Women leave jobs at mid-career in tech at higher rates than those in other fields. It's possible that benefits like egg freezing can improve female retention, but the procedure remains controversial.

Video: Egg-freezing is controversial but may keep more women in tech Watch Now

At Brigitte Adams' last job in tech, an office lactation room was turned into a prayer room. "There were no pregnant women at the company, ever," she said. "I was surrounded by men in engineering departments. You didn't see other women."

In the summer of 2011, Adams had just left a multinational corporation to become a consultant. She was 39 years old and not yet married, and began thinking about making plans for a future family. "It was sort of a typical scenario of a single career woman who really wanted kids," she said. Being a tech-minded person, she turned to a procedure that was at the time still labeled experimental: Egg freezing. Also known as oocyte cryopreservation, egg freezing is a process in which a woman's eggs are extracted, frozen, and stored for future use, as a way to preserve their reproductive potential.

It's been nearly three years since news broke that Apple and Facebook were offering egg freezing as part of their employee benefits packages, and a number of other tech companies have since followed suit. As more and more women in tech opt to undergo the procedure to improve their chances of pregnancy down the road, the question remains: Will egg freezing keep women from leaving the tech industry?

"For every woman I've talked to, and for myself, it's giving us more options," Adams, now 44, said. "As a woman, our span of finding the job, finding the mate, and getting a nest egg is just so compressed now that unless things work out perfectly and you meet the guy, for so many women, we're finding ourselves in our late 30s just sort of looking around saying, 'Why isn't this happening for me?'

"I think Apple and Facebook just brought to light that there are so many women dropping out of the workforce because they can't juggle it all."

It's no secret that there are a dearth of women in tech. In 2015, while women held 57% of all professional occupations, they only held 25% of all computing occupations, according to the National Center for Women & Information Technology, which collected several studies on the subject. Those numbers are even lower for women of color: Latinas hold only 1% of computing jobs, and black women hold 3%.

While 80% of women in science, engineering, and technology report "loving their work," 56% leave their organization at the mid-level point in their career, according to the Center for Talent Innovation.

One study found that about 50% of women in STEM fields--primarily computing and engineering--left their jobs after 12 years for other roles or time out of the workforce, compared to only 20% of women in other professions. Women in STEM also were more likely to leave their jobs in the first few years of their career than women in non-STEM jobs.

Women exit these lucrative jobs for a number of reasons, including workplace environment, lack of growth opportunities, and, to a lesser degree, raising children. Only 20% of women who left large private sector companies did so to take time out of the workforce--and evidence suggests that many of these women would not have left had there been more on- or off-ramping options, or more support for competing life priorities, according to the Center for Talent Innovation.

"From a tech perspective, any little thing that can help keep women in the workforce and feeling a sense that they have options is a great thing," Adams said. "It's just one more thing to almost get us up to that equal playing field. If sperm degenerated faster, I think we'd be having a different conversation."

Just 3% of all US companies covered egg freezing in 2016, according to the Society for Human Resource Management. In comparison, about 26% of enterprises offered in vitro fertilization coverage. But tech companies are at the forefront: Along with Apple and Facebook, Google, Uber, Intel, Spotify, and Salesforce now offer egg freezing and other fertility benefits.

A number of these companies faced backlash for offering egg freezing as a benefit, as critics feared that the true reason for the provision was to keep young women working at their desks longer.

"I don't think it's the cynical thing, that they want to keep their people working and delaying having children," said Dr. Carolyn Givens, medical co-director of the Pacific Fertility Center in San Francisco. "I think they're trying to compete for employees, and this is just another benefit that can set them apart from their competitors."

Adams cringes at the depiction of women who choose to freeze their eggs as business-driven manipulators of Mother Nature. "There's a misconception that we're all career mad," Adams said. "When you really look at it, there are so many women in this position that don't want to be in this position, but they're doing it as a safeguard."

In 2012, Adams founded the website Eggsurance, which offers egg freezing information, facts, and community, to better inform women about the process.

"It's hard to do it all," Adams said. "I would have loved to have been in a relationship. I would have loved to have had kids earlier. It didn't happen for me. What egg freezing did was give me some time to figure some things out."

Image: Pacific Fertility Center

Growing numbers

Egg freezing is expensive: An average cycle, which includes hormone stimulation, egg retrieval, and lab processing, costs around $16,000. There are additional costs to store the eggs for later use. And many women choose to undergo two or three cycles to retrieve more eggs for better odds for a later pregnancy.

