While it’s true millennials are delaying many of the milestones of adulthood that traditionally come before parenthood — marriage, financial security, a first home purchase — they’re not taking their fertility decision-making and planning lightly.
In the Healthline survey, we found that 32 percent of millennial women open to fertility treatments aren’t sure if they want to have a family. In order to reserve the option, they’re turning to a procedure that was quite rare just a decade ago: egg freezing.
Egg freezing and many other fertility options are becoming more popular because of advances in both assisted reproductive technology and awareness of the fertility options available.
“Eight years ago, there were very few people who were aware of the effectiveness of freezing eggs, and thus the value that it might play in their early 30s,” said Pavna Brahma, MD, a reproductive endocrinologist and fertility specialist at Prelude. “The awareness has definitely gone up, in particular in the population of people that are financially comfortable and know they’re not going to conceive in the next four to five years.”
Andrew Toledo, MD, a reproductive endocrinologist at Prelude, added that young women interested in freezing their eggs often come in with a relative or are driven by a major life event, like a breakup of a long-term relationship.
Landis told Healthline about her decision to freeze her eggs. “As I progressed into my 30s, I realized that every year was going by faster than the last, but that I still hadn’t found a parenting partner. I took advantage of egg freezing at 33 to give myself more options for the future,” she explained. “I’m hopeful I can get pregnant naturally with a partner. But you don’t know where life is going to take you.”
According to National Public Radio (NPR), and the Society for Assisted Reproductive Technology (SART), only about 500 women froze their eggs in 2009. SART removed the “experimental” label from the procedure in 2012, and more women have been taking advantage of the technology since then. In 2013, nearly 5,000 women used the preservation procedure, and fertility marketer EggBanxx predicts 76,000 women will have frozen their eggs by 2018.
Healthline’s survey found that the primary motivations for egg freezing included not having sufficient financial means for a child yet, choosing to focus on a career, and health issues. Surprisingly, only 18 percent of women in the survey said that not having a partner yet was their primary motivation for egg freezing.
“I see many young married couples around 30 who know they want to have kids in the future coming in to freeze eggs,” said Aimee Eyvazzadeh, MD, MPH, a reproductive endocrinologist and fertility expert.
Also, many couples choose to freeze embryos, or a woman’s egg fertilized by sperm, instead. Embryos and fertilized eggs are more robust than eggs, and therefore able to better survive the freezing and thawing process, according to Julie Lamb, MD.
Other than couples, Eyvazzadeh shared, “A little over 50 percent of women who are freezing their eggs at my clinic are in relationships. They have boyfriends or significant others, but they haven’t decided that this is the right guy or the right time to have a child. A lot of single women come in with their mothers as well.”
Still, Eyvazzadeh cautioned, the idea of egg freezing may sound easy, but it’s important to remember many fertility treatments are invasive and sometimes physically and emotionally difficult.
Landis recounted the unexpected physical and emotional response she had to her fertility medications. “I was very bloated and the hormones made me feel like I was on a rollercoaster — to the point that I didn’t feel like myself and avoided seeing friends for those three weeks,” she said.
While the number of women freezing eggs is rising, Eyvazzadeh pointed out that it isn’t as common as some may believe. “The idea that women everywhere are running to clinics to freeze their eggs is just not accurate. As long as the procedure involves several shots, a surgery, and feeling bloated, it’s never going to be that way,” she said. “Even when companies like Facebook and Apple are paying for 100 percent of egg freezing for employees, people still aren’t taking advantage of the technology that’s available to them.”
With so many millennial women delaying parenthood, the reality is many of these women will face more fertility problems than older generations, and they may also not fully understand the many facets of fertility that affect their chances of becoming pregnant. For example, delaying pregnancy reduces conception chances. According to the Southern California Center for Reproductive Medicine, a woman in her 20s has a 20 to 25 percent chance of conceiving naturally during each menstrual cycle. Women in their early 30s have about a 15 percent chance per cycle. After 35, it slips to 10 percent, and after 40, it’s just 5 percent. By the time a woman is over 45, her chances of getting pregnant during each menstrual cycle are less than 1 percent. That’s all while the risk of miscarriage rises with age. “Women’s most fertile time, unfortunately, is when societally, career-wise, and relationship-wise, it’s not a good time,” Toledo noted. It’s this gap between perceived knowledge and actual fertility literacy that presents an opportunity for millennial women — and their doctors — to talk more openly about their fertility and options before their peak childbearing years have come and gone.
“Infertility is heartbreaking. When you struggle with infertility, you experience grief every month looking at the pregnancy test and seeing it’s not positive,” said Stacey Skrysak, who underwent IVF at age 33, and writes about her experience on the blog Perfectly Peyton. Fertility problems fall equally on men and women: one-third of women and one-third of men. The final third is caused by a combination of the two sexes.
