You can’t have missed the conversations about the rise of freezing eggs for non-medical or “social” reasons in recent years, which forms part of an explosion in the use of fertility treatments, all with the promise of giving more options to prospective parents. The starting point is often the question of whether someone, almost always a wealthy, 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.
Having noticed the trend, I began to see that the same detail was missing from piece after piece: the statistical likelihood of these frozen eggs leading to live births. With notable exceptions, the focus is on affordability and the social factors that are causing so many more people to opt for this treatment, rather than discussion of what happens when someone actually uses the eggs to try to conceive. Frozen eggs are being marketed and spoken about as “fertility nest eggs” – even as more and more evidence about low success rates have emerged.
By now, you might have glanced 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 being roughly six months and the initial wait over a year. The consultant was giving me a risk/benefit analysis of starting testosterone (T) injections. The question of fertility came up. Had I looked into fertility preservation in the form of egg freezing? Shit, I thought, was I meant to?
“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 it rarely works.” At the time, I had no understanding of what it was exactly that rarely worked. In the ensuing 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 living as my true self. Transitioning 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, having contemplated what this would mean for years. Plus, the tone of the consultant’s advice seemed clear: If you’re really a man, you won’t care much about having kids. In fact, you probably just want to whip that womb out asap, eh?
My actual feelings about parenthood at the time, which I didn’t trouble him with, were ambivalent. I used to think I’d definitely have kids. Maybe I still would. Adoption, fostering and surrogacy all seemed like valid, albeit purely theoretical, options.
My GP was direct about it: the NHS wouldn’t help me freeze my eggs. And, yes, the chances of a live birth resulting from a frozen egg at that point stood well below 10%. I actually felt relieved that the number was so low as to make the question of somehow self-funding the procedure seem redundant.
That <10% figure has always stayed with me. It does somersaults in my brain every time I read or hear a piece that fails to mention what happens later, when those frozen eggs thaw and revert from being answers back to questions.
It’s important to say that birthrates from frozen eggs have improved. However, according to the UK regulator, the Human Fertilisation and Embryology Authority (HFEA), they are still lower than rates from fresh eggs, which sit between 20% and 30%. In 2016, the UK birthrate per treatment cycle from frozen eggs was 18%.
Coincidentally, in 2016 I learned that testosterone probably hadn’t made me infertile after all. I discovered this by chance from a YouTube vlog. In the almost eight years since, I’ve carried and given birth to my two children via artificial insemination and donor sperm. I’ve also, perhaps unsurprisingly, become interested in the research around trans people’s fertility and our reproductive choices. Needless to say, there’s very little research of this kind, including zero empirical evidence that testosterone affects trans male fertility. I still don’t know why doctors tell us it does, but I’m fairly sure that it’s got nothing to do with science.
Before conceiving my youngest via IUI (intrauterine insemination), I tried IVF myself in the hope of creating multiple embryos from the last vial 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 didn’t 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, the majority of times – it just doesn’t work. I still have a few embryos frozen so I also know the feeling when that hefty annual storage bill lands with a thud in your inbox.
It’s a relief to see that awareness is now being raised about for-profit fertility clinics potentially misleading patients over the data on egg freezing. As a transgender man, I was misled in a different way. I was told I had fewer reproductive options, where others are sold on the idea there’s a surefire way to secure more.
Thankfully, I learned my truth before it was too late. If I’d followed the standard NHS pathway and had a hysterectomy, believing testosterone had made me infertile and that the procedure was necessary to prevent certain cancers (a claim that is now debunked), my kids would not be here today. Having been through this, it pains me to think of women seeing frozen eggs as an investment in their future, only to discover, once they’re already out of other options, that it’s nowhere near 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 kinds know equally well what it is like to be misled, ignored and undermined by doctors. Sometimes our experiences are very similar and sometimes very different. In either case, there are insights to be learned and shared.
When it comes to reproductive health and choice, we all need better, more ethical and more affordable person-centred care and we are all much more likely to get it if we work together.
Freddy McConnell is a freelance journalist
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