Egg Freezing: Empowering, or Are We On Thin Ice?

Kathleen Reeves

A woman in her twenties who doesn’t want to have a baby yet is fine with us, but a woman in her late thirties seems to be a different story.

Rachel Lehmann-Haupt, the author of In Her Own Sweet Time: Unexpected Adventures in Finding Love, Commitment, and Motherhood, spoke about her decision to freeze her eggs on NPR’s "Talk of the Nation" yesterday. Lehmann-Haupt has seen both sides of the debate over egg freezing—she first decided not to do it, at age 35, and then reconsidered two years later.

While egg freezing was invented by scientists at the University of Bologna, in Italy, in the eighties, it didn’t receive a great deal of attention in the United States until a company called Extend Fertility began offering the technology in 2003. Lehmann-Haupt was wary of the promotion of the technology as “a source of empowerment,” not because she doesn’t think it’s empowering, but because she was skeptical of the relationship between Extend Fertility and its potential customers, as she says in her book, an excerpt of which appears in this week’s Newsweek:

I wondered if this new company was too aggressively trying to cash in on well-heeled women’s anxiety by turning them into guinea pigs and, more broadly, whether women should rely on technology to postpone motherhood.

Lehmann-Haupt decided not to freeze her eggs at this first encounter with the company, but after two years and a failed relationship, she flew to Italy to look into the procedure again. Her discussion with one of the Italian doctors who developed oocyte cryopreservation is one of the most interesting parts of her story. The technology was invented as an alternative to freezing embryos, which was nixed by the Catholic Church in Italy, and what it’s developed into—a way to extend fertility—has divided the doctors who were its creators. Dr. Raffaella Fabbri, a biologist, supports its commercial use, while Dr. Eleanora Porcu, whom Lehmann-Haupt describes on the NPR segment as “of an older-fashioned Italian culture, Catholic” does not. Dr. Porcu argues that egg freezing is anti-feminist:

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"It means that we’re accepting a mentality of efficiency in which pregnancy and motherhood are marginalized," she says. "We’ve demonstrated that we are able to do everything like men," she continues. "Now we have to do the second revolution, which is not to become dependent on a technology that involves surgical intervention. We have to be free to be pregnant when we are fertile and young."

We’re in a bad way, Porcu seems to be saying, if we are forced to fight against our biology. Callers on “Talk of the Nation,” all women, echoed this idea. One caller who called herself a pro-choice feminist and who adopted around the age of 40 said emphatically, “Biology works. There’s a reason why, when you get past a certain age, it’s really, really hard, actually, to be a mother, and maybe that time has passed.”

Is egg freezing received differently in our culture than other biology-tweaking technologies like the birth control pill or IVF because it’s newer, and we just haven’t gotten used to it, or because extending your fertility is less savory, somehow, than postponing it? A woman in her twenties who doesn’t want to have a baby yet is fine with us, but a woman in her late thirties seems to be a different story.

Another caller, a family physician, said she had twins naturally at age 36, and in the next breath argued that “the older you are the more high-risk your pregnancy is,” which is exactly how someone may have chided her twenty or thirty years ago for getting pregnant at age 36. As Lehmann-Haupt points out, the number of women having children between the ages of 35 and 44 has doubled since the eighties.

Lehmann-Haupt agrees that the workforce should be much more amenable to motherhood. But she defers, finally, to individual choice.

The debate has a socioeconomic dimension, of course, which complicates things. Whereas contraception is affordable and accessible to many women in the United States, egg freezing, at 15,000 dollars, is not. But fertility and reproduction is, more and more, socioeconomically fraught. Discussing other fertility options with one caller who’d had a hysterectomy, Lehmann-Haupt said, sounding slightly uncomfortable:

“It’s quite surreal, but people are beginning to, actually, outsource wombs to India these days.”

“Huh!” the caller said, interested.

As women who cannot or choose not to have children during their fertile years explore other options, someone, somewhere will find these other options to be unnatural or troubling. Egg freezing is only the latest technology to challenge our ideas about biology and choice.

Roundups Sexual Health

This Week in Sex: Some Men Base Condom Use on Women’s Looks

Martha Kempner

This week, a study suggests some men are less likely to have safer sex with women whom they find attractive. There's now a study of women's pubic hair grooming habits, and a lot of couples don't have wedding-night sex.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Men Less Likely to Have Safer Sex If Partner Is ‘Hot’

The old adage “Never judge a book by its cover” is apparently easily forgotten when it comes to judging potential sex partners. A new study in BMJ Open found that men said they were less likely to use a condom if their potential partner was hot.

