I feel sorry for women who are misled about egg freezing. If I had believed the doctors during my transition, my children wouldn’t be here | Freddy McConnell
YYou can’t have missed the conversations about the rise of egg freezing 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 more options to future parents. The starting point is often the question of whether someone, almost always a rich, heterosexual, white woman, should freeze her eggs as insurance against her ‘biological clock’, career development and/or the risk of not finding a partner with whom to have a relationship in time. to start a family.
Once I noticed the trend, I began to see that the same detail was missing piece by piece: the statistical probability that these frozen eggs would lead to live births. With notable exceptions, the focus is on the affordability and social factors that lead so many more people to choose this treatment, rather than on the discussion of 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 evidence mounts of low fertility rates success rates have 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 appointment at the gender identity clinic in London, with the gap between appointments being around six months and the initial wait time being over a year. The consultant gave me a risk-benefit analysis of starting testosterone (T) injections. The question of fertility came up. Had I looked at fertility preservation in the form of egg freezing? ShitI thought, was that the intention?
“No…?” I offered.
‘Well,’ was the gist of his answer, ‘you can ask your GP if they will reimburse the costs, but that probably won’t happen. It’s terribly expensive and I understand it rarely works.” At the time, I had no idea what exactly it was that rarely worked. In the weeks following my T prescription, I asked my doctor.
I had already made peace with infertility in exchange for any form of future living as my true self. Switching would, I thought, mean losing the ability to get pregnant. The consent form for starting T made the apparent trade-off clear, but I signed it without hesitation, after years of thinking about what this would mean. Furthermore, the tone of the advisor’s advice seemed clear: If you’re really a man, you won’t really care about having children. Actually, you probably want to get that uterus out as soon as possible, right?
My actual feelings about parenthood at the time, which I didn’t bother him with, were ambivalent. I always thought I would definitely have children. Maybe I still would. Adoption, foster care and surrogacy all seemed valid, if purely theoretical, options.
My GP was straight about it: the NHS wouldn’t help me freeze my eggs. And yes, the chance of a live birth from a frozen egg was well under 10% at that time. In fact, I felt relieved that the number was so low that the question of whether the procedure would somehow be self-funded seemed redundant.
That figure of <10% has always stuck with me. Every time I read or hear a piece, it does a somersault in my head, with no mention of what happens later, when those frozen eggs thaw and are no longer answers to questions.
It is important to say that birth rates from frozen eggs have improved. However, according to the British regulator, the Human Fertilization and Embryology Authority (HFEA), they are still lower than the rates for fresh eggs, which between 20% and 30%. In 2016 the UK birth rate per treatment cycle from frozen eggs was 18%.
Coincidentally, in 2016 I discovered that testosterone probably hadn’t made me infertile after all. I discovered this by chance through a YouTube vlog. In the almost eight years since, I have carried and given birth to my two children through artificial insemination and donor sperm. I have also, perhaps unsurprisingly, become interested in researching transgender fertility and our reproductive choices. Needless to say, there is very little research of this kind, including zero empirical evidence that testosterone affects the fertility of trans men. I still don’t know why doctors tell us this is so, but I’m pretty sure it has nothing to do with science.
Before I conceived my youngest via IUI (intrauterine insemination), I tried IVF on my own in hopes of creating multiple embryos from the last bottle of donor sperm I had on ice. I have no fertility problems and was 33 at the time. I have had two thawed embryo transfers. The first didn’t work and the second resulted in a miscarriage at week five. It was a stark reminder that even though things look good on paper, sometimes – statistically in most cases – it just doesn’t work. I’ve frozen a few more embryos, so I know the feeling when that hefty annual storage bill lands in your inbox with a thud.
It’s a relief to see awareness being raised now about for-profit fertility clinics potentially misleading patients about egg freezing data. As a transgender man, I was misled in a different way. I was told I had fewer reproductive options, while others were sold on the idea that there is a surefire way to secure more.
Luckily, I learned my truth before it was too late. If I had gone the standard NHS route and had a hysterectomy, believing that testosterone had made me infertile and that the procedure was necessary to prevent certain cancers (a claim that now debunked), my children wouldn’t be here today. Having gone through this, it pains me to think that women view frozen eggs as an investment in their future, only to discover, when they’re already out of other options, that it’s not nearly that simple.
In both contexts – in all contexts – healthcare providers have an absolute obligation to provide accurate and unbiased information. Nothing should blur these boundaries, whether it’s profit margins or a misplaced desire to police social and gender norms. Women and transgender people of all kinds 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 that can be learned and shared.
When it comes to reproductive health and choice, we all need better, more ethical, and more affordable person-centered care, and we’re much more likely to get it if we work together.