So-called ‘social’ egg freezing is on the rise, thanks to technological advances and the commercial realisation of financial gain. Unfertilised egg freezing was previously a desperate option considered by girls and women about to undergoing chemotherapy and seeking to preserve their fertility.
However the impetus for change came in 2012 when the procedure was declared to be no longer experimental by the American Society for Reproductive Medicine. By 2014, Facebook and Apple were offering egg freezing as a company ‘benefit’.
Egg freezing is a medical solution to a social problem, which doesn’t address the underlying causes of older motherhood
According to data released by the human fertility and embryology authority (HFEA) in the UK, there are now over 60 clinics currently offering this procedure, and there were over 800 patients in 2013, with the greatest number of treatment cycles undertaken by women aged 38-39. It is not known how many of these women froze their eggs for social rather than medical reasons, but the rise in demand is striking.
The technology is a modification of in vitro fertilisation (IVF), where women inject themselves on a daily basis with very large doses of fertility hormones so that they produce many eggs in a single cycle, known as super ovulation. These eggs are invasively extracted from the ovaries, and rather than being fertilised with sperm and re-transplanted as with IVF, the unfertilised eggs are frozen.
Ice crystal formation inside eggs has previously curbed the technique, however a new technology called vitrification avoids this, with eggs dehydrated and then snap-frozen in liquid nitrogen. To date, only a small number of babies have been born in this way in the UK, but early signs suggest they develop normally and healthily.
Over-hyped statistics are dismal, not empowering
Conceptually, empowerment and the ability to make informed decisions are closely connected. If egg freezing is truly empowering for women, central to this is the ability to weigh the success rate of the procedure in producing a pregnancy against the risks.
A 16% success rate of achieving a pregnancy is likely an overestimation
Health professionals have a good understanding of the risks involved -- vaginal bleeding, soreness, bruising and cramping, and in rare cases, a potentially lethal condition called ovarian hyperstimulation syndrome.
Alarmingly, given that the number of clinics offering the procedure, the success rate is far from clear, and is highly controversial. If you perform a simple internet search for egg freezing, you will be met by a wall of private health companies with a financial interest in promoting this new technology, presenting over-hyped data from the healthiest, youngest patients, with no two companies presenting data in the same way.
A rough estimate, obtained using HFEA data suggests pregnancy occured at a rate of 16% per cycle attempted in 2014. This figure however comes from all women, including young women undergoing the procedure for health rather than social reasons. It is known that eggs become less viable with age, and with the majority of women considering social egg freezing aged over 35 years old -- 16% is likely an over-estimation for these women.
“The technology is still so new and the data we have to date is from very young women. But as we know, this technology will be used increasingly by women in a very different age group,” Dr. Channa Jayasena, Clinical Senior Lecturer and Consultant in Reproductive Endocrinology and Andrology at Imperial College and Hammersmith Hospital warns.
With the technology marketed as an insurance policy for women, it is questionable how many women would opt for £4,000 (the approx. cost per cycle) of personal insurance in the knowledge of a 16% chance of the insurance company paying out.
Surely the philosophy of do no harm should be the guiding principle
An important ethical difference between IVF and social egg freezing is that with IVF, a pathology is being treated. With egg freezing for social reasons, the women undergoing this invasive procedure are perfectly healthy, their only condition often being desperation.
“Super ovulation is a great technology but it’s not without its risks. No two women react the same,” Jayasena said.
Along with the physical risks, the procedure requires both a heavy time and emotional investment, effectively handing over your body to science. In many cases, the women are emotionally vulnerable and driven by the strong desire to increase their chances of having genetically-related children.
The ability of health providers with a commercial interest to provide truly impartial advice to women is questionable.
“It’s a massive concern,” Jayasena tells me.
“The benefits are just not clear, but this [lack of knowledge of the benefits] is fairly low-profile on the websites of many commercial providers”.
