Putting your eggs in one basket: the ethics and effectiveness of egg-freezing
In the world of fertility preservation, there has been an exponential rise in the number of women freezing their eggs for non-medical reasons. As companies begin to offer egg-freezing as an employment perk, concerns are being raised about how success rates are reported and whether women are being marketed the treatment in an ethical way.
We talk to Dr Lisa Webber, consultant gynaecologist and subspecialist in reproductive medicine at the Wolfson Fertility Centre at Hammersmith Hospital, about the need for clear, transparent information so women can make informed choices at every age.
“For some women, choosing to freeze their eggs is a case of needing to try everything modern medicine has to offer them to have a baby.
We’ve offered egg-freezing at Hammersmith Hospital for over 20 years and mostly for medical reasons such as cancer. In the last five years, we’ve seen a steep rise in interest in non-medical egg-freezing – often known as ‘social egg-freezing’ – where women have chosen to have the treatment because they are not yet in a relationship where they can start a family.
There is a real need to get sensible information into the public domain about the process of egg-freezing and its success rates, so women are empowered with the knowledge to make the right decision for them. It’s important this treatment isn’t positioned as an insurance policy or guarantee of a baby, as sadly it is neither.
Without the full picture, egg-freezing can be used as a marketing tool and fertility like a commodity that can be bought and sold. As clinicians, it’s our role to make sure our patients understand their chances of success based on their individual circumstances.
Conversations about the success rates and fertility can be really challenging. Even if you are telling someone that they have less than a three per cent chance of conceiving, sometimes all they can hear is ‘there’s a chance’. This is where ethics and honest conversations come in. For example, the survival rate for eggs once frozen is around 65-70 per cent – so if you are a woman who only has a couple of eggs to freeze, this number is really significant.
You often read in the press that women should not freeze their eggs after a certain age because their chances of success are so low. I believe that all women should be given the opportunity to make a choice as to whether they want to have this procedure – provided they are armed with the correct information. For many women, it is incredibly important that they have tried everything possible to have a baby – even if they are very clear that the treatment is unlikely to be successful.
The medical risks of the egg-freezing process are low. In the last eight to ten years we’ve had much better technology that has allowed us to use a process called egg vitrification. This is far more successful than the ‘slow freezing’ process we used to use which could damage the egg.
When I talk about live birth rates with women, it’s based on what we know about the impact of age on fertility. We know, for example, that under 35 your chance of having a successful IVF cycle is just below 40 per cent. Ultimately the age of a woman’s egg is a defining factor and that doesn’t change. An egg from a 35-year-old woman that is frozen, is still more likely to have success than an egg from a woman over 40.
As more women freeze their eggs, we’ll begin to understand how many come back to unfreeze them. One study on egg-freezing showed that only 12 per cent of women who froze their eggs for non-medical reasons returned to use them. Interestingly the figure for men who had returned to unfreeze their sperm was in a similar ballpark. That said, if you followed these individuals up for longer, you might see the use rate increase and as more women freeze their eggs, unfreezing might become more commonplace.
Society still expects women to meet a partner and have a baby and I often see women who are under pressure from their friends and family to have the treatment because of their age. There are frequent mentions of egg-freezing in the media now and women are being targeted more precisely by egg-freezing content on social media.
Once you’ve opened up the discussion around egg-freezing with a woman, it can cause a lot of distress. I’ve never met a woman who was considering this treatment because of her career. It’s nearly always to do with not having a partner. Women often freeze their eggs because they are not in a relationship where they can have a child – by addressing egg-freezing, they are addressing the subtext of why am I not in a relationship? I usually recommend counselling to women considering egg freezing for this reason.
Egg-freezing before potentially sterilising medical treatments, such as chemotherapy, is usually paid for by the NHS (the exact eligibility criteria depend on where you live), but it is infrequently covered by insurance policies, although this may be starting to change. Egg-freezing for other purposes is only available privately. For women who are paying for the procedure themselves, it costs around £5-6K and the storage is approximately £350 year. There are then fees of around £2000 for using the eggs to create embryos and to transfer one into the womb.
The rules around how long eggs which have been frozen for non-medical reasons can be stored are under review. At the moment the limit is ten years, whereas for medical egg-freezing women can extend this limit by ten years every ten years up to 55 years. Non-medical egg-freezing has to be paid for. For me, the inequality in access is less about having to pay and more about whether all women are aware of their fertility choices and the impact of age on their options.
At the Wolfson Fertility Centre at Hammersmith Hospital, we have years of experience in fertility preservation. Unlike some clinics, every consultant at the Wolfson Fertility Centre has Royal College of Obstetricians and Gynaecologists (RCOG) subspecialty training. This means we have the highest level of expertise in our field possible and between us cover all aspects of fertility. This puts us in the best possible position to serve our patients and make sense for you of what can be a complicated area.
On 10 November at 1pm, Lisa is appearing in an online expert panel event on egg freezing – designed to dispel myths and present the facts for women considering the process. Book your ticket.
If you are interested in discussing fertility preservation options, contact our expert team: 020 3311 7700 or complete an enquiry form