This is an article that you need to read critically, beyond the headline.
Even a few paragraphs down they say this:
> The optimal age to freeze eggs varies depending on the source and metric, but almost all sources agree it's sometime between 19 and 26.
So there's some heavy bias inserted already into the title.
The next chart shows a peak around 19, but if you read the fine print it's not a chart about eggs at all. The subtitle says it shows:
> probability of getting pregnant for couples not on birth control
Not the quality of eggs frozen. They're saying one thing in text and showing a chart of something else. If you can't imagine why couples in their early 20s might have a higher rate of pregnancy than couples in their 50s then you might want to think a little deeper about the factors that go into that.
The writeup then goes into polygenic embryo screening, which then jumps to improving IQ by selecting embryos, which gets to their final argument which is that it's easier to collect more eggs when younger. So freezing a lot of eggs when you're younger allows for more boosting of your child's IQ through genetic screening based on a company called Herasight's data. Herasight has been widely criticized for overselling their abilities. Also, why do so many rationalist writeups end up back at a conversation about genetics and IQ?
I tried not to comment directly on the site because I wanted my points to stand on their own. However, Lesswrong has a long history on the internet. It’s part of the “rationalist” writing sphere which has become oddly preoccupied with topics like race and IQ, eugenics-adjacent topics, and never ending flirtations with reactionary ideologies.
They could have called it morewrong.com or morallywrong for all the right mathematical reasons instead. Their eugenics agenda is really more than a little bit tiresome at this point.
This article is answering a different question to what it is asking. It's asking "What is the most effective strategy to freeze your eggs if you're absolutely certain you will need to".
The reason women freeze their eggs in their early 30s is because they still have a good chance for it to be effective and they now have a strong idea they'll need to. You don't have that second piece of information at age 19.
Or to be specific: What is the size of the cohort of women you are expecting to freeze their eggs at the age of 19, who will use those frozen eggs. How many of them will give birth to children without the help of IVF, and how many will choose never to have children.
I think this article is a good example of rationalism. Which is basically getting very mathsy about 1 specific very of the data, without viewing the data in the context of the decision that is being made.
For example, what is the percentage of women you expect to freeze their eggs at age 19, who you then expect to be unable to afford the $500 every year to keep those eggs frozen over the next decade?
I don't see a very big reason mentioned: You might not need it at all. Sure, the optimal age to freeze might be 19, but if 80% of women are done with children by age 30, why would you have every woman spend the equivalent of buying a small car on something they're overwhelmingly not going to need?
Waiting to get a good balance of "your eggs are still reasonably healthy" and "if you haven't had kids until now, it'll probably be a while still" is probably the reason behind the current advice.
Apparently the harvesting procedure typically (but not always?) involves general anesthesia. That alone is never entirely risk-free. In this context, the temporary loss of bodily autonomy could be particularly problematic. All that comes on top of the required hormone treatment. It's not a trivial procedure.
On the other hand, it may be a useful tool to resist expectations to become a mother until it becomes socially acceptable to say no. So it might be important even if the eggs are not getting used.
This is the best argument against early egg retrieval. If it were just a matter of money, the argument holds. However, the treatment involves pumping you with hormones that make you feel like crap the week before and after. Almost daily bloody draws are involved.
Then you add potential complications from anesthesia and the egg retrieval itself, and you have a net negative expected value.
The first time my wife underwent egg retrieval, the surgeon accidentally pierced her ovary. She has had pain on that ovary since.
There's no way it's a worthwhile investment to invest thousands of dollars and take on significant risk and discomfort just for a tool to "resist expectations." You should invest that in a therapist. Or moving to a different state.
> if 80% of women are done with children by age 30
Is this assumption based on anything? Not saying you're wrong, after all the majority of the world's population live in poor countries where people have children younger. But at least In my social circles it'd be more accurate to say 80%+ of women start having children at age 30 (or later) then are done with it. And I know multiple women who had their first child at 40+!
No, the number is made up, I'm saying that there's a point where the advice makes sense. Whether or not that's actually the case now is then a matter of statistics.
Having done IVF with my wife I think this is the most underrated fertility advice available today.
I don't understand why governments of countries with increasing average age and low birth rate don't pay for this for all women. This is one the best pro-family policies that can be implemented.
> This is one the best pro-family policies that can be implemented
Hard disagree on that. You're coming from an angle of someone who wanted to have kids and do it in a mathematically optimal way. A lot of people see egg freezing as a way to delay having kids until they're older, which can become a disincentive to raising families when they're young and healthy enough to do it. If you want a pro-family policy, you should be spending the money on people with families and their children, not on a tool that is used to delay having children in common use.
