By Keiren C. Smith, MD
The Friday, May 3, 2013 Wall Street Journal essay, “Why I Froze My Eggs (and You Should, Too)” astounded me in many ways and left me with an overwhelming sense of sadness for the misguided author, Sarah Elizabeth Richards. Reading this career woman’s personal account of the tragic “wasting” of her prime dating years in her 20s and 30s, leading her to ultimately spend $50,000 and find herself “lying naked on a cold operating table in a foreign country while a stranger tries to harvest – egg by precious egg – the last of your fertility…” in order to “own her desire to be a mom” makes me wonder where feminism and medicine have gone so woefully wrong.
You see, I am one of those 50-something women who went to medical school in the 1970’s. I was aware that I would spend my “prime baby-making years in the trenches”; however, it never occurred to me to ask for loans to finance egg freezing and tuition. It never occurred to me that I would ever need to do so in order to “assume control of my fertility” and run the risk of my life “not having unfolded the way (I) imagined.” I didn’t need egg freezing to motivate me “to take charge of my life,’ in the words of Ms. Richards.
You see, I was motivated. I took charge. It was a choice I made as a young woman. Not awaiting any freezing, I worked very hard through college to be accepted into medical school and then continued to work hard to be the best physician to my patients that I could be. Family and children? I met my husband at age 37 over the bed of a lymphoma patient. At age 39, first baby. Then daughters two and three arrived when I was 40 and 43. However, the idea of children never concerned me until I met the essential part of my family and motherhood: a good husband.
I didn’t spend every date wondering if the guy with the beer in hand was a strong paternal candidate. Did he possess the right genes and desire to have children? I didn’t think about it. I liked to spend my free time with good, kind, fun and interesting guys. When I fell in love with the wonderful man I married, then, and only then, did I think of children. The concept of becoming a family or being a mother, without the inclusion of a father and husband, made no more sense to me than playing baseball without a glove or bat. Moreover, as a physician, I understood about “advanced maternal age” and the risks of pregnancy. I also saw firsthand the fragility of life and its unpredictability. If we did not have children, my life with my husband would still have value and purpose.
Regarding the medical issue of freezing eggs, while the advances in infertility treatment over the last decade have been amazing, the harvesting and freezing of eggs, “oocytes,” is not without significant risk to both mother and future baby. The procedure itself, over $50,000 as Ms. Richards states, involves injecting oneself with hormones to stimulate the maturation of oocytes within the ovaries. These injections carry the risk of infection and the side effects of hormonal manipulation. The actual surgical procedure itself, starkly described by Ms. Richards, carries the risk of death (from anesthesia), bleeding and loss of ovarian function, infection, and pain. Moreover, oocytes, unlike the fertilized egg or embryo used commonly in IVF, have a high water content which makes them particularly prone to cryoinjury. Even in the slow process of thawing, oocyes are less likely to survive (in one prominent study, only 50% of oocytes survived thawing. The percentage of live births approached 21%, not the 60% achieved with fresh eggs in vitro). This has led the Practice Committees of the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) to conclude that mature oocyte (egg) preservation is a reasonable option for preservation of fertility when medically indicated and embryo preservation is not possible. A history of bad dating partners is not a medical diagnosis; an option to years of regret should not involve a scalpel.
Thus to Ms. Richards and her need for “baby insurance” to “stop the sadness” she experienced as a mid-30s career woman: Having a child does not make one any less sad or unfulfilled. An egg should not be viewed as an “asset.” Intelligence, a generous spirit and kindness should be seen as assets instead. Spending years “frittering away your 20s” with a man you would not have children with and “wasting your 30’s with a man who wasn’t sure he even wanted children” is not a prudent decision if motherhood is your goal. Medicine should not be commandeered to help individuals indulge their insecurity so they can be “in control” An intelligent, independent woman should make choices based on fact – such as the fact that women have less chance of pregnancy as they age. A 20% chance of a thawed egg leading to pregnancy after the sterile, fatherless decision to harvest those eggs? I will take my chances with the man and the career I love anytime.
As a female physician I want to be perceived as a doctor first. The years of women proving themselves in the operating rooms and emergency rooms before me paved the way. Being a mother and having children means that I have maturely and responsibly made a commitment with the man I want to spend the rest of my life with to bring children into this world and raise them, too, as responsible, caring adults. I shudder that my daughters would enter any relationship with fears of infertility and lack of control as the motivators of their behavior. But alas, for many women today, having children comes down to that one word: control. “The most powerful gender equalizer of all – the ability to control when we have children,” Ms. Richards intones. Let me say this, life is full of things over which we have no control. The chances of conceiving with thawed eggs vs. conceiving naturally diminish greatly as we age – and for a reason. Pregnancy is a physiologic stress on the female body. An older woman’s circulatory and endocrine systems are more disposed to pre-eclampsia (life-threatening high blood pressure), miscarriage, and diabetes. Frozen, thawed, or natural eggs: with age comes risk. Medical science should be applauded for making these later-in-life pregnancies safer for both mother and child, but let’s get back to the crux of the matter.
It is time for women to take ownership of their actions and accept the natural consequences. If I choose a high-powered career in my 20s and pour myself into it as an ambitious man does, then there are sacrifices to be made. Having children may not be part of the equation. Or I may end up being the oldest mom in the kindergarten mothers’ group. Whatever I choose, freezing eggs to increase the chance of pregnancy when and if I meet the right “sperm donor” totally renounces what motherhood and feminism should be about. Becoming a mother isn’t all about me – there are three people involved: mother, father, and child. For centuries this model has held civilizations and family together. When a career woman like Ms. Richards waxes poetic that “no matter what happens in women’s lives – divorce, layoffs, illness, ambivalence – egg freezing can come to the rescue,” we have lost understanding of what motherhood and medicine should be all about.
Keiren C. Smith, M.D. is an associate scholar of the Charlotte Lozier Institute.