The fertility rate in the U.S has been falling consistently for years now. Less couples are having children because of a higher cost of living, career goals or barriers to conceiving, and experts are alarmed at the rate with which the decrease in childbirth has come.
A lower fertility rate means an aging workforce and an unpredictable future for the economy - but it also means that women are deciding for themselves when or if to reproduce, and taking the process entirely into their own hands.
The decrease in fertility rates has come largely because of the the falling rates of teen (and mostly unplanned) births. This sees the median age for women having children going up to between 25-34. And then of course there are the rising number of numbers of women deciding to have children in their forties. These are the women that experience the most difficulty conceiving and in whom need the most assistance with fertility treatments.
Whether it's In Vitro Fertilization (IVF), or Kim Kardashian's surrogate alternative - the likelihood of women resorting to frozen eggs is becoming higher by the day. Millennials are choosing not to have children until late into their careers and so naturally these alternatives are being increasingly more commonplace.
Below we talked to Ilaina Edison and Dr. Joshua Klein about their practice at Extend Fertility, which hopes to make the procedure more cost effective and less of an ordeal for would-be future mothers.
1. Tell us a little about Extend Fertility - what is the process?
Extend Fertility is a fertility practice that has revolutionized the approach to egg freezing; offering services at significantly lower prices in a specialized atmosphere designed around the lifestyle and goals of women who want to freeze their eggs for use later in life. Until now, most practices that offer egg freezing have been focused on treating infertility. We are the first practice dedicated entirely to women who want to preserve their fertility for the future—and we've created a revolutionary goal-focused pricing model that makes egg freezing more affordable and accessible to women at this stage of life. Above all, we educate women on their fertility and their egg freezing options so they can make informed decisions that are in-line with their own personal vision and life goals. The first step is a fertility assessment to gather information about a woman's fertility and her overall health, followed by a consultation with an experienced reproductive endocrinologist to discuss her fertility options and create a plan. The actual egg freezing process typically entails 8–10 days of hormone injections to stimulate a woman's ovaries to produce multiple eggs, and 5–7 short office visits, which will include blood tests and transvaginal ultrasound exams. Finally, there's a 15-minute surgical procedure performed under mild anesthesia to retrieve the eggs from her ovaries.
Each patient at the clinic is assigned a personal fertility advisor who will greet her at each appointment, accompany and guide her through each step of the egg retrieval process and serve as a sounding board for questions and concerns.
2. Describe the average woman who comes to see you.
The average age range of the women we see is 28-35 years. Other than that, there really is no “typical" or “average" Extend Fertility patient. Our practice sees women from all over the country, and from all walks of life.
3. When did you open - have you since much competition since you began?
We opened our clinic in New York in August 2016 because we noticed a growing need in the industry for an egg freezing-only practice that catered to the main pain points people were having with the process — most notably the lack of specialization, high costs, and impersonal service.
Our practice chose to focus solely on egg freezing because women who want to preserve their fertility options deserve a customized, personal and positive environment just for them. While there are a couple newer boutique egg freezing clinics in the U.S. we don't feel there is anyone else quite like us with the same level of unparalleled hospitality incorporated into their business plan.
4. Do you notice are women afraid of a stigma or is it becoming more normalized?
Some women do find these conversations challenging. One of the biggest reasons is that we don't seem to talk much about fertility or fertility treatments with our families or communities. It's a subject that tends to have a lot of secrecy around it. Many women are surprised at how supportive friends and family members are when they share their egg freezing plans. In fact, a recent study conducted by NYU Langone Medical Center found 90% of women who discussed their decision to freeze with family/friends were met with a positive/ supportive reception. One of our patients said that when she began her egg freezing cycle and started telling loved ones about it, many of them divulged they'd had their own journey with fertility preservation. She was surprised no one had spoken up before. These women find that once they started opening up and sharing their experience, they realized their loved ones were not all strangers to the issue themselves.
5. Can you give us a rough number of women attending the clinic? Have you a percentage growth?
We have seen month over month growth since opening, and now we are performing the same amount of egg freezing cycles as the top fertility clinics in New York.
6. Why, in your opinion are women turning more toward freezing eggs?People often think the women coming to see us are only doing it for career purposes, which is sometimes the case, but not always. There is not one specific reason women are choosing to freeze their eggs more now, but it is more so an accumulation of reasons. A study done this year by Zeynip Gurtin noted: “the fastest-growing group of women [turning to egg freezing] are those wishing to hold out for that elusive partner to have a family with, while recognizing that, biologically speaking, they are now standing on a reproductive precipice." In today's social climate, it is much more common for women to get married and have children later in life. However, this social shift has not yet had an impact on the biological “clock" that effects fertility; that is where Extend can help provide women with more options. Many women turn to egg freezing to take the pressure off dating, and so they can really take their time to find the right life partner for themselves. Additionally, many women are focusing on their careers, pursuing higher education, traveling and more.