According to the Society for Assisted Reproductive Technology (SART), almost 5,000 women in the US froze their eggs in 2013--up from just 500 in 2009. By 2018, fertility marketer EggBanxx estimates that some 76,000 women will elect to freeze their eggs. The majority of women who electively freeze their eggs are in their 30s, live in cities, and are white, the doctors interviewed for this story said.

FertilityIQ, a website aimed at assessing fertility doctors and clinics, estimates that 10,000 women completed between 25,000 and 30,000 egg freezing cycles in 2016, and that the volume is growing 30% year-on-year in New York, San Francisco, Boston, Chicago, and Los Angeles.

For many years, the only people freezing their eggs were cancer patients about to undergo chemotherapy that would destroy any chances of fertility, according to Dr. Alan Penzias, chair of the Practice Committee of the American Society For Reproductive Medicine (ASRM), and director of the Fellowship Program in Reproductive Endocrinology and infertility at Harvard Medical School.

These patients were the primary driver for the ASRM to remove the "experimental" label from egg freezing in 2012, along with growing data showing healthy babies being born from these frozen eggs.

However, the ASRM stated that its decision to drop the experimental label does not mean that it encourages the procedure for women without fertility issues.

Still, Dr. Marcelle Cedars, director of the Center for Reproductive Health at the University of California San Francisco Medical Center, said she has seen increasing numbers of women across all industries electing to freeze their eggs, and that the age is skewing younger, with more women in their late twenties and early thirties coming in. Women in their mid-to-late thirties are increasingly undergoing the procedure as well, she said. Cedars estimates that the center's volume rose from less than 100 patients to around 250 over the past few years.

"The advantage of doing it sooner is that the eggs are more likely to be healthy, and you need less eggs to get a viable pregnancy," Cedars said. "The potential downside is that for most of the young women, it's a very good chance that they'll never use those eggs."

The process generally works like this: A woman goes to a fertility doctor for an evaluation. The doctor determines their ovarian reserve, or the number of follicles they have available each month, and counsels the woman on the number and health of her eggs.

If the woman elects to move forward, she goes through 10 to 12 days of self-administered hormone injections. At the end of that time frame, the eggs are ready for retrieval. The woman is given a mild anesthetic, and the doctor extracts the eggs via a vaginal ultrasound probe. The retrieval only takes about 10 minutes.

Typically, women only need to take one day off of work for the procedure. For about two to three weeks after, they are not allowed to exercise, but can generally go back to normal life. If they want to do a second cycle, they can start the process again as early as one month later, and a third cycle the month after that, if they so choose.

"For women who are young and healthy, it's sometimes more difficult because it is something totally new for them--they're used to being healthy, they're not used to seeing doctors, and they're not used to having restrictions on their activities," Cedars said.

SEE: Egg freezing, so hot right now (CNET)

Expansion in tech

Though many tech giants now offer egg freezing benefits that are ostensibly meant to attract and retain female employees, most of them are very quiet about it, said Jake Anderson-Bialis, cofounder of FertilityIQ.

"Nobody wanted there to be a whole lot of publicity about this," Anderson-Bialis said, especially after the negative reaction that Apple and Facebook's news provoked from many in the media.

"At Facebook, Google, Apple, and now Uber, you see female employees freezing their eggs at a pretty quick clip now," Anderson-Bialis said. One reason companies may hesitate to announce these benefits is because they are expensive. Some also offer fertility benefits only to certain employees, such as heterosexual couples but not gay couples, or couples but not single women, and don't want to invite scrutiny, Anderson-Bialis said.

The tech industry far exceeds others when it comes to generous fertility benefits packages, according to research from FertilityIQ. Tech companies offered benefits nearly 35% higher than their peers across other industries--even relatively smaller businesses like Spotify, Gusto, and Wayfair.

When companies offer any sort of fertility benefit, including egg freezing, employees have higher levels of gratitude and loyalty to the company, according to research from FertilityIQ. "When we looked at fertility benefits in general, a majority of patients who enjoyed fully covered fertility treatments said they were more loyal to the company, and stayed in their job longer than they otherwise would have if this benefit had not been in place," Anderson-Bialis said. "I think that's a major driving factor for the companies to make the decision that they do--to satisfy the employee."

It is still too early to do a cost-benefit analysis on the egg-freezing perks announced by Apple and Facebook in 2014, according to a paper published in the DePaul Journal of Women, Gender and the Law earlier this year. But a 2015 survey from Reproductive Medicine Associates of New Jersey found that 68% of US adults aged 25 to 40 said they were willing to change jobs to ensure they had infertility coverage. That number jumped to 90% of those who had experienced fertility issues.

