Fertility & Social Freezing: Opportunities and Limitations

The number of women who have their eggs frozen and stored as a precautionary measure without a medical reason has increased in recent years. 2,755 people opted for "social freezing" in 2023. By comparison, the number was 1,210 in 2020. This is according to the most recently published yearbook of the IVF Register .

The idea behind social freezing: to gain more time to become pregnant for personal and social reasons. Essentially, it's about cheating the biological window of female fertility by removing eggs from the body at a time when the desire to have a child isn't yet acute. The extracted eggs are only implanted when the time is right for the woman.

According to the IVF registry, women decide on this type of egg retrieval at the average age of 35. "That's often almost too late," says reproductive medicine specialist Kai Bühling. The obstetrician-gynecologist doesn't offer social freezing, but he does advise on the procedure. He, too, has noticed an increase in demand in recent years. "I see the question of the right time frame for getting pregnant as an increasingly important issue."

What many people don't know: The quality and number of eggs are strongly dependent on age – not only in natural conception, but also in egg freezing. "From a medical perspective, social freezing is therefore only recommended up to the age of 35," explains Bühling.

Prof. Kai Bühling leads the hormone consultation at the University Medical Center Hamburg-Eppendorf. He is a specialist in gynecology and obstetrics, gynecological endocrinology, and reproductive medicine and also runs his own practice.

Source: UKE

After that, it becomes significantly less likely that enough eggs will be retrieved to allow for a pregnancy later. By comparison, a 25-year-old can retrieve an average of twelve to fifteen eggs in one stimulation session. A 35-year-old can only retrieve five to eight. Twenty eggs are needed for storage to give a good chance of pregnancy at a later date. After artificial insemination of previously frozen eggs, motherhood is achieved in around ten percent of cases. "Older patients then require three to four cycles – and that is significantly more stressful, complex, and expensive," says Bühling. "It's a major procedure."

The procedure: The patient uses certain medications to suppress her body's hormone secretion to prevent uncontrolled ovulation. Experts call this "down-regulation." Fourteen days later, she administers another injection. The medication is designed to specifically stimulate the ovaries. Doctors like Bühling call this overstimulation, meaning the goal is to produce as many eggs as possible—ten to twelve instead of the usual one.

Under anesthesia, the eggs are then removed vaginally with a thin needle. To ensure all the eggs are released from the uterine wall, another injection is needed 30 hours before the procedure. "Estrogen levels are elevated during this procedure," explains Bühling. Expected side effects could therefore include lower abdominal pain and edema.

According to the specialist, stimulation treatment costs around 2,000 to 4,000 euros per cycle. Two to four sessions are often necessary. In addition, there are around 300 to 500 euros per year for egg storage using "cryopreservation": The eggs are deep-frozen in liquid nitrogen at minus 196 degrees Celsius. This slows down the aging of the eggs. "For a 35-year-old woman who has her eggs frozen for seven years after three stimulation sessions, this results in a total cost of around 14,000 euros," states an article published in 2023 in the journal "Gynecological Endocrinology" that weighs the advantages and disadvantages of social freezing. This must be paid for out of pocket. Health insurance companies only cover the costs for illnesses and additional treatments that affect fertility - such as cancer.

Why opt for social freezing instead of trying the natural route? In Bühling's experience, questions about the compatibility of motherhood and career play a role among the women in his practice. Often, they lack a suitable partner. Even in long-term relationships, he often encounters doubts about whether the time is right for a child and whether the couple wants to commit to each other early in life.

The reasons for social freezing lie in circumstances that are partly beyond individual control, the article in the journal emphasizes, "primarily the lack of a suitable partner between the ages of 30 and 40." Another motivation is to avoid self-reproach for not having done anything about declining fertility.

Researchers from Great Britain revealed similar motivations in a study published in 2023 in the journal Obstetrics & Gynaecology . They surveyed 191 patients at a London fertility clinic who had chosen to freeze their eggs over a ten-year period. The reasons given by the vast majority were concerns about age-related decline in fertility and the lack of a relationship. Most women also wished, in retrospect, that they had frozen their eggs at a younger age. "This demonstrates the importance of early education to optimize outcomes and patient choice," the study authors write.

Even if a woman has successfully had her eggs retrieved and frozen, there is still a time limit to her desire to have children. If pregnancy is to occur, the eggs are thawed and then artificially inseminated – and implanted in the uterus. "Many fertility clinics only implant eggs up to the age of 45," explains Bühling. Even if the egg remains young in its frozen state, the body ages. "Pregnancy-related illnesses become more likely with age," explains the physician. These include high blood pressure, pregnancy poisoning, and premature birth. "So you have to be aware that such risks increase when you are over 40," says Bühling.

He therefore usually advises women in their 30s in long-term relationships who are interested in social freezing as a form of security not to postpone their desire to have children any further. "Just start," says the physician. "Social freezing is a major medical procedure." Hoping that a better time for having children will arise—that's not how life usually works.

In the article published in the journal of reproductive medicine, the authors, after weighing the medical and psychological pros and cons, conclude: Social freezing offers no guarantee of success and there are risks associated with egg retrieval. It is not a "cure" for the reproductive aging process.

But: "Social freezing can be seen as a backup in the absence of a partner, in the absence of a natural pregnancy, or in the absence of a biological clock." An informed, autonomous decision-making process, "which also includes a reasonable pause for reflection," is advisable. Gynecologists are responsible for providing careful and comprehensive information about all aspects of social freezing—and, above all, for pointing out its limitations.