Another huge problem with this proposal is that freezing eggs is only a small part of the cost. The cost of IVF later in life could push into six figures depending on how many rounds are needed. If we're talking about pro-family policies that can cost upwards of $50,000 to $100,000 per family, there are many more effective places to spend that like on childcare options.
IVF in Italy is included in universal health care already, regardless of age.
If the government is going to pay for IVF for 40 years old women it would be cheaper if those women had eggs frozen at 20 because overall you would succeed with fewer embryo transfers.
Of course that's not the only policy needed, we need affordable house for families, schools, decent parental leave for both parents.
Most 19 year olds probably wouldn't opt into injecting themselves twice a day for weeks and dealing with the side effects of the injections, then the subsequent extraction procedures (likely for multiple rounds) even if it was paid for. Which is reasonable, considering most women who want children will have them without IVF and don't need to go through any of that.
I went through it with my wife too and expecting a 19 y/o women to go through the IVF process as an insurance policy is a bit insane to me. In our modern, western society, this is age is still solidly childhood with not much definitive thoughts of future family, marriage, etc.
Governments need to make COL more affordable, birth rate will go up naturally
We definitely need better COL but I'm not convinced it's is the main factor for low birth rates as most countries living in poverty have very high birth rates. I think its a cultural difference that values earlier marriage and heavy family involvement in raising children which, the latter, reduces the stress of having to parent by yourself.
That money is better invested in providing affordable family housing. Even if IVF is available no one is going to actually have kids if you do nothing to make it economically sustainable to start a family.
Do we really want to rely on IVF to solve the fact that people can only afford a family home once they're well into their 40s? It's insanity if you ask me.
We, in the US, don't even have universal day care, or hundreds of other sensible things that would make child-rearing easy/less expensive. Jumping straight to "let's cover expensive IVF programs" is... well a big leap.
Because (1) it's not risk free, (2) it is painful, (3) it is quite costly over the longer term (4) you wouldn't want a 'pro-family' government to have access to a mountain of unfertilized eggs.
At least with people fighting with infertility, they want to have children, so helping them have children is more straightforward list of actions than convincing people who don't want kids to have them.
If you're curious what it's like for a couple of normies doing IVF, I wrote down our experience here to the degree I remembered: https://wiki.roshangeorge.dev/w/IVF
If I'm understanding that right, it cost $25k per run, and you did 3 runs, so $75k total? Or was it $25k for the full thing? Did insurance cover anything?
Our IVF clinic has a publicly available price sheet[0] so that is correct (thought he prices are higher now): $75k total for us. My wife and I are relatively old. Friends who were approximately 10 years younger collected some 50 eggs on a single cycle. There is a drop-off in egg -> embryo but the women with the 50 eggs are likely going to end up with more usable embryos than us.
Insurance coverage is broader now. When we did it, we used cash pay but nowadays where we live in California there is SB 729 that means most big insurance plans will cover IVF. Personally, I think that's a bit regressive. Older, more established couples like us are benefiting from what will be primarily paid into by younger couples. But if pre-implantation testing becomes widespread (a good thing, imho) then IVF will be more widespread so perhaps this is a forward-looking policy. Still, expanding the child tax credit and raising it to 10x what it is would be good, I think.
I went through this with my partner and it cost around CAD $30K all-in. Thankfully it was 100% covered by insurance (for the drugs) and by a provincial program (for the procedure).
The drugs for stimulating follicle growth cost around $500/day and the first cycle didn't result in enough mature follicles to be worth attempting the egg harvesting. In the second attempt, the duration was extended after a scan to let more develop. Every extra day, is an another $500.
If it weren't for the government program we were seriously looking at going to one of the many clinics in Mexico offering these services.
We weren't so lucky with the numbers though; here's significant attrition at every step and if you aren't starting with a good number it can look like: 5 follicles > 4 mature eggs > 2 embryos > 1 child
Didn't read that account but I went through it with wife. The egg collecting / embryo creating process is the expensive part, so depends on how many times you have to do that process. The re-implantation was significantly cheaper, so also depends on how many times you have to do that part but at least its less costly.
We ended up doing 1 extraction and 2 implantations. If I remember it was roughly ($15k-20k) then (~$5k * 2). This was about 8-9 years ago. We had no fertility issues and had other reasons for doing IVF, but if you do have fertility issues it's more risk the extraction and embryo process will fail and need repeating.
I've been through six egg retrievals. I've probably been lucky in the the physical effects weren't bad for me (but I've had/have endometriosis so I'm pretty used to just dealing with pain and discomfort). The emotional effects were harder. Not just the stress of not knowing whether it was even going to work (most times it didn't), but also the hormonal shifts resulting in rapid mood swings and irritability - which my partner found hard to deal with.
