Quote · The Peter Attia Drive
#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.
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Elective egg freezing: timing, success rates, the fertility funnel, and the tradeoffs of fertility preservation
At 1:27:40 · chapter starts 1:24:03
Peter opens with the intuitive argument for freezing eggs at 25 — the biological peak — but Tomioka reframes the question with a striking statistic: approximately 90% of women who freeze eggs globally never return to use them, most because they conceive naturally. [1] — Renato Tomioka "90% of women never use frozen eggs: Only about 10% of women who electively freeze their eggs ever return to use them, raising important que…" 1:24:05 This means the expected value of freezing at 25 is diluted by the high probability the eggs are never needed. The cost-effectiveness calculation therefore shifts the sweet spot to around 32 to 35, when the biological cost of waiting is becoming real but most cycles are still productive. The fertility funnel is then walked through step by step: follicles to mature oocytes (75%), fertilization, blastocyst development (30–60% of day-1 embryos), and aneuploidy screening — each step a multiplier of small numbers. A 25-year-old may start with 15 retrieved eggs and end up with a roughly 80% chance of at least one live birth — which Peter notes still seems surprisingly low. A 40-year-old starting with 8 eggs faces a far grimmer calculation: after the funnel, she may have zero or one euploid embryo. Tomioka personalizes this with the story of a patient who froze at 34, returned at 40, and found a single blastocyst that failed to implant. The cost breakdown in Brazil ($5,000 per cycle, roughly $1,650 per third across medication, procedure, and lab) and Israeli policy (unlimited state-funded IVF) bracket the access discussion.
Only about 10% of women who electively freeze their eggs ever return to use them, raising important questions about the cost-effectiveness and timing of egg freezing.
Despite biological arguments for freezing at 25, cost-effectiveness analysis suggests the optimal age for elective egg freezing is around 32 to 35.
At 40, a typical stimulated cycle yields around 8 eggs. After maturity rates, fertilization, development to blastocyst, and aneuploidy screening, you may be left with one or zero usable embryos. IVF isn't a guarantee — it's a multiplication of small probabilities that gets harder with every passing year.
