Ethics and egg freezing: some starters for ten

Egg freezing is becoming more common in the UK, with a growing number of women deciding to freeze their eggs each year and, outside the UK, some even suggest that the technology has gone mainstream.

With this increasing interest in egg freezing at the forefront of our mind, the Nuffield Council on Bioethics felt that it was the right time to take a closer look at some of the key ethical issues that the treatment raises.

This led to last week's publication of a bioethics briefing note on egg freezing in the UK. We aimed to set out key issues clearly for members of the public who might want to know more about egg freezing. But we also wanted to provide an 'ethical starter for ten' to prompt future policy debates on ethical issues concerning egg freezing. The rest of this article briefly explores three of these issues.

Extending the limit

One issue which the document was able to address straightforwardly concerns the time limit for eggs frozen for 'social' purposes. Progress Educational Trust, the charity which publishes BioNews, has an ongoing campaign on this, which has explored the options regarding extending the current ten-year time limit and – from our research – we concluded that there are few arguments against increasing this limit. The Department of Health and Social Care's forthcoming response to a public consultation on this issue will, we hope, draw similar conclusions.

Waiting for data?

Women interested in freezing their eggs need to be able to make informed choices. To do this, they need data – including those which indicate the likelihood of a successful live birth.

At present, however, the availability of outcome data on egg freezing is hamstrung by at least two factors: the fact that only a small number of women have returned to use their eggs after freezing; and that egg freezing is still a relatively new reproductive option. It might therefore be several years before more data on egg freezing outcomes begin to emerge more fully.

Waiting for longer-term data to emerge is not, however, a 'get out of jail free card' for those who provide information to women who are considering freezing eggs. An ethical approach to providing information to women as they make choices is as much about saying what is unknown as it is about saying what is known. In both respects, it is important that any difficulties that women encounter in navigating the data are eased by presenting available data clearly, accessibly, and transparently.

As one woman reports in Kylie Baldwin's excellent book, Egg freezing, fertility and reproductive choice, 'It's just frustrating with something like this you know, they [clinics] never give you complete straight answers to your questions […] You want to know precise answers to your questions but it's all very vague, every individual is different […] So, it was really hard really for me to gauge what my chances were.'

The importance of easy access to clear data is not just something that is 'nice to know'; rather it goes to the heart of women being fully informed about their decisions to have an invasive, and expensive, procedure.

Egg freezing as an employment benefit

One area where clear information and research are likely to be important in the future is where egg freezing is offered as part of an employment benefits package.

Some might ask, 'this isn't happening much in the UK. Why worry about it?' But the reason that we thought about this carefully in our briefing note is that it is not just the Nuffield Council's role to think about ethical issues that apply to the status quo – but to anticipate future developments that could raise ethical issues.

These issues include how, for some women, being offered egg freezing as an employment benefit could feel empowering and give a sense of being in more control over their reproductive future. For others, the offer might make them feel pressured to delay motherhood. The offer might also overshadow other options that play a key role in employers' support of women's reproductive choices, including improvements to family-friendly work environments, childcare subsidies, and family leave.

If more employers do consider providing this benefit, it is important that the views and experiences of women who are offered the benefit are monitored and explored through research. This may help to clarify how women perceive this benefit, what impact it may have on women in the workplace and at home, and any pressures they may feel to either take up the offer, or reject it.

Of course, egg freezing as an employment benefit might not take a foothold in the UK to the extent that it has in the US, for example. But we need to be prepared to consider the ethical implications if it does.

The Nuffield Council's briefing note on egg freezing discusses these ethical issues, and others, at further length. It is the eighth in a series of 'bioethics briefing notes' that aim to provide policymakers and members of the public with an overview of key issues on bioethics topics.