Employers encouraging egg freezing by offering egg freezing benefits is an abysmal conflict of interest. Employers reap tremendous medium-term benefits and the woman bears all of the long-term risks -- in this case the biggest risk of all .
Employers should be required to pay for future maternity disability care insurance e.g. 2-3 years of maternal leave fully paid, elective at any time, even after they separate from the company. Also disability compensation in the event that fertility fails. e.g. $500k / missed fertility .
That would reveal the true success rate of the procedure. If employers or fertility clinics believed it to be a deterministic process, the risks for the employer would be low.
It's also the optimal age to not have children! You're still figuring out your life, probably no stable partner or job, time to do some stuff you'll regret later, etc.
If everyone had kids at 18-20, then the grandparents could take care of the grandkids while in their 40s while the parents build their careers from 20-40, then start taking care of the grandkids as the cycle repeats
It really seems you have no idea what you’re talking about.
I have a couple of friends married for about 4-5 years, with a 4-years old son and a one year old daughter. They both have graduate degrees and stable jobs. They are near 40 years old.
Man, they are two zombies. They are drained. They push forward for the immense love of their kids but it’s incredibly evident they’re drained.
And the thing is… having kids at almost 40 should really be discouraged. They simply don’t have the same energy they had when they were 20, of course. Heck, i’m 33 and it’s evident to me I don’t have the same energy as when I was 23.
This modern idea that one should postpone having kids is incredibly stupid, I hope at some point society will self-correct somehow.
My parents and my spouse's parents were all in their late 30s having children, now we're in the same position due to infertility and now finally going through IVF. We're happy it's working but at the same time it's sad knowing they'll grow up never really knowing their grandparents.
The grandparent situation is sad af. It's also pretty sad being a mid-40s year old dad that doesn't have the energy to keep up with their kid. I pitched a little league game yesterday and it wiped me out. Also, the fact I (and you) will not know our grandchildren very well also is quite sad.
If my son has his first kid the same age I had him, I'll be in my 80s when that kid is starting little league (or that age). Then, factor in the fact that I don't know of any men in my family that have lived past 80 and it gets really grim. They were all heavy smokers and drinkers I remind myself with fingers crossed.
The most sad part for me, is I realized by delaying parenthood - I was just being selfish - and the net result is I minimized "shared time on earth" with the person I love the most. It's easy to say I wouldn't have been a good parent or I wanted X job/income first, but it's all just excuses and selfishness.
Readit News
Even a few paragraphs down they say this:
> The optimal age to freeze eggs varies depending on the source and metric, but almost all sources agree it's sometime between 19 and 26.
So there's some heavy bias inserted already into the title.
The next chart shows a peak around 19, but if you read the fine print it's not a chart about eggs at all. The subtitle says it shows:
> probability of getting pregnant for couples not on birth control
Not the quality of eggs frozen. They're saying one thing in text and showing a chart of something else. If you can't imagine why couples in their early 20s might have a higher rate of pregnancy than couples in their 50s then you might want to think a little deeper about the factors that go into that.
The writeup then goes into polygenic embryo screening, which then jumps to improving IQ by selecting embryos, which gets to their final argument which is that it's easier to collect more eggs when younger. So freezing a lot of eggs when you're younger allows for more boosting of your child's IQ through genetic screening based on a company called Herasight's data. Herasight has been widely criticized for overselling their abilities. Also, why do so many rationalist writeups end up back at a conversation about genetics and IQ?
The reason women freeze their eggs in their early 30s is because they still have a good chance for it to be effective and they now have a strong idea they'll need to. You don't have that second piece of information at age 19.
Or to be specific: What is the size of the cohort of women you are expecting to freeze their eggs at the age of 19, who will use those frozen eggs. How many of them will give birth to children without the help of IVF, and how many will choose never to have children.
I think this article is a good example of rationalism. Which is basically getting very mathsy about 1 specific very of the data, without viewing the data in the context of the decision that is being made.
For example, what is the percentage of women you expect to freeze their eggs at age 19, who you then expect to be unable to afford the $500 every year to keep those eggs frozen over the next decade?
Waiting to get a good balance of "your eggs are still reasonably healthy" and "if you haven't had kids until now, it'll probably be a while still" is probably the reason behind the current advice.
On the other hand, it may be a useful tool to resist expectations to become a mother until it becomes socially acceptable to say no. So it might be important even if the eggs are not getting used.
Then you add potential complications from anesthesia and the egg retrieval itself, and you have a net negative expected value.
The first time my wife underwent egg retrieval, the surgeon accidentally pierced her ovary. She has had pain on that ovary since.
