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Egg freezing: the 'options' approach to parenthood

In the 'Brave New World' of assisted reproduction, women can have their eggs frozen in their 20s and postpone motherhood for years, even decades. Critics are troubled.

Some women are paying up to ten thousand to have their eggs frozen so they can become parents later on. A new article in CMAJ says doctors should play a pivotal role counseling women about the pros and cons of a new and growing practice with the Orwellian-sounding name of 'social egg freezing.'

Egg freezing has been around since the late 1990s.  It was first developed for young women with cancer - where the cancer itself, chemo or radiation could cause sterility. Doctors use hormones to stimulate the ovaries to produce a lot of eggs.  The eggs are frozen and stored until the cancer is treated; the eggs are fertilized and implanted to enable the woman to become pregnant.  

Social egg freezing (I love the jargon) means taking the same technique and applying it to women who don't have cancer but who want to postpone motherhood. Once the eggs are retrieved and frozen, it's theoretically possible to store them for years or even decades.  The woman chooses when to thaw the eggs, they're fertilized with sperm, and the resulting embryos are implanted - years or even decades after the eggs were retrieved. It's been called 'the perfect 30th birthday present for women.'

Social egg freezing is not covered by provincial health.  The cost ranges between five and ten thousand dollars per treatment.  Storage cost for the frozen eggs is between three and five hundred per year - which adds up if the eggs are stored for ten or even twenty years.  Add to that the cost of in-vitro fertilization or IVF - to fertilize the thawed eggs and implant the embryos - and you're looking at thousands of dollars, putting it well beyond the price range of most women.  The cost and the lack of providers are two reasons why there are probably only a handful of women who have had it done so far.

How successful is social egg freezing has been so far is anyone's guess. Let's assume the clinic uses the most successful technique - flash freezing the eggs and using chemicals that protect the eggs from the effects of being frozen.  In that case, between ninety and ninety-seven percent of the thawed eggs survive.  Close to eighty percent are successfully fertilized, and up to forty-one percent are implanted.  The actual pregnancy rate per frozen and thawed egg is no more than twelve percent.  The American Society for Reproductive medicine estimates that between two and twelve percent of women end up having a child.  The younger the woman at the time the eggs are retrieved, the better the success rate.

Not surprisingly to me, critics are all over the risks to the procedure.  Top of the list is a medical condition known as ovarian hyperstimulation syndrome, which is caused by the use of fertility drugs.  At worst, the condition can cause blood clots, shortness of breath, vomiting, dehydration, abdominal pain, and hospitalisation. There are risks to IVF itself.  Then, there are the risk associated with being an older mother.  If the woman postpones pregnancy until her fifties, she is more likely to have diabetes, high blood pressure, and elevated cholesterol.  There may also be risks to the child.  Should such pregnancies be high risk, then there could well be increased medical costs that taxpayers will need to bear.

There are ethical and cultural implications of social egg freezing.  Is this an attempt to pressure women to have it all by giving them a means to postpone motherhood?  Does the cost bias motherhood in favour of those who can afford it?  

There is a simmering controversy in the medical community.  Last October, the Canadian Fertility and Andrology Society declared social egg freezing an option for women.  In the US, the American Society for Reproductive Medicine and the Society for Assisted Reproduction cautioned against the use of egg freezing.

So, what should women do? The article in CMAJ says part of the reason for the controversy is that you have vested interests trying to influence women.  For example, fertility doctors make their living providing assisted reproduction to women, and social egg freezing will increase the market.  For that reason, the authors say it's important that family doctors counsel women objectively about the benefits and the risks of the procedure - and how it fits in a broader discussion about reproductive health and the many options for having a family.

At the end of the day, the technique exists.  I think it's up to women to choose whether they want to plunk down as much as $15-20,000 for an optional pregnancy later on. This is one debate that ethicist should sit out.

For more on this, check out this free podcast put out by CMAJ.

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