life insurance policy not because you plan on dying tomorrow, but because you want to cover all of your bases.”