The topic of social egg freezing once again hit the headlines last week (8th August) with the release of a statement from the Royal College of Obstetricians and Gynaecologists (RCOG) which called for caution over the technology and greater recognition of its limitations. Drawing on my research on this topic, I was pleased to provide various comments on this statement live on Sky News, Radio Four, and BBC News throughout the day.
Dr Kylie Baldwin live on Sky News (08/08/2018)
The statement from the RCOG came following the release of two papers published in the British Journal of Obstetrics and Gynaecology on social egg freezing, and offered guidance and advice to women who are considering freezing their eggs. This advice is much overdue and is the first to come from an official UK body in almost 10 years (Cutting et al, 2009). The lack of such easily accessible advice thus far is surprising, if not concerning, not only because the numbers of egg freezing cycles being performed has risen by over 400% in the last eight years (HFEA, 2018), but also because several authors have raised questions about the quality and limitations of the reporting of the technology on clinic websites as well as in the popular media (Avraham et al, 2014; Mayes et al 2017; Wilkinson et al 2017).
In their statement the RCOG recognised the potential of egg vitrification in enabling women to have children later on in life, but also provided a warranted word of warning to women considering freezing their eggs noting the high cost of the technology and low rates of success. Research shows that women are currently on average 37 years of age at the time of freezing their eggs, and in 2016 less than a third of the egg freezing cycles performed were done with women aged 35 years or below (HFEA, 2018). This is significant given that a woman’s age the time of undergoing the procedure and the number of eggs frozen are recognised as the most important predictors of a future live birth (Doyle et al, 2016). Offering further comment from the RCOG, Adam Balen Professor of Reproductive Medicine, suggested that women who are considering the procedure should freeze their eggs as early as their 20s and certainly before the current average age of 37. However, women are only able to store frozen eggs for 10 years unless they can prove that they have become prematurely infertile in which case an extension to the storage period can be obtained up to 55 years. As I have described elsewhere this means that if a woman freezes eggs at 28 years of age she must use them by the time she is 38 or they will be destroyed leaving her without a fertility ‘back up’ plan right when she may need it the most. It is for this reason why myself and colleagues have launched a campaign to see the storage time limit extended.
Echoing other professional guidelines, the RCOG noted how clinics have a responsibility to provide women with a realistic idea of the likelihood of a live birth with their eggs relevant to their age at time of freezing. However, my research interviewing users of this technology found that women struggled to elicit age-specific and clinic-specific success rates about their chance of a future live birth and instead had to rely on limited published data from other centres that often did not reflect, or were not specific to, their age at time of freezing. This is most likely because unlike the success rates of IVF treatment which are published on the HFEA website, it is much more difficult to obtain success rates of IVF using previously frozen eggs as currently only small numbers of women have returned to use their eggs to attempt conception. This lack of clear data about their chance of a future live birth was troubling for some of my participants, yet women often suggested that by undergoing the procedure they would always be improving their chance of motherhood in the future. However, the problem facing these women as well as prospective users of egg freezing now, is that it is difficult to estimate to what extent they will be improving their chances. I suggest that a vague notion that egg freezing may increase the chance of a live birth in the future could lead a woman to spend the £5,000 plus required to freeze eggs. However, if the same woman was provided a more evidenced-based estimate that the chance of success may only be 5-15% she may feel under less pressure to undergo the procedure ‘just in case’ due to the low rate of success she may encounter. This is significant as my research found that a fear of future regret, of not making use of the technology and suffering unwanted childlessness in the future, was a key factor motivating many women to engage with the technology. Thus, if women are provided with information which clearly articulates the limitations of egg freezing they may feel under less pressure to engage with the technology and may feel less blame and guilt about their non-motherhood status both in the present as well as the future.
Whilst the RCOG provided some useful information to prospective users of egg freezing it was not able to offer insights in to what it is like to undergo the procedure. As such we were pleased to learn that on the same day of the release of the RCOG statement a paper by myself and Professor Lorraine Culley examining women’s experiences of social egg freezing was accepted for publication in the journal ‘Human Fertility’. In this paper we discuss how the process of egg freezing poses a different set of challenges for women compared to those experienced by individuals undergoing IVF to conceive. In particular, the women in our research often reported feeling lonely and isolated when undergoing the procedure, in part due to the fact that they were doing so without a partner. They also described a degree of stigma and embarrassment about making use of egg freezing and for ‘still being single’ at a stage in the lifecourse when normative expectations often included marriage and motherhood (Becker, 1997). As such, in many cases the most challenging aspect of undergoing the procedure for our participants was doing so alone and at a time where they would have preferred to have been pursuing motherhood naturally with a partner.
The participants in our research were generally satisfied with the care they received from the clinic, however they believed that clinics could improve their support of women undergoing egg freezing. This included by ensuring better awareness among clinic staff that women might be at the clinic to freeze eggs and not to attempt conception; by providing more time in consultations for women attending alone; and by displaying greater sensitivity and understanding of the reasons behind women’s use of egg freezing.
Our upcoming paper will reiterate the comments made by the RCOG and suggests that to ensure egg freezing is not oversold as a way to ‘stop the biological clock’ it is imperative that women are given as much individualised information as possible about the likelihood of having a live birth with frozen eggs or at the very least, are clearly informed of the limitations of current evidence. Furthermore, we suggest that it is important to make clear to all women, men and couples that the postponement of childbearing always lowers the chances of becoming a parent, even if they have access to IVF, and that IVF and ICSI have limitations and risks as does pregnancy in later life (Bewley et al, 2005)
By Dr Kylie Baldwin
References
AVRAHAM, S., MACHTINGER, R., CAHAN, T., SOKOLOV, A., RACOWSKY, C. AND SEIDMAN, D.S., (2014) What is the quality of information on social oocyte cryopreservation provided by websites of Society for Assisted Reproductive Technology member fertility clinics?. Fertility and Sterility, 101(1), pp.222-226.
CUTTING, R. et al. (2009) Human oocyte cryopreservation: evidence for practice. Human Fertility, 12 (3), pp. 125-136.
MAYES, C., WILLIAMS, J. AND LIPWORTH, W., (2017) Conflicted hope: social egg freezing and clinical conflicts of interest. Health Sociology Review, 27(1), pp.45-59.
WILKINSON, J., VAIL, A., & ROBERTS, S. A. (2017). Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites. BMJ open, 7(1), e012218.
Human Fertilisation and Embryology Authority (2018) Fertility Treatment 2014-2015 Trends and figures. HFEA Available at https://www.hfea.gov.uk/media/2563/hfea-fertility-trends-and-figures-2017-v2.pdf Accessed 14/08/2018
DOYLE, J.O., RICHTER, K.S., LIM, J., STILLMAN, R.J., GRAHAM, J.R. AND TUCKER, M.J., (2016) Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertility and Sterility, 105(2), pp.459-466.
BECKER, G. (1997). Disrupted lives: How people create meaning in a chaotic world. Univ of California Press.
BEWLEY ET AL (2005) Which career first? The most secure age for childbearing remains 20 – 35. British Medical Journal, 17, pp. 588-589.
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