Ice, ice, baby: Is freezing the answer to your biological clock?

Dear Dr G,

World Population Day has prompted me to think about the growing fertility crisis that seems to be affecting women around the world.

Everywhere I read about women having difficulties with infertility.

As someone in my early thirties who is still focused on building a career and has yet to find the right life partner, I can’t help but wonder whether I am unknowingly running out of time.

We are constantly reminded that a woman’s fertility declines with age, especially after the mid-thirties.

This leaves many of us feeling anxious and pressured, as though we have to choose between our personal aspirations and the hope of becoming mothers.

I’ve heard more people talking about egg freezing as a way of preserving fertility.

I am hoping to put Dr G on the spot for such an “insurance policy”,

Is it true women are having a fertility crisis? If so, what are the causes?

Could you explain who should consider egg freezing?

How successful is the procedure in helping women achieve pregnancy later in life, and what factors influence those success rates?

Are there any significant risks associated with the hormone injections, the egg retrieval procedure, or long-term storage of the eggs?

Thank you for taking the time to address this important topic.

Yours truly,

Freezing Freda

Nations across East Asia, Europe and increasingly Southeast Asia are witnessing record-low fertility rates. In Malaysia, the total fertility rate has fallen below the replacement level of 2.1 children per woman, mirroring trends seen in Singapore, South Korea, Japan and much of the developed world. For many women, this is not simply a matter of choice. It reflects the realities of modern life. Women today are better educated than ever before, have greater career aspirations, and often spend years establishing financial stability before considering motherhood. At the same time, many delay pregnancy because they have not yet found the right partner. Unfortunately, biology has not evolved as quickly as society. While careers can be postponed and opportunities revisited, ovarian ageing continues relentlessly.

Female fertility begins to decline gradually around the age of 30, with a more noticeable drop after 35 and a rapid decline after 40. Unlike men, who continue producing sperm throughout life, women are born with all the eggs they will ever have. Approximately one to two million immature eggs are present at birth. By puberty, only around 300,000 remain, and fewer than 500 will ever be ovulated during a woman’s lifetime. Both the number and quality of eggs diminish with age. The fertility crisis has therefore become increasingly common. Around one in six couples worldwide will experience infertility at some stage of their reproductive lives. Delayed childbearing is now recognised as one of the leading contributors. However, age is only one piece of the puzzle.

Modern lifestyles also play a significant role. Rising rates of obesity can interfere with ovulation through hormonal imbalance, while being underweight can equally disrupt menstrual cycles. Smoking accelerates ovarian ageing and reduces the number of viable eggs. Excessive alcohol intake, recreational drugs and exposure to environmental pollutants, including endocrine-disrupting chemicals found in plastics and certain pesticides, have all been implicated in impaired fertility. Chronic stress, poor sleep, sedentary lifestyles and highly processed diets may further compromise reproductive health. Medical conditions such as endometriosis, thyroid disorders and previous pelvic infections also contribute significantly to infertility.

For women who know they are unlikely to start a family until later in life, egg freezing has emerged as an increasingly attractive option. Advances in vitrification, an ultra-rapid freezing technique introduced over the past decade, have dramatically improved the survival of frozen eggs after thawing. Egg freezing begins with hormone injections over approximately 10 to 12 days to stimulate the ovaries to produce multiple mature eggs. These eggs are then retrieved through a minimally invasive procedure. Mature eggs are immediately frozen and stored in liquid nitrogen at extremely low temperatures, where they can remain preserved for many years without significant deterioration.

Like any medical procedure, egg freezing carries potential risks. Most women tolerate ovarian stimulation well. Ovarian hyperstimulation syndrome, once a major concern, is now uncommon because of improved treatment protocols. Egg retrieval itself carries small risks of bleeding, infection or injury to surrounding organs. However, egg freezing is not a guarantee of future motherhood. It is better described as fertility preservation rather than fertility insurance. Success depends on several factors, particularly the woman’s age at the time of freezing and the number of mature eggs successfully stored. A woman who freezes 15 to 20 eggs before the age of 35 has a significantly higher chance of achieving at least one live birth than someone freezing fewer eggs at 40.

The biggest challenge may not be medical but psychological. Some women may develop a false sense of security, believing that frozen eggs guarantee pregnancy regardless of future age. In reality, pregnancy still depends on successful fertilisation, embryo development, implantation and the woman’s health when she eventually attempts conception. Moreover, pregnancy at an older maternal age carries increased risks such as hypertension, gestational diabetes and preterm birth, irrespective of the age of the eggs.

Egg freezing is undoubtedly one of the most important advances in reproductive medicine, but it is not a substitute for biology. It offers women greater choice and greater control over their reproductive future, yet it cannot completely stop the biological clock. The earlier women understand their fertility and the options available to them, the better equipped they will be to make decisions that align with both their personal aspirations and their dreams of parenthood. As the American author Maya Angelou wisely said, “Do the best you can until you know better.” For women navigating today’s fertility challenges, knowledge is the most powerful form of reproductive freedom. Women contemplating freezing their fertility for future motherhood often put Dr G on the spot for an opinion; his view is: “When you are already thinking of fertility, your instinct is already guiding you!”