September 30, 2020

expert reaction to a briefing note on freezing of eggs for fertility purposes

A briefing note, published by the Nuffield Council on Bioethics, discusses the freezing of eggs for fertility purposes.

A spokesperson for the Human Fertilisation & Embryology Authority (HFEA) said:

“Egg freezing is a viable clinical technique to preserve women’s fertility, with more patients than ever in the UK choosing to freeze their eggs, yet it’s by no means a guarantee to have a baby.

“While egg freezing is becoming a popular choice, it’s important that anyone who is considering freezing their eggs knows what the procedure involves, including chances of success.

“All licensed fertility clinics in the UK must provide patients with relevant information, so they can make informed treatment choices. Our website also provides free, clear and independent information on fertility treatment, including egg freezing, and we regularly publish the latest data on fertility treatment and success rates to help patients make informed decisions.”

Dr Kylie Baldwin, Senior Lecturer with the Centre for Reproduction Research, De Montfort University, said:

“As egg freezing becomes more popular, clinics and those advertising the technology have a responsibility to provide transparent, age-related success rates which details the probable chance of a live birth with frozen eggs in the future. This information should be drawn from in-house clinic data or, if not available, then the best comparable data. Providers of egg freezing should be discouraged from advertising success rates taken from highly specialised clinics which often use eggs from much younger women than the average user of the technology in the UK, or should be transparent about the extent to which they expect to be able to replicate such success rates in their own clinics.

“Women should be made aware at the outset that they may need to undergo multiple rounds of egg freezing in order to store enough eggs for future use; particularly women who may be undergoing the procedure at an older age. The current 10 year storage time limit on eggs frozen for social reasons requires urgent revision to enable women to use their own genetic material to attempt to conceive at a time that is right for themselves and their family. The current time limit is not only inequitable but nonsensical and could prevent women from freezing eggs at a biologically optimal age due to the fear that their eggs may need to be used or destroyed before they are ready or need to use them.”

Dr Meenakshi Choudhary, Consultant Gynaecologist & Sub Specialist in Reproductive Medicine, Newcastle-upon-Tyne Hospitals NHS Trust, said:

“The briefing note on egg freezing in the UK by the Nuffield Council on Bioethics hits the right notes for clinicians and women to ponder over this key relevant issue. Studies have shown that the most common reason that makes a woman choose social egg freezing is a lack of a partner. However, when exploring the views of women considering elective egg freezing for non-medical reasons in a clinic setting, I have realised that the other key but preventable factor is lack of understanding of their male partners of fertility awareness and knowledge about female age related decline in fertility. Addressing this may help a couple in a committed relationship to plan their fertility at an appropriate time.

“I led a study that looked at 15 years of HFEA data on chance of a live birth after egg freezing which was presented at the Fertility 2020 conference in Edinburgh https://www.britishfertilitysociety.org.uk/press-release/data-show-that-freezing-your-eggs-now-is-no-guarantee-of-a-baby-later/ . We are seeing more and more women seeking to preserve fertility for medical or social reasons. We wanted to know what to tell them about the potential for success with egg freezing. So we took the available data and found some significant results.

“The findings suggest that although success rates using frozen eggs are on the rise, women seeking to preserve fertility should be made aware that freezing eggs is far from a guarantee that you will have a baby later with a likelihood of success as low as 1 in 5 chance of having a baby. One of the limitations of our retrospective data study was that we could not look at effect of length of storage on the live birth chance. If there is a direct correlation of length of freezing and live birth chance, it is vital that we look at its wider implications especially for long term storage in elective egg preservation as well as donor egg bank.

“With the ongoing campaign to extend the HFEA’s ten-year storage limit for social egg freezing, it is more crucial that we are able to help these women who have opted or wish to opt for this option as a reproductive choice to make a fully informed decision knowing what their chances are of having a live birth taking also into account how long they keep their eggs in ice for. But this will only be possible if we have that data ourselves to inform them.

“It is our duty to use egg freezing judiciously ensuring first we do no harm but arming the women seeking egg freezing with the power of knowledge so that they can make an informed personalised decision which is dynamic and changes with time as their situation changes. I believe in ‘Reproductive empowerment’ to make an informed reproductive choice.

“And reproductive empowerment will only be possible if we address all key points ie fertility education and awareness to aid fertility planning for both women and men, realistic expectations of egg freezing and its implications as well as late parenthood, and lastly but not the least, other family forming options as an alternative route to fulfilling parenthood.”