Advanced maternal age
As fertility drops with age, the risks of birth defects and pregnancy complications increase. For example, the danger of miscarriage rises, and the risk for developing hypertension, diabetes, and preeclampsia goes up too. It’s also more likely the baby will be born prematurely or have Down syndrome or autism. Most survey participants labeled age 50 as the age at which it’s too late to have a child. That’s the same age the
The role of male fertility
Three-quarters of the millennial women surveyed knew that many factors affect a man’s fertility. Diet, anxiety, physical activity, and alcohol and drug use and abuse play into male fertility. Only 28 percent of people in the survey knew marijuana use lowers a man’s fertility. In the last decade, marijuana use among adults has
Fertility helicopter parenting
Parents and grandparents of millennials seem to be worried about the younger generation’s baby-making prospects, too. According to the survey, almost one-third of women with daughters, nieces, or granddaughters of child-bearing age were concerned these women were waiting too long to conceive. Almost one-fifth (18 percent) were willing to pay for an egg freezing cycle to help preserve their loved one’s fertility. That’s something both Toledo and Brahma have experienced in their practices. “Most of the patients that we’ve dealt with have the financial capability, have some sort of insurance coverage, or have a relative that wants to be a grandparent that’s paying for the procedure,” Toledo shared with Healthline.
The emergence of the intervention generation
The first children born through IUI and IVF are now old enough to be parents themselves. When these intervention methods first began, like egg freezing just a decade ago, they were extremely rare. Today, a third of millennials told Healthline they’re willing to use these fertility options to help them conceive. Donated sperm has been used for decades by women without a fertile partner, but donated eggs are a little newer to the fertility treatment list of options. Still, only 12 percent were willing to use an egg donor, and 15 percent were OK with using a sperm donor. On the other hand, they also said they wouldn’t hesitate to donate an egg to someone else who was having trouble conceiving.
Insurance coverage of fertility
Hopefully, as millennials shape the future of parenthood, they’ll push insurance policy to keep up with their needs. Insurance coverage of fertility issues varies widely. In June 2017, Connecticut became the first state to cover fertility preservation, or egg freezing, through health insurance when the procedures are considered medically necessary. Fifteen states also have mandates for fertility treatment. Insurance companies in Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island are required to cover some infertility treatments. While pregnancy coverage is one of the essential health benefits of the Affordable Care Act (ACA), fertility treatments are not. Companies and individual plans have the freedom to offer fertility coverage as part of a plan, but it’s not required. Fertility IQ’s Best Companies to Work for as a Fertility Patient report found that more than half (56 percent) of people had no fertility benefits, while nearly 30 percent had full fertility benefits. The prospect of fertility benefits is even being used as a recruiting tool for some businesses. Some tech companies offer fertility coverage at a 35 percent higher rate than other similarly-sized companies. That may be in large part because tech companies are in a talent war with one another, and any edge over a competitor can help them win a prized recruit. Whatever the sector, the millennial workforce is seeking more financial help with covering the costs of their fertility treatments. Nearly half (47 percent) of people polled in the Healthline survey believed health insurance companies should cover fertility treatments. Even more millennials (56 percent) who took the survey agreed with this sentiment. Startups like Future Family and Nest Egg Fertility have begun to address the expense of fertility tests, egg freezing, or IVF with radically different pricing models and rates. Americans also believe fertility coverage should be highly inclusive. According to the Healthline survey, 51 percent of adults surveyed and 64 percent of millennials believe all couples or single parents, regardless of their marital status or sexuality, should be eligible for fertility benefits.
The introduction of IVF led to a steep increase in births of multiples, but recent advancements in IVF efficiency have helped reduce the rates of multiple births. In 1998, new guidelines discouraged doctors from transferring more than three embryos at a time. This was designed to reduce the risk of a multiple birth with triplets or more. And it worked — since 1998, the rate of multiple births fell by nearly 30 percent to just 1 percent of all births. Still, in the United States in 2013, 41 percent of all pregnancies that resulted from IVF were multiples. Soon, doctors hope advancements in infertility treatments will help them make better embryo selections before implanting them in a woman’s womb. Currently, for genetic testing, doctors rely on Preimplantation Genetic Screening (PGS). It started being used around 2008, and women were increasingly choosing to utilize it — for about an additional $4,000 — to make their IVF cycle more successful. “There are so many advances that make IVF more efficient and more successful,” Brahma said. “Back in the ’80s, every fresh IVF cycle probably resulted in one opportunity for a child. Now, many people who do IVF in a prime setting can probably build their whole family off of one cycle. We can do PGS and select the best embryos, and we can minimize miscarriage. The success rate has taken off since we can now select embryos so well.” “It takes the fertility space about five years for trends to finally catch on,” Eyvazzadeh explained. “Genetic testing of embryos took a long time to catch on. Now in the [San Francisco] Bay Area, I’d say most families are using PGS.” Fertility doctors predict there will be more advancements in embryo selection and endometrial (tissue lining the womb) receptivity science in the near future. Brahma gave us an overview of the promising developments: “For embryo testing, we’ll be able to drill down into the embryo at the genetic, mitochondrial, and molecular level to make sure we’re selecting the best embryos. There will also be a lot more work around the endometrial receptivity issue.” Eyvazzadeh predicted that people will start doing the fertility gene tests first, as part of the fertility awareness panel that they’re doing, to see if they can wait to freeze their eggs. That prediction plays into a current trend Eyvazzadeh mentioned to Healthline. “The idea that there’s no such thing as unexplained infertility is gaining speed. We’re at that point now with technology that you can look at someone’s genetic profile and explain to them why it’s so hard for them to get pregnant.”
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Healthline proprietary infertility information
For this report, Healthline conducted proprietary traffic and search analysis of fertility topics. Within the search traffic Healthline received for fertility, the largest area of search centered around treatments (74 percent of searches). While 37 percent of treatment seekers were searching for a fertility clinic or doctor. Many people also showed high interest in natural treatments (13 percent). The most popular natural fertility treatment was acupuncture.