It's fair to say that egg freezing is having a bit of a 'moment' of late, that may have begun around the time last year when Apple and Facebook announced they would be paying for female employees to have their eggs frozen as a job 'perk' (reported in BioNews 776). With the flood of media coverage that has followed, it would be easy to think that everyone is rushing out to have their eggs frozen. But the statistics suggest a different story. The HFEA says that between 2008 and 2013 only 41 live births were achieved using frozen eggs and Italian data - so far the most comprehensive we have - suggest a success rate of around 10 percent. So what are we to think?
Will egg freezing's moment turn into a transformative one that finally enables women to take full reproductive control and beat the biological clock? Or is it just another way to tell women they can't have a career and a family? These were just some of the questions tackled at the Progress Educational Trust's recent event 'Beating the Biological Clock: Should You Freeze Your Eggs?', organised in partnership with the Anne McLaren Memorial Trust Fund and supported by the London Women's Clinic.
First to speak was Professor Barry Fuller, a cryobiologist from UCL, who took us through some of the technical ins-and-outs of egg freezing, or cryopreservation. This helped demonstrate why the success rates with egg freezing have been so low to date. A successful freeze and subsequent thaw require many sensitive steps go smoothly to produce a functional oocyte. Vitrification — a more recent form of cryopreservation that uses flash freezing — is improving the success rate, but Professor Fuller emphasised that, as a society, we need to clear about exactly what the success rates are.
Next we heard from Dr FranÃ§oise Shenfield, a lecturer in reproductive health from UCL. Dr Shenfield's talk looked to some of the wider issues surrounding egg freezing such as, whose interests does it serve, should the government pay for it, and does it risk raising false hopes? This brought us swiftly back to the issue of that all-important success rate. Dr Shenfield outlined a study being conducted by ESHRE, where she holds a position, that plans to collect Europe-wide data on the practice. We have a collective responsibility to ensure women get accurate information, she said.
Dr Imogen Goold, associate professor of Law at Oxford University, considered the regulation of egg freezing and the different options available, from outright prohibition to restricting access to certain people. In doing so, she asked why people want to freeze their eggs anyway. She highlighted the correlation between delayed motherhood and educational attainment and salary, the need to be psychologically ready to be a mother, and the need to find the right partner. She noted that in many cases it is actually a rational decision to delay motherhood. Dr Goold also looked to the future and what the consequences could be of widespread egg freezing. We could slide from permitting egg freezing to expecting women to do it, she suggested. And, women could be harmed when their perceived insurance policy fails. We must respect women and let them make their own choices, she concluded, but this does not mean we should not regulate the industry.
Last to speak was Maureen McNeil, Emeritus Professor in Sociology at Lancaster University, who said that she was deeply concerned by the rhetoric around egg freezing. The headlines are almost universally positive, she said, but there seems to be a disconnect between what is being offered and what is being delivered. Egg freezing reflects the increasing medicalisation of women's bodies, Professor McNeil explained, noting that it means women undergoing medical procedures they wouldn't otherwise have gone through. It poses physical risks and locks them into undergoing IVF. She also highlighted the financial costs of egg freezing, which are substantial. Finally, she questioned whether egg freezing can really free women of their fertility anxiety. Egg freezing may allow women to delay motherhood, she said, but it is not addressing the gender equality issues that lead them to do so in the first place.
Following thee introductions, the chair Kate Brian invited contributions from the audience, making for a lively two-hour debate that could easily have continued all night.
Several themes and issues arose during this section of the event. One that we came back to several times was that of whether women should undergo an 'MOT' aged 25 to find out their ovarian reserve, which Dr Shenfield said she thought was a good idea. Dr Goold also agreed with this, particularly if it encouraged women to freeze their eggs younger, rather than arrive at the clinic aged 40, when it may be too late. However, Dr Goold cautioned that just giving women information is not enough and won't necessarily stop them feeling under pressure. Professor McNeil echoed these thoughts saying that such a practice would only increase women's anxiety around reproduction and turns attention away from dealing with the wider issues.
Another issue raised was, how do we pay for it? This was a popular subject among the audience. Bertie Leigh of Hempsons Solicitors, who was in the audience, argued that this was the only big question we should really be discussing. Professor David Baird from the University of Edinburgh, who was also in attendance, said that it would not be good value for the NHS to pay for egg freezing. Meanwhile, Dr Sam Abdalla, from Lister Hospital, raised the issue of inequality, saying that egg freezing will become a class issue, with only those able to afford it getting access.
Men did not completely escape mention, when clinician/researcher Dr Dan Reisel pointed out that they shouldn't be let off the hook. Professor Fuller said that he thought we need to make sure that men, and not just women, receive education about fertility, while Professor McNeil said that a better work/life balance for both men and women, and greater gender division of parenting is needed. The focus on egg freezing is helping keep these issues a 'woman's problem', added Dr Goold.
Education was also a key issue that was raised throughout the debate with Dr Shenfield emphasising the need for us to acquire better data. Meanwhile, Dr Goold stressed the need for us to convey good quality information to women but then to respect their rights to make their own decisions.
But women do not necessarily find these decisions easy to make. This was demonstrated towards the end of the event when a woman attending, who said she had just seen her 42-year-old friend go through her third round of IVF, asked simply: 'What should I do?' This got a sympathetic chuckle from the audience, perhaps because if such a straightforward question had a straightforward answer then we probably wouldn't have been holding the event in the first place.
There seemed to be no disagreement among the panellists or the audience that, when it comes to egg freezing, women should be able to make their own decisions. But, the event highlighted that the issue is not just about individual choices but also asking, as a society, 'What should we do?'
The Progress Educational Trust's next free-to-attend public event is '10 Years Since the End of Donor Anonymity: Have We Got It Right?', taking place in central London on the evening of Tuesday 3 November. See here for further details.