Is this assumption based on anything? Not saying you're wrong, after all the majority of the world's population live in poor countries where people have children younger. But at least In my social circles it'd be more accurate to say 80%+ of women start having children at age 30 (or later) then are done with it. And I know multiple women who had their first child at 40+!
I don't understand why governments of countries with increasing average age and low birth rate don't pay for this for all women. This is one the best pro-family policies that can be implemented.
Hard disagree on that. You're coming from an angle of someone who wanted to have kids and do it in a mathematically optimal way. A lot of people see egg freezing as a way to delay having kids until they're older, which can become a disincentive to raising families when they're young and healthy enough to do it. If you want a pro-family policy, you should be spending the money on people with families and their children, not on a tool that is used to delay having children in common use.
Another huge problem with this proposal is that freezing eggs is only a small part of the cost. The cost of IVF later in life could push into six figures depending on how many rounds are needed. If we're talking about pro-family policies that can cost upwards of $50,000 to $100,000 per family, there are many more effective places to spend that like on childcare options.
If the government is going to pay for IVF for 40 years old women it would be cheaper if those women had eggs frozen at 20 because overall you would succeed with fewer embryo transfers.
Of course that's not the only policy needed, we need affordable house for families, schools, decent parental leave for both parents.
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Governments need to make COL more affordable, birth rate will go up naturally
Do we really want to rely on IVF to solve the fact that people can only afford a family home once they're well into their 40s? It's insanity if you ask me.
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Instead of doing what the body is natural designed to do lets go fully against it because of the current environment.
Dead Comment
Insurance coverage is broader now. When we did it, we used cash pay but nowadays where we live in California there is SB 729 that means most big insurance plans will cover IVF. Personally, I think that's a bit regressive. Older, more established couples like us are benefiting from what will be primarily paid into by younger couples. But if pre-implantation testing becomes widespread (a good thing, imho) then IVF will be more widespread so perhaps this is a forward-looking policy. Still, expanding the child tax credit and raising it to 10x what it is would be good, I think.
0: https://springfertility.com/finance/
The drugs for stimulating follicle growth cost around $500/day and the first cycle didn't result in enough mature follicles to be worth attempting the egg harvesting. In the second attempt, the duration was extended after a scan to let more develop. Every extra day, is an another $500.
If it weren't for the government program we were seriously looking at going to one of the many clinics in Mexico offering these services.
We weren't so lucky with the numbers though; here's significant attrition at every step and if you aren't starting with a good number it can look like: 5 follicles > 4 mature eggs > 2 embryos > 1 child
We ended up doing 1 extraction and 2 implantations. If I remember it was roughly ($15k-20k) then (~$5k * 2). This was about 8-9 years ago. We had no fertility issues and had other reasons for doing IVF, but if you do have fertility issues it's more risk the extraction and embryo process will fail and need repeating.
* feeling bloated during the process (and feeling heavy in the stomach)
* the discomfort of the actual injections (there are two daily)
* pain post-retrieval that was reminiscent of cramps
One of our other friends who had many eggs retrieved on a single cycle actually got ovarian torsion which is supposed to be outrageously painful.
Employers should be required to pay for future maternity disability care insurance e.g. 2-3 years of maternal leave fully paid, elective at any time, even after they separate from the company. Also disability compensation in the event that fertility fails. e.g. $500k / missed fertility .
That would reveal the true success rate of the procedure. If employers or fertility clinics believed it to be a deterministic process, the risks for the employer would be low.
"Figuring out your life" was not a thing when humans evolved.
Deleted Comment
I have a couple of friends married for about 4-5 years, with a 4-years old son and a one year old daughter. They both have graduate degrees and stable jobs. They are near 40 years old.
Man, they are two zombies. They are drained. They push forward for the immense love of their kids but it’s incredibly evident they’re drained.
And the thing is… having kids at almost 40 should really be discouraged. They simply don’t have the same energy they had when they were 20, of course. Heck, i’m 33 and it’s evident to me I don’t have the same energy as when I was 23.
This modern idea that one should postpone having kids is incredibly stupid, I hope at some point society will self-correct somehow.
If my son has his first kid the same age I had him, I'll be in my 80s when that kid is starting little league (or that age). Then, factor in the fact that I don't know of any men in my family that have lived past 80 and it gets really grim. They were all heavy smokers and drinkers I remind myself with fingers crossed.
The most sad part for me, is I realized by delaying parenthood - I was just being selfish - and the net result is I minimized "shared time on earth" with the person I love the most. It's easy to say I wouldn't have been a good parent or I wanted X job/income first, but it's all just excuses and selfishness.