7. Is this mostly single women or women in relationships coming to you?
We hope to educate all women on their fertility preservations options so they can make informed decisions that are in-line with their own personal vision and life goals. This is a deeply personal decision because it not only matters where your mind is, but where your body is. That being said, each woman's experience is unique, and our wide range of clientele reflects this (single, married, and everything in between).
8. How long do the eggs remain fertile?
Scientifically speaking, frozen eggs can be stored indefinitely. There have been numerous healthy babies born from eggs frozen for 5–10 years, with the longest reported successful thaw coming after 14 years. There is no evidence that the health or viability of frozen eggs decreases over time.
Judging from the best studies and data available: when eggs are frozen and subsequently thawed in a high-quality lab, they appear to have a nearly equal potential to produce a healthy pregnancy to fresh eggs.
9. Do you see this science as a rapidly improving field? Will it be much changed in ten years?
Cryopreservation is a decades-old procedure used in several branches of medicine. The basic premise is this: cooling cells, in this case, egg cells, to a very low temperature (think -196º Celsius, or about -320º Fahrenheit) stops all cell activity, including aging. In layman's terms, that means that freezing your eggs prevents them from aging as they normally would, maintaining their youthful glow (and lack of chromosomal defects) indefinitely.
Vitrification is a “flash freezing" technique that cools cells so quickly to a temperature of -196º Celsius (about -320º Fahrenheit) that they become “glass-like," or “vitrified," minimizing the chance that the water inside the cells will form damaging ice crystals. This is especially important for egg freezing, since eggs (as opposed to other things we might freeze, like sperm) are large size cells with a high content of water.
Vitrification is superior to any other method of egg cryopreservation. Studies have demonstrated that egg survival rates (meaning the percentage of eggs that are still viable after they're thawed) increase from 61% after slow freezing—the older method of egg cryopreservation—to 91% after vitrification. However, not every practitioner offering egg freezing uses vitrification.
Our laboratory team has unique expertise in this cutting-edge method. The assistant director of our embryology lab, Dr. Leslie Ramirez, studied with Dr. Kuwayama to perfect her technique. Extend Fertility is Dr. Kuwayama's East Coast representative laboratory; before any other cryogenic lab is permitted to use this method, their embryologists must train with Dr. Ramirez.
10. What's one common misconception about freezing eggs, and one thing everyone should know?
It is a common misconception that egg freezing is new and experimental. This misconception stems from the fact that, prior to 2013, anyone who froze their eggs had to do so under an experimental protocol, because the procedure was fairly new and there wasn't enough data available just yet. However, the processes used in egg freezing—like ovarian stimulation, egg retrieval, and even cryopreservation—have actually been in use for decades.
The “experimental" label was dropped in 2013 after the American Society for Reproductive Medicine (ASRM) issued a statement declaring there was enough scientific evidence to show that egg freezing was safe and effective. Their decision was based on the success of vitrification, a more effective fast-freezing method, and new studies that determined frozen eggs have roughly equivalent pregnancy rates to “fresh" eggs when used for in vitro fertilization.
Another myth is that there is a fertility cliff at age 35. Age 35 doesn't represent some sort of hard stop for your fertile years. In reality, your fertility is at its peak between your late teens and early 20s and declines gradually throughout your adult life. However, the downward sloping line between age and fertility does steepen in the mid-30s. In fact, the American Society for Reproductive Medicine estimates that, generally, a woman's fertility “decreases gradually but significantly beginning approximately at age 32 and decreases more rapidly after age 37 years."
11. What's the price range?
Price plans range from $4500 - $10,000 depending on how many eggs you wish to have frozen, and the egg freezing cycles you decide on.
Gender divisions in sports have primarily served to keep women out of what has always been believed to be a male domain. The idea of women participating alongside men has been regarded with contempt under the belief that women were made physically inferior.
Within their own division, women have reached new heights, received accolades for outstanding physical performance and endurance, and have proven themselves to be as capable of athletic excellence as men. In spite of women's collective fight to be recognized as equals to their male counterparts, female athletes must now prove their womanhood in order to compete alongside their own gender.
