Social egg freezing
Published November 2016
Egg freezing is a relatively new medical procedure that involves extracting and subsequently freezing and storing eggs for (potential) later use in assisted reproduction. The American Society for Reproductive Medicine removed its experimental label in 2013 and recommended it for use in response to medical premature infertility. It is now also increasingly available to healthy women who wish to bear children later and ‘insure’ against natural fertility loss with age – dubbed ‘social egg freezing’ (SEF).
Are there recent scientific, legal or social developments?
New vitrification techniques for freezing eggs are reported to reduce the risks and increase rates of survival, fertilisation and pregnancy. The Office for National Statistics (ONS) reports that the average age for first time mothers is increasing. Apple and Facebook announced in 2014 that they would offer SEF as a ‘benefit‘ for female employees in the US. The ethical debate has re-ignited, gaining a significant amount of media attention.
Are there complex ethical issues?
An overarching debate concerns whether and how society should address natural fertility decline and involuntary childlessness. Should the solution be medical, or focus on social change, education and promotion of earlier child-bearing? The apparent consensus in the academic debate is in favour of SEF. The debate mainly focuses on whether SEF promotes or hinders reproductive autonomy and gender equality in light of current social pressures on women to e.g. both have careers and bear children, and on the potential risks to both the (potential) mother and future child (which are difficult to assess due to a lack of relevant data). Further ethical issues arise due to the availability of SEF. It is expensive, leading to concerns over equality of access. Some clinics offer ‘freeze and share‘ programmes that reduce costs if patients donate some of their eggs for treatment or research purposes. However, the emotional and psychological impact of oocyte donation may be downplayed in such programmes, and the desire for SEF capitalised on inappropriately. SEF might be a candidate for public funding like IVF. Arguably, they both address infertility; however, SEF is used in anticipation rather than in response to infertility which may make them relevantly different. There is a perceived negative attitude towards women who pursue SEF for career-related reasons, whereas there is more sympathy towards those who simply have not found a partner yet. The relevance of the reasons for pursuing SEF could be considered, and the impact of these attitudes on women and their choices explored. There is a concern that marketing and SEF employment ‘benefits’ will lead SEF to be viewed as an ‘insurance policy’, inappropriately encouraging or even pressuring women to pursue it and delay pregnancy, and potentially affecting their ability to make an informed decision and give informed consent as well as raising questions about providers and employers’ responsibilities. A further issue relates to the lack of data on SEF and the health of future children. Do clinics have a duty to record data on SEF? Who has the responsibility to record data on the long-term health of children born from frozen eggs? Should women pursuing SEF (and their future children) be able to opt-out of studies?
Is there a potential policy impact?
The Human Fertilisation and Embryology Act 2008 regulates egg freezing, and there are HFEA guidelines for all clinical processes. However, there are no specific regulations or guidelines for SEF. There are mixed messages concerning the acceptability and safety of SEF from other organisations which leads to a lack of clarity for the public. The HFEA have been criticised for not regulating the information provided (relating to the effect of age on success rates), or the costs charged by private clinics. Policy makers need to consider whether specific legislation or guidelines are required for SEF concerning age limits (max and min), marketing practices, informed consent procedures, storage time-limits (currently 10 years without medical reasons) and subsidisation.
Is it a subject of public concern?
There is a continuing trend of women getting pregnant later in life, as highlighted by the ONS report. This fact combined with a natural decline in fertility with age leads to a significant number of people suffering from infertility problems, which makes the issues of infertility, and its possible prevention, a matter of public concern.
Is the consideration timely?
The recent HFEA report includes 2014 data on egg freezing (medical and social) for the first time. It reports a 25% increase in the number of women seeking the treatment between 2013 and 2014. The 2016 Timeless project, a joint venture between the LSE, the Wellcome Trust, and Liminal Spaces, aims to educate and encourage debate about SEF and fertility. The Progress Educational Trust ran an event on SEF in June 2016. Media articles appear regularly highlighting new developments such as a brand new clinic in the US dedicated solely to egg freezing – a new model that could potentially be brought to the UK.
Can the Council offer a distinctive contribution?
The European Society of Human Reproduction and Embryology published a comprehensive report in 2016 which includes a detailed summary of the ethical issues. The Council could add to this, exploring the issues further, engaging members of the public, providing a platform for anyone with an interest to debate the issues, and providing guidance to policy makers on which areas may require legislation and guidance.
Possible future work topics
This is one of the topics that have been suggested as possible project areas for further investigation by the Council. These topic summaries do not aim for comprehensiveness; rather, they are intended to sign-post some of the key considerations and to provide a starting point for discussion. Each summary includes links to relevant publications on the topic.
Possible future work topics are selected and/or revised regularly, following discussions among members of the Future Work Sub-Group and the Council. This set of topic summaries was published in November 2016.