Short One Stork: Optimism Bias In Egg Freezing
Humans are optimistically biased -- tending to believe that we'll get the good outcome and ignoring the risks as things that happen to other people.
This is not a helpful bias when it comes to egg freezing.
Pamela Mahoney Tsigdinos has one of the sad stories -- in a piece on the "sobering facts" about egg freezing at WIRED:
It has been 36 years since the birth of the first in vitro fertilization (IVF) baby. We've since been led to believe that science has mastered Mother Nature. This is not true. I know. I am a former patient of three clinics in the Bay area, all of which were happy to sell me services as long as I could pay the bill. I had multiple fresh and frozen embryo transfers. Instead of taking home a baby, I came away with tremendous heartache. And my experience is not unique. Around the world, there are an estimated 1.5 million IVF procedures each year, and 1.2 million fail.The very latest whizzy reproductive 'product' being marketed and wrapped into lucrative employee benefit packages at companies like Apple and Facebook is egg freezing. Lost in all the cheerleading about empowerment and liberating women from their biological clocks is a more buzz-killing, underreported set of facts, which women and families would benefit tremendously in understanding. The American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine (ASRM) do not endorse the use of egg freezing to defer childbearing. The ASRM's decision to lift the 'experimental' label from this still young procedure in 2012 only applied to medically indicated needs, such as women with cancer.
Moreover, there is no long-term data tracking the health risks of women who inject hormones and undergo egg retrieval, and no one knows how much of the chemicals used in the freezing process are absorbed by eggs, and whether they are toxic to cell development. Furthermore, even with the new flash freezing process, the most comprehensive data available reveals a 77 percent failure rate of frozen eggs resulting in a live birth in women aged 30, and a 91 percent failure rate in women aged 40.
...The Bottom Line
Today service providers and clinics cavalierly market egg freezing to fertile women without fully understanding or communicating the risks. Though I am neither for nor against egg freezing as an idea, I believe strongly that women must be fully informed about reproductive medicine before setting their hopes on it. ... And this science, particularly where egg freezing is concerned, is still in its infancy.
via @instapundit
But AMY!!!
When two women love each other very much, why SHOULDN'T they be able to make a baby???!??
People should do what they want!!
Because Policy!
Crid [CridComment at Gmail] at October 26, 2014 1:38 AM
A lot of people both male and female don't understand female fertility. I've known lots of women who had the idea they would work till 30. Find Mr. Right in 30-32. And have 2-3 babies from 35-40. Reality just doesn't work that way.
And it is not just the women. A male coworker was amazed we are trying for another child. He is 35 and his wife is 38. They plan to wait to try for a second child. I expect they will be waiting permanently.
Ben at October 26, 2014 7:43 AM
When two women love each other very much, why SHOULDN'T they be able to make a baby???!?
Crid, I'd like to introduce you to the barn door. Feel free to close it, though Rambler is already hoofing it up in the pasture.
Any other done deals you'd like to add to your list of complaints?
Amy Alkon at October 26, 2014 10:03 AM
> I'd like to introduce you
> to the barn door
Remarkable— Your point is, in essence and indubitably:
Golly, I suppose someone could say that about health effects of these procedures too, right?:Crid [CridComment at Gmail] at October 26, 2014 1:21 PM
A friend of mine is due next month with twins from egg freezing and IVF. She had breast cancer about five years ago and had a bunch of eggs frozen before starting treatment. She's 37. She and her husband were told their chances for success were 15% over three cycles/attempts.
I know success rates are low, but I'd like the option available to me if I could afford to pay for it. I do also wish the clinics are more realistic up front in odds of success, declining fertility with age, etc. I know women in their 40s who very unrealistically expect to have children with minimal issues as if they were still in their 20s.
BunnyGirl at October 26, 2014 2:45 PM
> but I'd like the option available
> to me if
These may be the most deadly words in contemporary public life. Everyone wants to have 'options,' in the style of 1990's financial derivatives. But people forget that:
We're running out of money for options.
Crid [CridComment at Gmail] at October 26, 2014 7:25 PM
A lot of people both male and female don't understand female fertility. I've known lots of women who had the idea they would work till 30. Find Mr. Right in 30-32. And have 2-3 babies from 35-40. Reality just doesn't work that way.
Posted by: Ben at October 26, 2014 7:43 AM
I like to say: IF you want kids and you're female, assume you won't get pregnant after age 30 and plan accordingly, since chances are you'll end up pushing the envelope anyway.
All these advances in infertility treatment reminded me of something Katha Pollitt said in an interview about her new book "Pro: Reclaiming Abortion Rights":
"Another theme of anti-abortion coverage is, give the baby up for adoption, make another woman happy. Well, if a woman wants to do that, fine. But the idea that abortion is a problem, and adoption is the solution, is really the wrong way to look at it. First of all, if we did that, there would be a surplus of babies in about five minutes. There are not as many people who want to adopt as adoption organizations want you to think there are."
(snip)
Makes sense, I suppose, when you consider all the older foster kids who don't get adopted. (Plus infertility treatments.)
lenona at October 27, 2014 4:15 PM
Egg freezing is not at the point at which anyone should be delaying having children they are in a position to have responsibly (i.e. you have a partner who would be a decent parent, you're not financially unstable, etc.) on the strength of the promise of frozen eggs. Heck, frozen embryos aren't at that point, really, even ones that have been certified as having normal chromosomal structures….
…but frozen embryos offer more promise than frozen eggs, partially because they just freeze more effectively, but partially because the medical profession has had infinitely more experience with growing, freezing, thawing and transferring them. Success rates from frozen embryos are dramatically higher than they were a decade ago. That didn't happen in a vacuum. If egg freezing is ever going to progress in terms of effectiveness, women are going to need to freeze a lot more eggs….