Jean (whose name has been changed), a 38-year-old who works at Google, was unaware the company offered egg freezing until Dr. Givens, who she knew socially, brought it up to her. "I'm not married, never had kids, and had never really considered freezing my eggs until I was chatting with Dr. Givens," Jean said. "That got me thinking, 'Well, if it's a benefit...' since the most prohibitive part of it is cost. And so I started looking into it to see if it was something I wanted to do.

"At this point, I don't even know if I want to have kids. I haven't made that decision yet," Jean said. "But when the time comes, I may not have that option naturally, so I wanted to do this so that it can still be an option for me."

Jean underwent three cycles in 2016, and Google covered the vast majority of the procedure, she said. "It's an amazing benefit," Jean added. "It definitely beat a lot of the more fluffy benefits--team outings and things like that will only do so much. But this type of benefit is one that makes you believe the company truly values their employees."

Google declined to comment for this story.

"It gives me freedom," Jean said. "I don't even know if I'll end up using them. But I like that it relieves the stress that a lot of women go through getting to a certain age, and removes that timing from a consideration of who I date or my career choices. I don't have to consider that aspect anymore."

Image: Center for Reproductive Health at the University of California San Francisco Medical Center

Success rates

Since egg freezing is a relatively new procedure, there is little research on its safety and success.

The chance that any individual frozen egg will lead to a birth is about 2% to 12%, according to the ASRM. This low number tends to surprise patients, Cedars said.

Pregnancy rates are highly dependent on how old the woman is when the eggs are retrieved, and how many eggs were retrieved. While there is no comprehensive data on live birth rates from elective egg freezing, SART found that of the 414 egg thaw cycles in 2013, 99 babies were born, representing about 24%. However, some of these eggs may have been frozen using an older method, which has a lower success rate.

One of the biggest misconceptions is that there is a specific number of eggs you can freeze that will guarantee you have a baby, Penzias said. "Certainly having more eggs frozen gives you a better chance than having fewer, but biology is subject to vagaries we are always trying to figure out," he said. "We would never want somebody to walk away believing that no matter how many eggs are frozen, it guarantees having a child."

Adams only underwent one cycle of extraction. She was paying for the procedure out of pocket, and said that her doctor did not counsel her to complete a second or third cycle. From the 11 eggs she froze, only one viable embryo was created upon thawing.

"That was the hardest news I ever got," Adams said. "At 44, there's no way of going in and retrieving more eggs. You have to remember that this is not a guarantee, it's a possibility. When I went into it, I was very aware of that, and was willing to take the gamble. Now that I'm in the midst of it, it's very hard. I've seen so many women get pregnant with their frozen eggs--it was sort of an expectation."

In a March blog post on Eggsurance, Adams shared some heart-wrenching news.

"I was told on Saturday that I was pregnant. I was told on Tuesday the embryo had died," she wrote. "I have no more eggs to try. I have no more eggs to retrieve. I have no energy to try again. I am mourning the loss of a baby and the loss of ever having a biological child."

Stories like this make it important for women to be educated and prepared for the realities of egg freezing, Cedars said. Because doctors only focused on patients with cancer or fertility problems for so long, the increase in elective egg freezing spurred in part by tech company benefits requires a new way of thinking. "This is a group that comes in thinking they're doing something proactive for themselves, and I think we have realized that we need to counsel them a bit differently because they are a healthy patient population doing an elective procedure," she said.

Family-focused benefits

Even with the lifting of the experimental label, "there has not been additional evidence produced, or studies done on the safety and efficacy of egg freezing," said Marcy Darnovsky, executive director of the Center for Genetics and Society. "We have a lot of anecdotal evidence that there are problems, and we don't have the kind of studies you would expect for a procedure that so many women are undergoing."

Tech companies who want to retain female employers should instead look to their workplace policies, Darnovsky said. For example, offering parental leave, creating a culture that does not penalize women for taking time off to care for a newborn, and providing a work/life balance that allows time to grow relationships with potential partners and families would all support women and families, Darnovsky said.

"All those types of things would be far better insurance for women who want to have families than a technique that, for that purpose, remains experimental, is risky for women, and may be risky for the children who might ultimately be born," Darnovsky said.

