ED: Women should be given the chance of freezing their eggs if it is their best option. There is a risk this procedure is glamorised and the success rate over-estimated.
Modern lifestyle has a detrimental effect on the world’s fertility rate. In many developed countries, childless women aged 40-44 years have doubled from 1976 to 2006, now over 20% of these women. Fertility rates are below replacement levels (two children per woman) for over 80 nations, projected to increase to over 130 countries by 2050. At this time, two thirds of the world’s population will have fertility rates below replacement level.
Many women choose to have fewer children, and delay the time of their first child. For many women, each child has a significant impact on their financial and personal lives. Parenthood can be put on-hold for many years, while women wait for a good relationship with the right partner and a stable career path.
Egg freezing is becoming “hot and trending” in the news and social media. Silicon Valley companies (e.g. Apple, Facebook) are sponsoring their female employees to freeze their eggs. The reasons for egg freezing for fertility preservation can be broadly categorised into medical and social.
For medical egg freezing, oncology patients freeze their eggs prior to receiving gonadotoxic agents. Less commonly, other medical conditions like mosaic Turners and SLE can also cause premature ovarian insufficiency. In social egg freezing, healthy women choose to freeze their eggs to extend their fertility window.
With improved egg-freezing techniques by vitrification, the survival rate of frozen eggs is good (85%). Data suggests that the pregnancy rates using frozen eggs is generally similar to IVF (23-27%). Women should be advised that while success rates are good, there is no guarantee of having a child. For a reasonable success rate, women should have their eggs frozen before age of 36. For those older than 36, some suggest we should aim to freeze about 30 eggs; not all women can produce that number of eggs, even from multiple cycles of ovarian stimulation.
Comprehensive counselling of women make them aware of the high cost and they have realistic expectations about success. Delaying conception can increase the chance of complications during pregnancy which may affect the health of the mother and child. Women must be made aware of the regulations and future costs in relation to the frozen eggs. In many countries, the duration is limited to 10 years with possible extension (e.g. UK and Australia). It is also possible that eggs will have to be donated or discarded when not used in the future.
- Women should be offered egg freezing if it is their best option.
- Comprehensive counselling should cover cost and expectations.
- Best results occur if eggs are frozen before a woman is 36.
References available on request.
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Author competing interests: nil relevant disclosures.
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