…at younger ages. Yes, eggs frozen by a 40-year-old woman are unlikely to turn into a baby. Eggs frozen by a healthy 25-year-old with no known fertility issues, though? That's another issue. Of course, most 25-year-olds aren't going to be interested in freezing eggs, short of known threats to fertility such as looming chemo -- would you want to go through a round of hormone injections and pay five figures at the peak of your fertility? Most people wouldn't. That's why I find Apple and Facebook's offers to pay for egg freezing to be promising, because there's the likelihood that at least some women who aren't pushing the envelope will decide that hey! if it's free, why not? (Worth pointing out: Younger women typically require lower doses of hormones for assisted fertility purposes and are less likely to fail to produce eggs if treated under a protocol designed to minimize the risks of ovarian hyperstimulation syndrome.) If those eggs are never used, well, no harm, no foul -- not even the Catholic Church disapproves of disposing of unfertilized human ova. On the flip side, you'll likely have at least a few cases in which, say, an apparently healthy 28-year-old woman is diagnosed with Hodgkin's and told that she'll need to freeze eggs ASAP if she wants to have a hope of bio kids, only to respond, "Oh, I did that three years ago. Can you start injecting me with the chemo NOW, please?"
I'll repeat something I've said before: Most people just aren't going to be interested in postponing parenthood IF they are in a position to do so in favor of high-tech options. Let's see -- expensive, taxing medical treatments involving countless vaginal ultrasounds and multiple other parties, or free, fun sex? Not much of a choice. The people interested in the potential of high-tech options, with the exception of those with known fertility issues, are going to be people who don't have spouses (or spouse candidates) yet. Yes, yes, wimmenz work too hard and are giving over their fertile years to The Man, totes, but we live in a society in which people tend to get married later. More than that -- we live in a society in which the success rates for people who get married in their 30s (for the first time, anyway) are higher than for those who get married in their 20s. We also live in one that requires either advanced schooling/training for high-powered careers, or loooong hours spent working, or both. That's not terribly compatible with early parenthood for either men or women -- men just don't face the same biological time limit.
Not sure what the answer is. I think freezing ovarian tissue and re-implanting it will probably be more useful than egg freezing -- think of it as naturally, and safely, delaying menopause for an extended time, allowing for natural conception. But egg quality is not the only issue with reproducing at an advanced maternal age. There are plenty of "structural" issues such as heart defects that aren't genetic, but that are strongly correlated to maternal age. And the older reproductive system just doesn't respond as well to a first pregnancy/delivery as a younger one. A 40-year-old woman having her first child has a 50 percent chance of ending up with a C-section. Yes, yes, the U.S. is liability-averse and C-section-heavy, whatever…but older women just don't progress in labor for first deliveries, on average, as well as younger women. Throw in fun conditions such as pre-eclampsia, and things get even more complicated.
Not sure what the answer is. I do think that OB/GYNs need to, after confirming with their patients that they want kids, communicate the facts about female fertility to those patients. (Patients like Amy can be left alone after responding, "Nope! Definitely don't want kids.") But, in my opinion, the facts are there IF you want to look at them and IF you want to see them. I figured them out despite all of the People magazine covers with 40something celebrities showing off their newborn twins cooing about how it just happened! A whole lot of people don't WANT to know. Yes, some of those people don't want to know because they want to break up with great potential spouses to have more time for clubbing after late work days…but a lot don't want to know because they just haven't found Mr. Right, or even Mr. All Right, yet, and they don't want to be the frantic woman discussing names for her potential offspring on the first date. Desperation is not an asset on the dating market.
I've known lots of women who had the idea they would work till 30. Find Mr. Right in 30-32. And have 2-3 babies from 35-40. Reality just doesn't work that way.
It did for me, though I did both the "finding Mr. Right" and "having 2 babies" part in the 35-40 timeframe. But I didn't PLAN things that way. I wasn't single until I was almost AMA because I worked too hard -- it took me that long to find someone with whom I would be compatible. My husband was well worth waiting for. I would rather be childless with him than have kids with someone else. Fortunately, it didn't come down to that…though having the kids required the help of modern medicine. (I speak of the risks of having kids at an older age from experience.) But I was able to resign myself to the possibility of not having bio-kids before I met my husband. Desperation was not oozing from my pores when we had our first date. I think in some cases, egg freezing is about allowing women some space to view guys as people, not as last-chance sperm donors, which can in turn make it more likely that those guys will be interested in sticking around and becoming fathers. As for the bigger issues of modern society vs. biological realities…don't have any answers, sorry. But I do think that Apple and Facebook should be commended, not vilified, for acknowledging that there is an issue, and taking a small step to perhaps further the discussion along.
marion at October 27, 2014 11:37 PM
Amy Alkon
http://www.advicegoddess.com/archives/2014/10/26/short_one_stork.html#comment-5354227">comment from marionMarion, thanks so much for that -- and I love this bit:
Amy Alkon at October 28, 2014 5:27 AM
I'm glad things worked out for you Marion. I can understand waiting to find the right person. I was 32 when I found my Ms. Right. But both of us were looking long before then.
I know a fair number of people who don't even start looking till 28. And that is of both genders. The coworker I mentioned is male. He clearly thinks he has plenty of time to have kids and is waiting before trying for a second.
I have no issue with people who don't want kids. Or even those who don't want any more kids. I just know people who want kids and put it off too long. My coworker's wife is 38 or 39 and they are waiting.
Ben at October 28, 2014 1:01 PM
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