In this small study, researchers showed pictures of 20 women to 51 heterosexual men. The men were asked to rank how attractive the woman was, how likely they would be to have sex with her if given the opportunity, and how likely it was they would use a condom if they did have sex with her. The results revealed that the more attractive a man found a woman, the less likely he was to intend to use a condom during sex with her.

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Men also rated how attractive they consider themselves, and the results showed that this was also related to condom use. Men who thought of themselves as more attractive were less likely to intend to use a condom.

Researchers also asked the men to estimate how many out of 100 men like themselves would have sex with each woman given the opportunity and finally, how likely they thought it was that the woman in the picture had a sexually transmitted infection (STI).

The results of these two questions turned out to be related: The men assumed that women whom other men would want to sleep with were more likely to have STIs.

This did not make the men in the study any more likely to intend to use a condom with those women. In fact, the men were most likely to intend condom use with women they found less attractive, even though they considered these women less likely to have an STI.

This was a small study with a relatively homogenous group of men ages 18 to 69 near Southhampton, England, and it measured intention rather than behavior.

Still, the results could present a challenge for public health experts if men are making condom decisions on a broader scale based on attraction rather than risk assessment.

How and Why Women Groom Their Pubic Hair

A new study published in JAMA Dermatology is the first nationally representative survey of U.S. women’s pubic hair grooming habits. The study included more than 3,300 women ages 18 to 64.

Overall, 84 percent of women had engaged in some pubic hair grooming. Pubic hair grooming was more common among younger women (ages 18 to 24); among white women; and among women who had gone to college.

Before you start thinking everyone is out getting Brazilians, however, grooming means different things to different women. Only 21 percent of women said they took all their pubic hair off more than 11 times, and 38 percent of women say they’ve never done so. Moreover, waxing lags behind the most popular hair removal methods; only 5 percent of women say they wax compared with 61 percent who shave, 18 percent who use scissors, and 12 percent who use electric razors. (Respondents could choose more than one answer in the survey.)

Most women (93) do it themselves, 8 percent have their partners help, and 6.7 percent go to a professional.

The researchers were most interested in the most common reason women groom their pubic hair. The most common reason was hygiene (59 percent), followed by “part of my routine” (46 percent), “makes my vagina look nicer” (32 percent), “partner prefers” (21 percent), and “oral sex is easier” (19 percent).

Tami Rowen, the lead author of the study and a practicing gynecologist at the University of California, San Francisco, told the New York Times, “Many women think they are dirty or unclean if they aren’t groomed.”

But while people may think that, it’s not true. Pubic hair actually exists to help protect the delicate skin around the genitals. Rowen and other doctors who spoke to the Times believe that women, especially teenagers, are taking up grooming practices in response to external pressures and societal norms as reflected in images of hairless genitals in pornography and other media. They want young people to know the potential risks of grooming and say they’ve seen an increase in grooming-related health issues such as folliculitis, abscesses, cuts, burns, and allergic reactions. As some may remember, This Week in Sex reported a few years ago that emergency-room visits related to pubic hair grooming were way up among both women and men.

This Week in Sex believes that women should be happy with their genitals. Keeping the hair that grows does not make you dirty—in fact, it is there for a reason. But if shaving or waxing makes you happy, that’s fine. Do be careful, however, because the doctors are right: Vulvas are very sensitive and many methods of hair removal are very harsh.

Wedding-Night Sex May Be Delayed, But That’s OK With Most Couples

Summer is a popular wedding season, with couples walking down the aisle, exchanging vows, and then dancing the night away with friends and families. But how many of them actually have sex after the caterer packs up and the guests head home?

According to lingerie company Bluebella—about half. The company surveyed 1,000 couples about their postnuptial sex lives and found that 48 percent of them said they did “it” on their wedding night. Most women in those couples who did not get it on that night said they were just too tired. The men, on the other hand, said they were too drunk or wanted to keep partying with their friends. (It is unclear whether the survey included same-sex couples.)

By the next morning, another 33 percent of couples had consummated their marriage, but about 10 percent said it took 48 hours to get around to it.

But whenever couples did have that post-wedding sex, the overwhelming majority (84 percent) said it lived up to their expectations.

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.