Social egg freezing should be offered to single women approaching their late thirties: AGAINST: Women should be freezing their eggs earlier

Abstract

Over recent decades, women in the UK are postponing starting a family, with potential consequences for their reproductive performance. Research has shown that young people are not aware of the natural limits of female fertility and significantly overestimate the success rates of assisted reproductive technologies in helping them to conceive at an advanced age (Lemoine Am J Bioeth 2015;15:37–48). One option available to prevent age-related fertility decline is egg freezing. A study investigated the intentions of women aged 28–35 years to use egg freezing and found that women were overwhelmingly not considering the use of fertility preservation because they did not feel the threat of infertility (Keurs Reprod Biomed Online 2016; 121–131). It is therefore unsurprising that of the 1173 egg freezing cycles that took place in the UK in 2016, only 32% of patients freezing their eggs were aged 35 or below (HFEA Fertility treatment 2014–2016). This has significant consequences regarding the outcome of egg freezing treatments. The only meta-analysis to investigate this concluded that the highest discriminating factor for success was freezing eggs before 36 years (Cil Fertil Steril 2013; 492–499). The most recent prospective study evaluating the efficacy of egg freezing using vitrification found the proportion of vitrified oocytes resulting in live birth to be 8.2% in women under 36 years (12.1 oocytes required per live birth) and 3.3% in women 36–39 years (29.6 oocytes required per live birth). Several issues regarding egg freezing practice in the UK need to be highlighted. First, the majority of women are taking measures to preserve their fertility too late, as a ‘last ditch’ effort, instead of a planned and informed choice in their early to mid-thirties. Second, the majority of published studies on egg freezing efficacy are from experienced centres with large egg freezing numbers, and these data cannot necessarily be extrapolated to smaller clinics that have only recently started oocyte vitrification. Third, egg freezing is indirectly encouraging women to have children at an advanced maternal age, which carries with it significantly increased risk of medical complications in pregnancy. This is especially relevant to women freezing their eggs when they are already in their late thirties. Finally, social egg freezing is not government funded. Because of lower success rates per egg, women in their late thirties would need approximately 30 eggs to have a good chance of achieving pregnancy. They would therefore require on average three cycles of stimulation, at a cost of approximately £15 000. This does not include the annual storage fee of £200–400 or the cost of the fertility treatment she would need in the future to use her frozen eggs. In conclusion, doctors should continue to perform egg freezing for those single women in their late thirties for whom the high costs and low success are acceptable. However, the future focus should be on providing accurate information by educating women from an early age. This would allow women to plan their reproductive behaviour more realistically, present to fertility clinics at a younger age, thus reducing the chance of involuntary childlessness. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.