Doctors with patients in possession of ovaries, take note.
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After a recent visit to her OBGYN, Chaya Babu hopped off the exam table, got dressed, and headed into a nearby office for a quick debrief on the appointment. Her doc gave her a pretty standard post-prodding rundown on general health and hormonal concerns—and that's when she popped the question.
"Very casually, she was like, 'I also want to bring up the option of egg freezing,'" the 34-year-old Babu recalls. "She was like, 'I have a lot of patients like you who are living their cool, fun lives, and when they're done doing their cool things they want to have families."
While she jokes that her gyno may be overestimating just how cool her day-to-day is, the Brooklyn-based writer and educator is one of a growing number of Americans who are postponing motherhood in favor of career and personal pursuits, or for whom motherhood may not factor into the life-planning equation at all. Recent studies have shown that women are waiting longer than ever to have kids, and birth rates among women in their thirties and forties are on the rise. Which is why even though Babu isn't planning to choose motherhood, she wasn't necessarily offended by the question (though she does take some issue with the "fun now, family later" binary). "I felt like the timing was very appropriate, and it is her job," she says. "If anything, I was like, should she have brought this up earlier?"
Should she have? That depends. Egg freezing—or "oocyte cryopreservation" if you're nasty—is still relatively new. In 2008, the American Society of Reproductive Medicine (ASRM) gave the procedure an "experimental" designation, a label the organization only removed in 2012. Since then, elective egg freezing has become both more popular overall and more common among younger women.
And Babu's hunch is right—generally speaking, the earlier the better.
"Ideally, we'd like to see patients before they're 35," says Boston IVF's Rita Sneeringer, a reproductive endocrinologist and a clinical instructor at Harvard Medical School. "But that said, if you have a woman who's 35 to 40, somewhere in that rage, who's not in a relationship, who wants to have children eventually, who wants to preserve her fertility—if she freezes her eggs at 37, let's say, but doesn't use them until she's 40, there's going to be a much better chance with those eggs, even if they're frozen before 40."
"In terms of OBGYNs speaking to their patients about this as an option, I think it's reasonable to discuss fertility plans with a patient when they're getting into their thirties," she adds. "And this can certainly be offered as an option at any point in their thirties."
Should your doc bring it up before that? There is, after all, a whole group of startups like Extend Fertility and Progyny marketing egg freezing to millennial women under 35. Sneeringer concedes that yes, in an "ideal world," freezing all women's eggs at age 25 would be the absolute best. But while 25-year-old eggs are some of the best candidates for freezing, most 25-year-olds aren't the best candidates for an expensive elective procedure that's rarely covered by insurance. Egg freezing typically comes with a price tag between $10,000 and $12,000, and long-term storage can run you around $800 a year—not exactly an option if you're a recent college grad who's barely making rent as it is.
Taking into account the later age at which millennials now achieve financial security, it seems like maybe there isn't an ideal age to ask a woman if she wants to toss a batch in the freezer. And here's another thing that may leave patients a little suspicious: Some reports have suggested that OBGYNs might recommend egg freezing with their own financial interests in mind rather than thinking about what's best for their patients.
The good news, says Sneeringer, is that you can wait until your pockets are a little fuller. There's probably not a huge difference between eggs that are preserved at 25 and those that are preserved at 35. Much like women's fertility overall, it's only after 35 that the odds start to turn against you. She's even had patients older than 40 who have opted to go with freezing, though she says at that point fertility markedly changes and women start to see diminishing returns.
Before you pull the trigger on that "I-might-want-to-have-kids-someday-just-not-yet" GoFundMe campaign, there's something else to consider: Not every doc thinks you need to have the egg-freezing chat in your twenties and thirties. In fact, ask the ASRM, and they'll tell you your gynecologist maybe shouldn't bring it up with you at all. "ASRM's practice committee does not recommend encouraging elective egg freezing for social reasons," says public affairs manager Eleanor Nicoll.
She says that while the technology has vastly improved over the last few years, the committee's decision to remove the "experimental" designation only applies to women who may need to delay pregnancy out of medical necessity. "Data on the safety, efficacy, cost-effectiveness, and emotional risks of elective oocyte cryopreservation are insufficient to recommend elective oocyte cryopreservation," the organization concludes in its Mature Oocyte Cryopreservation guidelines, citing relatively low success rates and the idea that it could inspire "false hope" in patients.
Specialists like Sneeringer don't see it that way. She acknowledges that there isn't a ton of data backing up the procedure right now ("most people haven't used their eggs yet," she explains), but says it only makes sense for a gynecologist to talk fertility with patients, and this is one option they should know is out there. "If you are in your thirties and you haven't met the right person yet, but you're thinking, 'I definitely want to have children, I definitely want to at least have the option to try,' that's the ideal person to come in and have their eggs frozen.'" She sees all kinds of people who are planning for the future, both single women and couples who might want to conceive that aren't quite there yet, life-wise.
While she may not want to have kids herself, Babu appreciates that her OBGYN raised the question—even if she wishes she'd been asked if she was, you know, considering motherhood at all before the freezing idea was lobbed her way. After all, shouldn't doctors give their patients access to all the tools they might want to take advantage of?
"What if you're someone who's literally never heard of egg freezing, and you're basing your life decisions off of that not existing?" Babu asks. "You would want to know."
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