In 2016, Intel expanded its fertility benefits to include egg freezing and storage of egg, embryo, sperm, and cord blood, according to Danielle Brown, Intel's former vice president of human resources and chief diversity and inclusion officer. That year, the company also quadrupled its fertility benefits coverage, increasing it from $10,000 to $40,000 for medical services, and $20,000 for prescription expenses. The benefits were announced formally to employees and the public.

"We made these changes to help our employees reach all of their goals, not just work goals, by reducing the significant financial burden of fertility treatment," Brown said. "Offering egg freezing is another way for us to give employees choices and flexibility in deciding when to start a family while pursuing their careers."

She also noted that the company offers many programs for working parents, including eight weeks paid bonding leave, doubled reimbursement for emergency backup child care, and near-site child care centers.

In August 2016, human resources startup Gusto became the first company in California to offer full fertility benefits to all employees, including LGBT workers and their same-sex partners. The company eliminated the need for a medical diagnosis of infertility for its employees to get fertility treatments covered, said Katie Evans-Reber, a member of the People team at Gusto. About 10 employees have used the benefits so far, she said.

"It helps with retention, and helps us demonstrate the care that we have for mothers and families in general," Evans-Reber said. "I think when Facebook and any other business giant did it, there was some sort of backlash, and it was perceived in the Valley as wanting to keep folks at their desk longer and put off having a family. We don't view it like that at all. We want you to have a family, so we're just as encouraging to our parents and new parents in particular."

Image: Extend Fertility/Rick Wright Photography

Opening the conversation

Dr. Givens of the Pacific Fertility Center said her practice has seen a 50% increase in the number of egg freezing cycles in the past year, with about 300 completed procedures. She is also seeing more interest from younger women.

The increase is largely due to buzz and word of mouth, Givens said, particularly in cities like San Francisco, New York, Chicago, and Los Angeles, where there are a lot of thirtysomething professional women who are still single. "When half of your friends are freezing their eggs, you're going to feel like, 'Maybe I should be doing this,'" Givens said. "And then when the companies start covering it, then it almost becomes a no-brainer."

"News of employers offering it in their benefits has opened doors for conversation on the topic that really hasn't happened before," said Ilaina Edison, CEO of Extend Fertility in New York City, a clinic that offers egg freezing exclusively. "It's moving from something that used to be taboo to something that's much more openly discussed amongst groups of women."

Meg, a 29-year-old tech company cofounder in New York City, had been thinking about freezing her eggs for years. When she felt ready to explore the procedure more seriously, she posted on Facebook, "Where should I get my eggs frozen in NYC?"

"One of the beautiful things about technology, especially social networks, is that we have more conversations about everything," Meg said. "For me it was similar to asking 'What Italian restaurant should I go to in my neighborhood?'"

Meg began the injections, slipping away to take them in the bathroom after giving a keynote talk at a conference, and doing the same even while out on a date. The hormones made her body feel uncomfortable, she said, but she didn't feel that her life had to change much while undergoing it. She paid for the procedure out of pocket.

Jamie, 37, works at a small tech company in San Francisco. She froze her eggs in February, after a coworker went through the process. "We're about the same age, and we've gone through the battles of trying to find love here in the Bay Area, and just not getting there as quickly as we wanted," Jamie said. "I started really thinking about it and recognizing that I'm 37, I'm still single--how much do I want a family, and what steps should I take so that I don't ever have regrets?"

She went to a doctor in November 2016 for an initial screening. Her January work schedule was busy, so she decided to go through the process in February 2017. "The procedure itself was easy," she said. "I took a day off work for it, and the next day I was in the office at 7:00 am."

Jamie said she didn't anticipate how emotional the experience would be. The hormones made work feel more overwhelming than usual. "I was so attached to [the eggs] developing and being the best they can be because these could be my potential children," Jamie said. "You want it to be successful."

She paid for the procedure out of pocket, with help from a government 340B program, which covered a majority of the prescription costs.

Jamie recently took on more travel for work. "I feel more comfortable saying yes to that travel because I'm like, 'OK, you gave yourself a couple more years to be able to find that person,'" she said. "If I didn't do this, I probably would be pushing back on some of this travel to get out there and date. I'd still be under pressure."

A number of Jamie's friends in their late 30s working in tech are considering freezing their eggs, she said. "There is this pressure on you, because we're all moving into bigger roles from where we started out," she said. "We're seeing ourselves progress to VP or director-level positions, where we can't take the brakes off too much, but we also want to be able to achieve some of those life goals too, and try to find a balance."

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