When the risk to benefit ratio is not known -- and for some older women approaches zero -- one would hope that the medical profession’s philosophy of 'primum non nocere' or do no harm is the guiding principle of private fertility clinics. Yet in the early days of this technology, and without transparency in terms of the data, this cannot be guaranteed.
Jayasena is particularly concerned about this lack of regulation on egg freezing to date.
“What concerns me is that technology is moving so fast, and legislation cannot keep up with it. There needs to be some regulation to ensure women go into this informed. A mandatory counselling period, as with other procedures with profound risks, would be helpful,” he said.
A medical solution to a social problem
Kylie Baldwin is a sociologist at De Montfort University in Leicester. Her research is focused on examining the reasons behind egg freezing for non-medical reasons. She is concerned that egg freezing does not address the underlying problems faced by women in today’s society.
“Egg freezing is a medical solution to a social problem, which doesn’t address the underlying causes of older motherhood,” Baldwin said.
Her research, which involved interviewing women who had chosen to undergo the procedure, revealed a number of perceived barriers to motherhood, which made egg freezing an attractive option. Lack of job security, fear of maternity discrimination in the workplace, and the absence of an appropriate partner were all major reasons, with almost 90% of the women not in a relationship at the time of undergoing egg freezing.
More women are in full-time employment than ever before. While the UK government is making efforts to address the challenges faced by mothers in employment, with more flexible working hours and working tax credits, the sentiment remains that society is failing parents.
Childcare remains unaffordable and variable in quality, there is no paid family leave, and an absence of pay equity policies to support working parents, all of which are compounded by a housing crisis, an unstable job market and zero-hour contracts. The risk is that the normalization of egg freezing will shift responsibility to compensate for these societal problems onto women to the detriment of their physical and mental health.
Nicola Sturgeon MSP spoke out about the stigma of childlessness
Neurosis on fertility for commercial gain?
A social premium is now placed on having a genetic relationship to your child
The marketing and media coverage of egg freezing also serves to create a social pressure and moral imperative for women to engage in the technology, despite the cost, risks, and the knowledge that egg freezing is not medically necessary for the majority.
In recent years, fertility and the ‘risk’ of childlessness have received intense media coverage, arguably creating a neurosis surrounding fertility and involuntary childlessness. IVF has undoubtedly been beneficial for a great number of families, but the social consequence is a premium now placed on having a genetic relationship to your child.
The stigmatisation of childlessness serves to increase the pressure felt by childless 30-something women, which may push some towards egg freezing.
Earlier this month, SNP leader and First Minister of Scotland Nicola Sturgeon spoke out about the stigma of childlessness after revealing that she suffered a miscarriage in 2011 aged 40.
In a statement released last week, after extracts of the book Scottish National Party Leaders, which details her miscarriage, were published in The Sunday Times, Ms Sturgeon said:
“There are many reasons why women don't have children. Some of us simply don't want to, some of us worry about the impact on our career -- and there is still so much to do, through better childcare, more progressive working practices and more enlightened attitudes, to make sure we don't feel we have to choose.
“And sometimes, for whatever reason, having a baby just doesn't happen -- no matter how much we might want it to.
“For me, as for many women, all of these things have been true at different times of my life -- the point is that judgments and assumptions shouldn't be made about what are personal choices and experiences.”
It is likely that egg freezing is here to stay. Although the professionals interviewed agreed that in there is a need for this technology, they also agreed that it does not represent a solution to deeper, underlying issues facing parents today.
For women to be able to make an informed decision, a thorough debate with health professionals who have no vested financial interests is needed along with legislation to protect against commercial exploitation.
At an event debating this topic at the British Science Festival in Swansea last week, 88% of the public audience initially agreed with the statement that social egg freezing was good for society. By the end of the panel discussion and debate, this figure dramatically decreased, with 62% of the audience disagreeing with the statement. This swing highlights the complexity of the debate, and the need for responsible, impartial discussion.