Egg freezing gains traction among elite athletes: ‘There aren’t enough studies on how it affects them’

Elite athletes have been choosing to freeze their eggs on their own for years, when they find a gap during holidays or even while rehabilitating after surgery for an injury. Right at the point when they are focused on winning and setting records, they must ask themselves whether they will want to become mothers, because the peak of their careers coincides with the highest quality of their eggs and the best time to get pregnant. What’s new now is that national teams, leagues, and clubs are beginning to take charge of the process. The Royal Spanish Football Federation (RFEF) is finalizing an agreement with a fertility clinic to offer vitrification treatments to its players, which it will make public in September. In addition, the Spanish Footballers’ Association recently announced a collaboration agreement with a private hospital “to make the experience of its assisted reproduction unit available to members.”

The first soccer club to sign an agreement with a clinic for treatments was Racing Louisville, of Kentucky, in 2021, which committed to covering subsequent cryopreservation costs for players who leave the club. The procedure costs between $2,320 and $4,640, plus medication costs of between $930 and $1,160 and preservation fees of $465 per year. This year, UEFA recommended “including fertility and reproductive treatments in employment policies,” and a few weeks ago Chelsea announced a partnership with a clinic along with a fund to cover “assessments, treatments, and counseling.”

An elite sporting career can begin at 17 and extend to 35 or older. “Previously, women’s soccer was not at today’s level, the current care was not available, and that means players now have more resources; in terms of performance, we are better prepared,” explains Eva Ferrer, a specialist in sports medicine. A former team doctor at FC Barcelona Femení and a member of UEFA’s expert panel on women’s health, she says vitrification has started to be discussed more over the past couple of years, but it is still something relatively new.

“There are not enough studies on how the treatment [ovarian stimulation] could affect, for example, the joints or soft tissue,” Ferrer adds, and that influences how training should be adapted to avoid injuries. She also points out that the medications used must be declared on the therapeutic use exemption form (TUE), so the player is not sanctioned for doping, and that there is not yet full awareness of the issue.

In May, the largest national professional athletes’ union in the world, the Professional Footballers’ Association in England, announced its partnership with a fertility clinic for men and women. In 2024, the U.S. players’ union agreed that it would cover the administrative costs of a management and counseling provider in its collective bargaining agreement, although the treatment itself is covered by the individual’s health insurance. In Spain, the most recent collective agreement for first-division women’s players included some provisions on pregnancy and postpartum, but does not provide for ovarian preservation or fertility assistance.

The treatment to freeze eggs lasts about two weeks. The woman must self-administer injections of hormonal medications that stimulate the ovaries so that, instead of a single follicle maturing, several develop and multiple eggs can be retrieved in the same cycle. Afterward, the doctor performs an ovarian puncture under sedation to extract them. The patient may experience discomfort and bleeding in the subsequent days while the ovaries return to their normal size after stimulation. Clinics recommend collecting around 10 oocytes; otherwise the procedure can be repeated. Risks include ovarian hyperstimulation, in which too many follicles grow uncontrollably, or ovarian torsion, when a follicle twists and compromises blood circulation.

“The medical protocol states that normal life can be resumed, but for a high-performance athlete these are days when you do not perform at the same level: you will not run as fast or at the same intensity,” explains gynecologist Rebeca Beguería, who has accompanied the process for several players. They will feel low on energy and carry an increased risk of injury, and may suffer greater damage from a blow to the abdomen. The doctor, co-founder of the Blivf clinic in Barcelona, explains: “Your body’s blood is redistributed; it is concentrated there; the abdomen and chest are more swollen, there is a tendency to migraines and fluid retention.”

Beyond the sporting world, other companies also cover these treatments for their employees and have been criticized by those who believe they are encouraging women to postpone motherhood to extend their careers. Egg freezing offers a way to avoid interrupting your career, but it also delays pregnancy beyond the ideal age. Specialists emphasize that it is important for all women to learn about both the risks and the benefits of the process.

Sports medicine for women

“Medically, the recommendation is that women get pregnant as early as possible, because biologically we are designed to be mothers by, at most, age 35 and we have extended that,” Beguería explains. Eggs and embryos lose quality over time and there is a much greater risk of complications, hypertension, or diabetes in a pregnancy at 45. The doctor adds: “There is a dissociation between what we should do biologically and what life actually allows, and cryopreservation is the least bad strategy.” The first professional women’s footballer in Spain to give birth and return to play was María Alharilla. She did so in 2021 and is now captain of Levante.

Beguería notes that “sports medicine is trying to gather more information from a female perspective, because until now it has been viewed, diagnosed, and treated based on the male body.” There is a lack of studies on how these hormones influence performance and how they affect ligaments, joints, and muscles. “We need more women on professional teams to support them because the perspective is not the same. Many of them are surrounded by men all day,” the gynecologist emphasizes.TA

The decision of when and how to become a mother sometimes also depends on the sport, because each discipline has a different calendar. The Women’s Tennis Association, which organizes the professional world circuit, last year introduced a rule allowing top-750 players who are out of competition for more than 10 weeks for a fertility preservation procedure to return to the tour with a special entry ranking for the next three tournaments. Clubs in the Women’s National Basketball Association reimburse up to $20,000 annually for such expenses not covered by insurance.

“The world of track and field was one of the first where we saw female athletes become pregnant and return to very high levels of performance,” Ferrer recalls. Being a mother is not incompatible with continuing one’s career, but it was not the norm until recently, and teams still need to adapt to learn how to support this recovery process with its unique challenges. However, there are still more barriers than sources of support for this career break.

Triathlete María Pujol Pérez says that becoming a mother wasn’t part of her plans: “In my prime, I was training at my hardest and dedicating myself entirely — body and soul — to my sport.” She used to do up to four training sessions a day, seven days a week — an average of 30 hours a week. She wasn’t aware of this option until gynecologist Manuel Fernández, director of the Vida Sevilla Recoletas clinic, told her about cryopreservation and guided her through the process. “It’s expensive, but it’s an option for the future,” she says years after becoming the mother of a daughter. For her, it’s still very difficult to get pregnant while competing at a high level: “Almost all the female athletes I know [who have become mothers before retiring] are in their thirties and have already had successful careers.”

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