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.
Following are excerpts from "Unleash the Girls, The Untold Story of the Invention of the Sports Bra and How It Changed the World (And Me)" By Lisa Z. Lindahl
There is an idea that has popped up everywhere from Chaos Theory to Science Fiction and New Age memes known popularly as the "Butterfly Effect." Simply put, it is the notion that one very small thing—the movement of a butterfly's wing say, or the ripple in a lake caused by a pebble being thrown into it—can cause tremendous effect far away: the butterfly's wing a tornado, the ripple a large wave on a distant shore. Cause and effect, does it have limits? The field of physics is telling us that it takes only observation to bring a thing into being. We cannot consider these areas of investigation and not acknowledge that everything—everything—is in relationship in some way or another with everything else.
So, it is evident to me that commerce of any kind is, also, just about relationships. It all boils down, on every level to this simplicity. While we usually think of relationships as occurring between people—it is far more than that.
I used to teach a course in entrepreneurship specifically for women in The Women's Small Business Program at Trinity College in Burlington, Vermont. I made this concept of relationship and its importance central in how I taught the marketing thought process. I would stress that for a product or service to be successful, it had to meet a perceived need. There is a need, and it wants to be met; or it may be thought of as a problem to be solved. Or there may be an existing solution that is less than adequate.
For example: In my universe as a runner there already were a plethora of bras available, but they were inadequate for my purpose. The relationship between my breasts, my running body, and my bra was creating discomfort and distraction. A new solution had to be found, the relationship occurring when all these things came together had to be fixed. Utilizing this point of view, one sees a set of issues that need to be addressed—they are in relationship with each other and their environment in a way that needs to be changed, adjusted.
Nowhere is this viewpoint truer than in business, as we enter into more and more relationships with people to address all the needs of the organization. Whether designing a product or a service or communicating with others about it—we are in relationship. And meanwhile, how about maintaining a healthy relationship with ourselves? All the issues we know about stress in the workplace can boil down to an internal balancing act around our relationships: to the work itself, to those we work with, to home life, friends and lovers. So quickly those ripples can become waves.
Because Jogbra was growing so quickly, relationships were being discovered, created, ending, expanding and changing at a pace that makes my head spin to recall. And truly challenged my spirit. Not to mention how I handled dealing with my seizure disorder.
"My Lifelong Partner"
Let me tell you a bit about my old friend, Epilepsy. Having Epilepsy does not make any sort of money-making endeavor easy or reliable, yet it is my other "partner" in life. Husbands and business partners have come and gone, but Epilepsy has always been with me. It was my first experience of having a "shadow teacher."
While a child who isn't feeling she has power over her world may have a tantrum, as we grow older, most of us find other more subtle ways to express our powerfulness or powerlessness. We adapt, learn coping mechanisms, how to persuade, manipulate, or capitulate when necessary. These tools, these learned adaptations, give a sense of control. They make us feel more in charge of our destiny. As a result, our maturing self generally feels indestructible, immortal. Life is a long, golden road of futures for the young.
This was not the case for me. I learned very early on when I started having seizures that I was not fully in charge of the world, my world, specifically of my body. There are many different types of epileptic seizures. Often a person with the illness may have more than one type. That has been the case for me. I was diagnosed with Epilepsy—with a seizure type now referred to as "Absence seizures"—when I was four years old. I have seen neurologists and taken medications ever since. As often happens, the condition worsened when I entered puberty and I started having convulsions as well—what most people think of when they think of epileptic seizures. The clinical name is generalized "Tonic-clonic" seizures.
In such a seizure the entire brain is involved, rather like an electrical circuit that has gone out as a result of a power surge. I lose consciousness, my whole body becomes rigid, the muscles start jerking uncontrollably, and I fall. Tonic-clonic seizures, also known as "grand mal" seizures, may or may not be preceded by an aura, a type of perceptual disturbance, which for me can act as a warning of what is coming. The seizure usually only lasts for a few minutes, but I feel its draining effects for a day or two afterwards. Although I would prefer to sleep all day after such a physically and emotionally taxing event, I have often just gotten up off the floor and, within hours, gone back to work. It was necessary sometimes, though definitely not medically advised. I'm fond of saying that having a grand mal seizure is rather like being struck by a Mack truck and living to tell the tale.
Having Epilepsy has forced me to be dependent on others throughout my life. While we are all dependent upon others to some degree—independent, interdependent, dependent—in my case a deep level of dependency was decreed and ingrained very early on. This enforced dependency did not sit well with my native self. I bucked and rebelled. At the same time, a part of me also feared the next fall, the next post-convulsive fugue. And so I recognized, I acquiesced to the need to depend on others.
The silver lining of having Epilepsy is that it has introduced me to and taught me a bit about the nature of being powerless—and experiencing betrayal. I could not trust that my body would always operate as it should. Routinely, it suddenly quits. I experience this as betrayal by my brain and body. It results in my complete powerlessness throughout the convulsion. Not to mention an inconvenient interruption of any activities or plans I might have made.
Hence, I am the recipient of two important life lessons—and I was blessed to have this very specific and graphic experience at a young age. It made me observant and reflective, giving me the opportunity to consider what/where/who "I" was. I knew I was not "just" my body, or even my brain.
So, who or what did that leave? Who, what am I? Much has been written about trauma, and about near-death experiences, both of which seizures have been classified or described as. I won't delve into that here except to say that experiencing recurrent seizures and the attendant altered states of consciousness that sometimes accompany an episode (the euphemism for a seizure) changes one. It deeply affects you. It is both illuminating and frightening. It opens you up in some ways and can close you way down in others. For me it made it easy to consider the possibility of other ways to perceive, of other realms. And as an adult I became interested in quantum physics, where Science is pushing and challenging our long-held perceptual assumptions. Me, who was poor in math and disinterested in Science while in school! So if not merely body and brain, who am I? Spirit. And with Epilepsy's tutelage, I was encouraged to question, seek, try to understand what lies beyond.
Living with Epilepsy has also given me great strength. In realizing the futile nature of trying to have "power over" Epilepsy, I developed a deep well of "power within"—that inner strength that comes in the acceptance of that which one cannot change—and looking beyond it.
Through my experience building the business of Jogbra with the unique lens afforded me by my Epilepsy partner, I came to understand more fully the nature of power and what it means to be truly powerful.
Specifically, that having power and exercising it is not simply a manifestation of the ego. It need not be "power-tripping." It is how I wield my power that matters, making the all-important distinction between creating a situation of power over, power with, or empowering and having and creating strength in oneself and others.
Being powerful is a big responsibility.
To put all this another way: do I choose to create situations in which I am able to wield power over others? Or do I choose to empower others, sharing my strengths with them, while nurturing their strengths as well? The first is not true power. It is control. The second I believe to be the essence of true and positive power: strength. And integral to creating a more harmonious world, oh by the way.
While this may be apparent, even basic to others, it was an "aha!" moment for me. Too often in the years ahead I would give away my power and question my own strengths,. Time and again, however, my inner strength, my shadow teacher's gift, helped me survive and thrive until I could take responsibility for and embrace more fully my own power.
© Lisa Z. Lindahl 2019