Prof Jason Kasraie, Consultant Clinical Embryologist and Chair of the Association of Clinical and Reproductive Scientists (ARCS), said:

“Egg freezing is an extremely useful technology for women who are about to undergo treatment (e.g. chemotherapy) that might render them infertile, where it is often their only hope of a future child. It is important to note though that egg freezing using modern vitrification (flash freezing) techniques is a relatively new technology and there is limited information available on future pregnancies and live births following treatment. It is important to advise patients that there is no guarantee of future pregnancy when eggs are frozen. In the context of social egg freezing, women should be advised that fertility declines quite rapidly in their mid-to-late thirties and the best chance of achieving a pregnancy is still to attempt natural conception. Women contemplating social egg freezing should also be advised that the chances of achieving a pregnancy with frozen eggs decline rapidly if the eggs are frozen over the age of 35. In short, egg freezing does not guarantee future children and women should really only consider it as a treatment of last resort.”

Dr Alison Campbell, Director of Embryology, CARE Fertility, said:

“At CARE Fertility, we believe that egg freezing, whether for medical or social reasons, can give women more control of their reproductive future, empowering them with choices of having children at a time that suits their personal and professional goals, if conceiving proves difficult when they are ready. CARE scientists have been providing egg freezing for more than a decade for medical, donation and social reasons.

“CARE considers the growing conversation about fertility preservation to be crucial in increasing awareness and helping more women explore their fertility options. All choices about reproductive health must be fully informed by clear, scientifically-based evidence and information, and at CARE, we ensure that our patients feel completely confident with their choices by discussing all options and aspects of their treatment, including the medical process, risks, consent and success rates, in detail.

“CARE Fertility empowers women by offering advanced fertility treatments, including egg freezing, with compassion and uncompromising excellence, while advocating greater education around women’s reproductive choices and supporting advancements in the field with our world-leading research.”

Prof Joyce Harper, Professor of Reproductive Science, Institute for Women’s Health, University College London, said:

“The report by the Nuffield Council on Bioethics is timely. We are seeing an increase in the marketing of egg freezing to young women, with a lack of unbiased information including the value of egg freezing, the success and the cost. The Human Fertilisation and Embryology Authority (HFEA), who collect national data on egg freezing, unfortunately do not collect data on why eggs were frozen which is key as there is a difference on whether eggs were frozen for medical reasons or to put motherhood on hold. The latest HFEA data shows that ‘most women who froze their eggs in 2016 were in their mid to late 30s and early 40s’ which will have a huge effect on success. The Nuffield report highlights the need for fertility education to ensure women are aware of female fertility decline. As the Nuffield report concludes, we need reliable data, a revisit of the 10 year storage rule, and there is concern on how egg freezing is marketed.”

Dr John Appleby, Lecturer in Medical Ethics, Lancaster University, said:

“The Nuffield Council on Bioethics briefing note on egg freezing gets the analysis of the key issues right. This is an ethically important briefing note about a fertility preservation technique that is growing in use every year.

Here are my main thoughts:

• The UK’s 10 year egg freezing rule for social egg freezing (SEF) is not fit for purpose and this briefing highlights how we have very little reason for maintaining it any longer. In fact, maintaining the 10 year limit on social egg freezing would do more harm than good.
• As the briefing note highlights, harvesting egg cells and freezing them entails a considerable investment of time, money and a person’s body. We should not be setting limits on the length of time this investment can last unless we have very good reasons to do so – and we do not have good reasons in the case of social egg freezing.
• If the UK fails to remove the 10 year limit on social egg freezing, there is a risk that some UK patients will be forced to travel abroad in order to access the egg freezing services that they want.
• The Council’s briefing note also highlights the fact that women are often treated differently to men when it comes to reproductive issues and regulation. This is true and we need to remain aware of the fact that reproductive medicine has a long history of unethically trying to regulate and paternalistically control women’s bodies in a way that has never been the case for men. Any time the government reviews a policy like the 10 year rule for social egg freezing, they must be very careful that they do not perpetuate any possible pre-existing sexism in our medical regulations.

Sarah Norcross, Director, Progress Educational Trust (PET), said:

“We are delighted the UK’s leading ethics body, the Nuffield Council on Bioethics (NCOB), has given the green light to revising the 10 year storage limit for social egg freezing. This is another positive step forward in PET’s #ExtendTheLimit campaign to change the 10 year limit and give women reproductive choice. Have your say and sign the petition at http://www.progress.org.uk/extendthelimit. With more women than ever choosing to freeze their eggs, it is time for the law to be changed.”

‘Egg freezing in the UK’, a briefing note by the Nuffield Council on Bioethics, will be published online at 00:01 UK time on Wednesday 30^th September 2020, which is also when the embargo will lift.

Declared interests

Dr Kylie Baldwin: “Dr Kylie Baldwin is the author of the book Egg freezing, fertility and reproductive choice: negotiating hope, responsibility and modern motherhood which is free to read here.”

Dr Alison Campbell: “Dr Alison Campbell is an employee of CARE Fertility, a private company providing fertility services.”

Sarah Norcross: “Sarah Norcross is director of the Progress Educational Trust, a fertility charity which has campaigned for the egg freezing limit to be extended.”

None others received.