Journalists critically examine egg freezing with more nuance
It is reaffirming to see that CHR is no longer alone in expressing discomfort with what is going on in the commercial egg freezing world. After an initial rather enthusiastic bout of commentaries in the lay media after major social media and tech companies announced limited financial coverage for female employees who wanted to freeze their eggs, suddenly, those same media discovered that not everything that shines is, indeed, gold.
Two clearly less enthusiastic and more realistic commentaries on the topic were published last month in prestigious newspapers, The Guardian and Washington Post, both liberal publications committed to female empowerment. Among many other marketing strategies, self-empowerment that would allow young women to pursue their careers and, still maintain at the same time their abilities to become mothers later in life, has been a principal argument of the quickly growing commercial egg freezing industry in “selling” the concept of egg freeing to usually single young women.
As Jessica Glenza points out in the January 2, 2018 issue of The Guardian, “a growing number of women, often working and unmarried, are ready to postpone motherhood and that’s music to the ears of investors in fertility clinics.” In other words, the article ponders the “commercialization” and “industrialization” of the egg freezing business under the highly appropriate title, “Fertility and canapés: why egg freezing parties are a hot item on Wall Street.”
We, of course, have repeatedly pointed out in these pages how misplaced we find the concept of “egg freezing parties,” not because we object to proper marketing efforts but because these marketing efforts often trivialize the concept of egg freezing. Egg freezing is not only a much more complex medical intervention than Botox treatments (we are presenting this analogy because the idea for egg freezing parties followed the earlier practice of Botox parties), but it is also a significantly more consequential step in a woman’s life, which, therefore, deserves more considerations, more information and much more detailed informed consent!
As Glenza points out in her article, the number of egg freezing cycles performed every year is increasing rapidly, indeed, 11-fold since 2009, and the competition for this business has been fierce. Moreover, even if recruited at egg freezing parties, this serious medical procedure requires considerable medical skills and can create significant risks for patients. Detailed informed consent, therefore, is essential.
Most young women inquiring about egg freezing, however, receive, at best, cursory information. Indeed, many are often misled by the informality of the recruitment process (whether at egg freezing parties or elsewhere) and miss important facts:
- They are committing to a complex medical procedure.
- Who the physician is, therefore, matters. Like anything in medicine, egg freezing can be performed well or poorly.
- Unless done in medical emergencies (i.e., cancer or other situations where ovaries are expected to stop functioning in young women), egg freezing is still considered an experimental procedure.
- It is a basic ethical principle in medicine that procedures with uncertain outcomes should be considered “experimental” until an acceptable level of certainty about outcomes has been achieved.
Ariana Eunjung Cha in the January 27, 2018 issue of The Washington Post offers a more personalized picture of egg freezing, when, among other items, presenting the story of a woman who froze 11 eggs. This woman described “a wonderful sense of freedom” after she froze her eggs in her late 30s at a cost of $19,000. When close to her 45th birthday she was still not in a permanent relationship; content with the idea of becoming a single mother, she “excitedly unfroze her 11 eggs and selected a sperm donor.” Her world, however, collapsed when from her 11 eggs only one embryo was produced by the IVF center, and this embryo failed to lead to pregnancy. Her disappointment was so profound that “she remembers screaming like a wild animal, throwing books, papers, her laptop – and collapsing to the ground.”
This is NOT how egg freezing is supposed to work! Yet, ever more frequent stories like this over the last two years, were what led us to decide to offer at CHR a very different kind of egg freezing program.
Let us just review what was done poorly in the case reported in the Washington Post article: It all starts with the woman freezing her eggs in her late 30s. This is a relatively advanced age for egg freezing. Was she told of the consequences of freezing eggs at such advanced ages? Was she, for example, told that the older a woman is at time of egg freezing, the more eggs she must freeze to maintain an equal pregnancy and/or live birth chances? Was she told that most frozen eggs never become transferrable embryos? Was she ultimately told that 11 frozen eggs are really much too few at her age to offer reasonable chances (as there is never certainty) for at least one pregnancy?
She, quite obviously, never received appropriate informed consent because, otherwise, she would not have experienced the “wonderful sense of freedom” after freezing eggs she told the reporter about. Much more likely with appropriate informed consent, she would have worried whether she had cryopreserved enough eggs. Indeed, hopefully, she would have done at least one more cycle and, had she come to CHR, she would have spent not $19,000 for one egg retrieval cycle but less than $10,000 for up to four cycles if she needed that many.
Egg freezing is NOT an insurance, it’s always a gamble in which more eggs mean better chances in winning the lottery–nothing more than that!
We are sure that very few IVF centers are as explicit as CHR in providing informed consent to their patients when discussing egg freezing. We, indeed, know for a fact that especially IVF centers which only do egg freezing cycles falsely represent that egg freezing no longer is considered an experimental procedure, even though the American Society for Reproductive Medicine (ASRM) still considers egg freezing an experimental procedure, exactly because it is so unpredictable (except in above noted medical emergencies). And so does CHR!
Informed consent at CHR, is, as it should be, very detailed, pointing out all pros and cons of egg freezing. It, however, also offers patients very detailed advice on how many eggs they should freeze at different ages in order to achieve a certain likelihood of live birth, and how many egg retrievals it will, likely, take to get to such numbers. This way, every patient knows exactly what to expect medically, effort wise and cost wise, and can choose multi-cycle packages appropriately.
For further questions, please write to us or call us at 1 212-994-4400.
This is a part of the February 2018 CHR VOICE.