Event Review: A Decade of Egg Freezing – Experiences, ethics, expectations

A decade has passed since oocyte cryopreservation, more commonly known as egg freezing, was deemed no longer 'experimental' by both the American Society of Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE) in 2012. While some celebrated the technology as a revolutionary tool for women to manifest their reproductive autonomy, others warned that it opened a Pandora's box of bioethical, gender, financial, and legal issues to be addressed.

It is apt therefore that, to mark this first decade, Dr Zeynep Gürtin, University College London (UCL), and Professor Marcia Inhorn, Yale University, Connecticut, gathered 20 of the world's leading experts on egg freezing. A roundtable conference took place: A Decade of Egg Freezing: Experiences, Ethics, Expectations for the Brocher Foundation, a Swiss non-profit private foundation. Each participant presented their empirical findings and personal views about the clinical practice, ethics, and future of egg freezing. As young scholars investigating egg freezing (respectively at UCL and the Geneva Graduate Institute, Switzerland) and attending as 'rapporteurs' at our first in-person research conference, we felt privileged to meet an international group of social scientists, ethicists, legal scholars, and clinicians who we have cited in our own work.

The conference started with Professor Joyce Harper, UCL, who explored age-related fertility decline and the rising age of motherhood, setting the context for why increasing numbers of women are interested in egg freezing. We were concerned by the prevalence of inaccurate, incomplete, or misleading information around egg freezing described by Dr Karin Hammarberg of Monash University, Melbourne, ‎‎Australia, Professor Pasquale Patrizio of Yale University, and Chanelle Scott of University of Cambridge, who delved into the emergence of 'fertility testing' in both clinical and non-clinical settings. However, we were most surprised to learn about 'eggcations' from Professor Charlotte Kroløkke, University of Southern Denmark, and the phenomenon of marketing egg freezing as a form of 'self-care' or holiday in a beautiful destination. As young women, we related to concerns that glossy marketing could needlessly normalise or even encourage women to undergo this medical intervention, this was emphasized by King's College London's Dr Lucy van de Wiel's fascinating exposition of the huge financial interests behind this 'market'.

The speakers also explored the many discrepancies between the public image and actual experience of egg freezing, reiterating research showing that women freeze their eggs primarily due to lack of the right (or any) partner, rather than career reasons. Dr Kylie Baldwin, De Montford University, Leicester, described many patients' sense of responsibility to establish what they perceive as preconditions for parenthood, such as stable careers or homeownership. Professor Inhorn and Professor Daphna Birenbaum-Carmeli,  University of Haifa, Israel, introduced the concept of 'a reluctant alliance' between feminism and egg freezing, reluctant she said since many feminists continue to critique the technology and many women who freeze their eggs are reluctant to call themselves feminists.

We appreciated the rigorous discussions on affordability and accessibility, shedding light on the practical issues of inclusion and exclusion around this expensive procedure by Professor Heidi Mertes, Ghent University, Belgium and Dr Michiel De Proost, Free University of Brussels, Belgium as well as by Dr Molly Johnston of Monash University, who challenged the accepted binary of 'medical' versus 'elective' egg freezing, and instead proposed a new way to conceptualise patients who freeze their eggs as 'proactive' and 'reactive'. Dr Yolinliztli Pérez-Hernández, EHESS, Paris, France added ethnographic insights regarding women's views and experiences of a 'freeze and share' programme. Professor Delphine Gardey and Dr Solène Gouilhers, both from University of Geneva, Switzerland furthered discussions of accessibility by adding  an often-overlooked perspective with their analysis of how clinicians experience the legal and practical barriers transgender people face in accessing this technology.

Looking towards the future, Professor Michaël Grynberg, the coordinator of ESHRE's Special Interest Group in Fertility Preservation, gave a glimpse of upcoming technological possibilities and stated the imperative to improve fertility preservation techniques and their safety. Dr Rita Vassena, Clinica EUGIN, Barcelona, Spain, illustrated how egg freezing may help combat the shortage of donor eggs and create standardised outcomes in patients. Relatedly, Professor Guido Pennings, Ghent University, Belgium explored the various implications that may arise if patients who freeze their eggs subsequently choose to donate their frozen oocytes, and raised the potential problems of the accumulation of 'unused' or abandoned frozen eggs in clinics in the future. Legal scholar Professor Emily Jackson, London School of Economics, highlighted the specific regulatory considerations around egg freezing, concerning for example, transparency of information, storage time limits, advertising, cost, and disposal.

While many presentations piqued our interest, coming from the USA and Japan (respectively), where egg freezing is private and expensive, we were amazed to learn about other cultural contexts, and in particular the recent coverage of egg freezing in France. We look forward to new research that will develop over time about what this means in practice. In our own research investigating public discourses around egg freezing, we are keen to explore the psychological and emotional experiences of patients who freeze their eggs, their perceptions of financing and reimbursement schemes, as well as possible distribution of unused or abandoned eggs.

Dr Gürtin concluded the Brocher meeting by reflecting on the impressive amount of knowledge gained over the last decade of egg freezing, but also called attention to the many knowledge gaps that remain. The field of egg freezing is growing rapidly, and multidisciplinary, cross-sectoral discussions should be commonplace. While this conference served as an important milestone, we would hope to see future conferences bring together not only scholars, clinicians, and embryologists but also fertility business owners, policy makers, and most importantly potential patients who wish to freeze their eggs themselves.