Vardit Ravitsky argues that elective egg freezing offers an individual solution to a social problem that should be addressed not only through high-tech medical intervention but also through policy change.
Elective or ‘social’ egg freezing is a relatively new option available to younger women who are not yet ready to conceive but wish to increase their chances later in life. In 2012, two important professional societies published clinical recommendations regarding this emerging technique. The American Society for Reproductive Medicine suggested it should no longer be considered experimental, but did not endorse its routine elective use, while the European Society of Human Reproduction and Embryology did not find convincing arguments against its elective use. These recommendations received much media attention, making elective egg freezing a hotly debated social issue.
Egg freezing is a technique that allows long-term storage of eggs in sub-zero temperatures. Although no reliable data are available, it is believed that to date thousands of babies have been born worldwide from previously frozen eggs. This technique is used in infertility treatment when more eggs are retrieved than needed or as a means of medical fertility preservation. In elective egg freezing, this technique is used by healthy and fertile women and may be described as ‘self-egg-donation’, where the young donor and the future older recipient are the same woman.
Elective egg freezing is controversial because it involves an invasive risky procedure performed on a healthy woman, who is not undergoing IVF for fertility treatment. Egg retrieval itself carries risks such as ovarian hyperstimulation syndrome, bleeding and infection and little is known about its long term implications for the woman’s health. These risks must be understood in the context of limited data on how the use of previously frozen eggs impacts the chance of conception and the health of offspring. Some have expressed concerns that the procedure may represent a ‘false promise’ of preserving fertility in the light of current low success rates of IVF in general. The counseling of healthy women considering egg freezing should thus be tailored to their unique context and contain the most updated evidence regarding the medical risks of the procedure and the actual chances of conception in the future.
In Western societies today, where women enjoy a greater level of equality and play a more significant role in the work force than ever before, delayed motherhood has become prevalent. The biologically ideal window of time for reproduction has thus become for many women a practically impossible time to start a family. Indeed, the proportion of women giving birth in their early forties in Canada, for example, has doubled between 1988 and 2008.
In light of current social forces and trends, elective egg freezing is often perceived as a means of promoting women’s reproductive autonomy, allowing them to expand the natural reproductive cycle and to choose motherhood at a time that is appropriate for them. It is also perceived as promoting gender equality by ‘leveling the playing field’ and allowing women to become mothers later in life, a choice that previously belonged only to men. However, this portrayal of the technique overlooks two important elements. First, elective egg freezing is a very expensive option, costing approximately $4000 to $15000 (US) plus an additional cost of medications of $2000 to $4000 dollars, and annual storage fees of around $440. The elevated cost of this option means that while it may level the playing field between men and women, it may create a new type of reproductive inequality between rich and poor women.
Second, the emphasis on elective egg freezing as promoting autonomy and individual choice fails to acknowledge the social context of delayed motherhood. Some speak about “women who have just waited too long to have their children,” implying lack of appropriate planning or self-centered preferences. If delaying motherhood is simply a ‘lifestyle choice’, then the risks and cost involved in elective egg freezing may be perceived as prices women must pay for their life choices. However, this portrayal of elective egg freezing fails to address the tremendous social pressures experienced by younger women to establish themselves before becoming mothers. The strong social message is that to be a responsible mother, a woman should first get an education, establish a career, and attain financial and relationship stability.
In light of these pressures, the choice to delay motherhood must be understood not solely in individualistic terms, but rather in the context of the social reality of today’s Western societies. From this perspective, elective egg freezing should be portrayed as an individual solution to a social problem, a solution that puts the onus on women and fails to address the social dimensions of the problem in terms of policies that would allow women to choose motherhood earlier in life, such as paid maternity leave, subsidized childcare and family-friendly work environments.
Vardit Ravitsky is Associate Professor at the Bioethics Program at the University of Montreal and Director of the Ethics and Health Branch of the Centre de recherche en éthique de l’Université de Montréal (CRÉUM)
Freezing technology may be useful for young women diagnosed with cancer, unless she wishes to live a child-free life or navigate the adoption process. Freezing eggs prior to chemotherapy has been the primary use of egg freezing, as the chemo is likely to destroy the fertility of the ovaries. Once Canadian women have lost their fertility due to cancer, options are limited.
“Some have expressed concerns that the procedure may represent a ‘false promise’ of preserving fertility in the light of current low success rates of IVF in general.”
This statement should be qualified. The IVF low rates occur in a population that is sub-fertile or infertile, and those numbers include women between the ages of 36-45. Lesser medical interventions have failed, as few couples move directly to IVF as their first infertility treatment. Often time multiple problems are at play.
In couples under the age of 35, IVF clinics should achieve a 45-50% implantation success rates. If the clinic is not achieving these rates, something about the clinic is not up to North American standards.
Fresh egg donor cycles implant at a high rate — of about 60-70% per transfer at experienced clinics. Many clinics achieve consistent rates of over 65%. These numbers, per clinic, are published by the CDC and SART.
These high rates make logical sense, as women who are under the age of 35, and are not diagnosed with infertility problems, (endometriosis/ PSOC) are likely to generate high quality eggs.
A young fertile woman, under the age of 35, who is diagnosed with cancer, would have an good chance of preserving her fertility if she freezes her eggs at a experienced clinic. She also might consider the problematics of donor egg cycles in Canada when considering her options.
That said – if the lab is not used to dealing with frozen eggs, that could lower success rates quite a bit. It can be tricky for inexperienced embryologists to work with frozen eggs versus embryos. I do not know which Canadian labs, if any, have expertise in freezing eggs, as opposed to embryos. The expertise and experience of the lab and the embryologist is critical.