That has been the reality for Caster Semenya, a South African Olympic champion, who has been at the center of the latest gender discrimination debate across the world. After crushing her competition in the women's 800-meter dash in 2016, Semenya was subjected to scrutiny from her peers based upon her physical appearance, calling her gender into question. Despite setting a new national record for South Africa and attaining the title of fifth fastest woman in Olympic history, Semenya's success was quickly brushed aside as she became a spectacle for all the wrong reasons.
Semenya's gender became a hot topic among reporters as the Olympic champion was subjected to sex testing by the International Association of Athletics Federations (IAAF). According to Ruth Padawer from the New York Times, Semenya was forced to undergo relentless examination by gender experts to determine whether or not she was woman enough to compete as one. While the IAAF has never released the results of their testing, that did not stop the media from making irreverent speculations about the athlete's gender.
Moments after winning the Berlin World Athletics Championship in 2009, Semenya was faced with immediate backlash from fellow runners. Elisa Cusma who suffered a whopping defeat after finishing in sixth place, felt as though Semenya was too masculine to compete in a women's race. Cusma stated, "These kind of people should not run with us. For me, she is not a woman. She's a man." While her statement proved insensitive enough, her perspective was acknowledged and appeared to be a mutually belief among the other white female competitors.
Fast forward to 2018, the IAAF issued new Eligibility Regulations for Female Classification (Athlete with Differences of Sexual Development) that apply to events from 400m to the mile, including 400m hurdles races, 800m, and 1500m. The regulations created by the IAAF state that an athlete must be recognized at law as either female or intersex, she must reduce her testosterone level to below 5 nmol/L continuously for the duration of six months, and she must maintain her testosterone levels to remain below 5 nmol/L during and after competing so long as she wishes to be eligible to compete in any future events. It is believed that these new rules have been put into effect to specifically target Semenya given her history of being the most recent athlete to face this sort of discrimination.
With these regulations put into effect, in combination with the lack of information about whether or not Semenya is biologically a female of male, society has seemed to come to the conclusion that Semenya is intersex, meaning she was born with any variation of characteristics, chromosomes, gonads, sex hormones, or genitals. After her initial testing, there had been alleged leaks to media outlets such as Australia's Daily Telegraph newspaper which stated that Semenya's results proved that her testosterone levels were too high. This information, while not credible, has been widely accepted as fact. Whether or not Semenya is intersex, society appears to be missing the point that no one is entitled to this information. Running off their newfound acceptance that the Olympic champion is intersex, it calls into question whether her elevated levels of testosterone makes her a man.
The IAAF published a study concluding that higher levels of testosterone do, in fact, contribute to the level of performance in track and field. However, higher testosterone levels have never been the sole determining factor for sex or gender. There are conditions that affect women, such as PCOS, in which the ovaries produce extra amounts of testosterone. However, those women never have their womanhood called into question, nor should they—and neither should Semenya.
Every aspect of the issue surrounding Semenya's body has been deplorable, to say the least. However, there has not been enough recognition as to how invasive and degrading sex testing actually is. For any woman, at any age, to have her body forcibly examined and studied like a science project by "experts" is humiliating and unethical. Under no circumstances have Semenya's health or well-being been considered upon discovering that her body allegedly produces an excessive amount of testosterone. For the sake of an organization, for the comfort of white female athletes who felt as though Semenya's gender was an unfair advantage against them, Semenya and other women like her, must undergo hormone treatment to reduce their performance to that of which women are expected to perform at. Yet some women within the athletic community are unphased by this direct attempt to further prove women as inferior athletes.
As difficult as this global invasion of privacy has been for the athlete, the humiliation and sense of violation is felt by her people in South Africa. Writer and activist, Kari, reported that Semenya has had the country's undying support since her first global appearance in 2009. Even after the IAAF released their new regulations, South Africans have refuted their accusations. Kari stated, "The Minister of Sports and Recreation and the Africa National Congress, South Africa's ruling party labeled the decision as anti-sport, racist, and homophobic." It is no secret that the build and appearance of Black women have always been met with racist and sexist commentary. Because Black women have never managed to fit into the European standard of beauty catered to and in favor of white women, the accusations of Semenya appearing too masculine were unsurprising.
Despite the countless injustices Semenya has faced over the years, she remains as determined as ever to return to track and field and compete amongst women as the woman she is. Her fight against the IAAF's regulations continues as the Olympic champion has been receiving and outpour of support in wake of the Association's decision. Semenya is determined to run again, win again, and set new and inclusive standards for women's sports.