Yyou can not discuss the rise of freezing eggs for non-medical or “social” reasons in recent years, part of an explosion in the use of fertility treatments, all with the promise of giving expectant parents more options. The starting point is often the question of whether someone, almost always a rich, straight, white woman, should freeze her eggs as insurance against her “biological clock”, career development and/or the risk of not finding a partner in time with whom . to start a family.
After noticing the trend, I began to see that the same detail was missing from piece after piece: the statistical probability that these frozen eggs would result in live births. With notable exceptions, the focus is on affordability and the social factors that cause so many more people to opt for this treatment, rather than discussing what happens when someone actually uses the eggs to try to conceive. Frozen eggs are marketed and talked about as “fertility nest eggs” – even as more and more evidence about low success rates emerged.
By now you may have looked at my byline photo and wondered: wait, why does Baldy care about this?
In 2013 I attended my third or fourth gender identity clinic appointment in London, the gap between appointments was around six months and the initial wait over a year. The consultant gave me a risk/benefit analysis of starting testosterone (T) injections. The issue of fertility came up. Have I looked into fertility preservation in the form of egg freezing? CrapI think, was i meant
“No…?” I offered.
“Well,” came the gist of his reply, “you can ask your GP if they’ll cover the cost, but they probably won’t. It’s terribly expensive and my understanding is that it works very little.” At the time, I had no understanding of what exactly it was that rarely worked. In the following weeks of waiting for my T prescription, I did ask my GP.
I was already at peace with infertility in exchange for any kind of future life as my true self. Transition would, I thought, mean losing the ability to conceive. The consent form for starting T made the apparent trade-off clear, but I signed it without hesitation, after years of thinking about what it would mean. Moreover, the tone of the consultant’s advice seemed clear: If you are really a man, you will not care much about having children. In fact, you probably just want to whip out that uterus as soon as possible, right?
My real feelings about parenting at the time, which I didn’t bother him with, were ambivalent. I used to think I would definitely have children. Maybe I still would. Adoption, foster care and surrogacy all seemed like valid, albeit purely theoretical, options.
My GP was right about that: the NHS wouldn’t help me freeze my eggs. And, yes, the chances of a live birth from a frozen egg at that time were well below 10%. I actually felt relieved that the number was so low that the question of self-funding the procedure seems redundant.
That <10% figure has always stuck with me. It does somersaults in my brain every time I read or hear a piece that doesn't mention what happens later, when those frozen eggs thaw and return from answers to questions.
It is important to say that birth rates from frozen eggs have improved. However, according to the UK regulator, the Human Fertilization and Embryology Authority (HFEA), they are still lower than the rates of fresh eggs sitting between 20% and 30%. In 2016, the UK birth rate per treatment cycle of frozen eggs was 18%.
Coincidentally, I found out in 2016 that testosterone probably didn’t make me infertile after all. I discovered this by chance from a YouTube vlog. In the nearly eight years since then, I have carried and given birth to my two children through artificial insemination and donor sperm. I also, perhaps unsurprisingly, became interested in the research surrounding trans people’s fertility and our reproductive choices. not too little there are very few research of this kind, including no empirical evidence that testosterone affects trans male fertility. I still don’t know why doctors tell us to do this, but I’m pretty sure it has nothing to do with science.
Before I got pregnant with my youngest via IUI (intrauterine insemination), I tried IVF myself in hopes of creating multiple embryos from the last bottle of donor sperm I had on ice. I have no fertility issues and was 33 at the time. I went through two thawed embryo transfers. The first did not take and the second resulted in a week-five miscarriage. It was a stark reminder that, even when things look good on paper, sometimes – statistically most times – they just don’t work. I’ve frozen a few more embryos so I also know the feeling when that hefty annual storage bill lands with a thud in your inbox.
This is a relief to see that awareness is now being raised about for-profit fertility clinics potentially misleading patients about the data on egg freezing. As a transgender man, I was deceived in a different way. I was told I had fewer reproductive options, where others were sold on the idea that there was a surefire way to ensure more.
Fortunately, I learned my truth before it was too late. If I had followed the standard NHS route and had a hysterectomy, to believe that testosterone made me infertile and that the procedure was necessary to prevent certain cancers (a claim which is now denied), my children would not be here today. After going through this, it pains me to think of women who see frozen eggs as an investment in their future, only to discover, once they’ve run out of other options, that it’s not nearly as simple as that.
In both contexts – in all contexts – healthcare providers have an absolute duty to provide accurate and unbiased information. Nothing should be allowed to blur those lines, be it profit margins or a misplaced desire to police social and gender norms. Women and trans people of all stripes know equally well what it’s like to be misled, ignored and undermined by doctors. Sometimes our experiences are very similar and sometimes very different. In both cases there are insights to learn and share.
When it comes to reproductive health and choice, we all need better, more ethical and more affordable person-centered care and we’re all much more likely to get it if we work together.
