While “modern” fertility “advice” is based on ancient data, there is an increased risk of birth defects and miscarriage after 35. Adam Conover explains how corporate America and the egg freezing industry took advantage of the infertility fear.
” When she was 9 years old, Moaza Al Matrooshi found out she would need chemotherapy in order to receive a bone-marrow transplant and treat a potentially fatal blood disorder.
Her family worried the chemotherapy would cause her to become infertile, so they made a decision that was considerably rare at the time: Professor Helen Picton, Head of the Division of Reproduction and Early Development at the University of Leeds removed her right ovary and froze the tissue.
Last Tuesday, about 15 years later, Al Matrooshi, of Dubai, gave birth to a healthy baby at London’s Portland Hospital for Women and Children. The 24-year-old woman is believed to be the first in the world to deliver a baby after having frozen an ovary tissue before puberty.” …
… continue reading Woman believed to be the first to have a baby using ovary frozen before puberty, The Independent, 19 December 2016.
Oocyte cryopreservation is a technique with considerable potential in reproductive medicine, including fertility preservation, as a way of delaying childbearing and as part of oocyte donation programs. Although the technique was relatively ineffective at first more recently numerous modifications have led to higher success rates.
To compare the effectiveness and safety of vitrification and slow freezing as oocyte cryopreservation techniques for fertility outcomes in women undergoing assisted reproduction.
We searched electronic databases, trial registers and websites, including the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO (date of search 3 March 2014).
Two review authors independently selected randomised controlled trials (RCTs) comparing vitrification and slow freezing for oocyte preservation in women undergoing assisted reproduction.
DATA COLLECTION AND ANALYSIS:
Two review authors independently extracted the data from eligible studies and assessed their risk of bias. Any disagreements were resolved by discussion or by a third review author. Data extracted included study characteristics and outcome data. The overall quality of the evidence was assessed using GRADE methods.
Two RCTs were included in the review (106 participants). Neither study reported live birth rate. Vitrification was associated with an increased clinical pregnancy rate compared to slow freezing (RR 3.86, 95% CI 1.63 to 9.11, P = 0.002, 2 RCTs, 106 women, I(2) = 8%, moderate quality evidence). The effect of vitrification compared to slow freezing on ongoing pregnancy rates was only reported in one small study, with inconclusive findings (RR 6.07, 95% CI 0.86 to 43.04, P = 0.07, one RCT, 28 women, low quality evidence).No data were reported on adverse effects, nor were any other outcomes reported in the included trials. The evidence was limited by imprecision. We assessed the included studies as at low to unclear risk of bias as the methods were not well described.
Oocyte vitrification compared to slow freezing probably increases clinical pregnancy rates in women undergoing assisted reproduction. However, the total number of women and pregnancies were low and the imprecision is high which limits applicability. The effect on ongoing pregnancy is uncertain as data were sparse. No data were available on live births or adverse effects.
Sources and more information
Vitrification versus slow freezing for women undergoing oocyte cryopreservation, the Cochrane database of systematic reviews, 9:CD010047. doi:10.1002/14651858.CD010047.pub2. 2014 Sep 5.
Is too much hope placed in egg freezing?, the BMJ 351:h5955 , 06 November 2015.
Use of oocytes donated for in vitro fertilization (IVF) has increased in recent years. Donated fresh oocytes traditionally have been used immediately, creating embryos for transfer into the uterus, with extra embryos being cryopreserved for later use.
In January 2013, the American Society for Reproductive Medicine declared the technique of oocyte cryopreservation (egg freezing) no longer experimental, although it called for “more widespread clinic-specific data on the safety and efficacy of oocyte cryopreservation … before universal donor oocyte banking can be recommended.” Based on data that IVF outcomes with cryopreserved and fresh donor oocytes are comparable, some IVF centers established frozen donor egg banks. However, data reflecting IVF outcomes in routine clinical practice with cryopreserved donor oocytes had not previously been published, according to background information in the article.
Sources and more information
Outcomes of Fresh and Cryopreserved Oocyte Donation, JAMA. 2015;314(6):623-624. doi:10.1001/jama.2015.7556, articleid=2425734, August 11, 2015.
In vitro fertilization using frozen eggs associated with lower live birth rates, MedicalXpress, August 11, 2015.
Frozen Donor Eggs May Lead to Fewer Births Than Fresh Ones, HealthDay, Aug. 11, 2015.
Fertility preservation for age-related fertility decline
” Dominic Stoop and colleagues discussed the application of fertility preservation techniques to counter natural age-related fertility decline. We are concerned about some factual rates presented by the authors.
Most importantly, the authors fail to mention that natural conception rates in women older than 30 years, although rarely studied, are actually quite good. Estimates of the probability that women will have a naturally conceived child when they initially attempt conception at the age of 35 years are 85%.
As the authors point out, for women aged 25 years, failure rates for fertility preservation after oocyte vitrification are 70%, and increase to more than 85% for women older than 40 years.
Unfortunately, the vast majority of clinics offering this service—including the authors’ own clinics—are not sharing these rates with potential consumers, nor are they discussing the potential health risks to infants or women.
In delicate matters such as reproduction, we would anticipate a clear distinction between clinicians’ various interests, including scientific, professional, and financial. Although the three authors are formally correct when declaring no competing interests, their work in large fertility centres that actively advocate fertility preservation might be perceived as such. ”
Doctors are being warned not to encourage young women to freeze their eggs as a way to avoid “future regret,” says a just-published article in the Canadian Medical Association Journal that argues egg freezing risks perpetuating expectations that being a mother is central to being a woman.
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Sources and more information
Social egg freezing: risk, benefits and other considerations, cmaj, April 13, 2015.
Family doctors important in advising young women on egg freezing for future fertility, eurekalert, 13-APR-2015.
Doctors warned not to encourage young women to freeze their eggs in new medical journal article, nationalpost, April 14, 2015.
Egg freezing not a fertility panacea, Metro Canada, April 14, 2015.
The firestorm of critical response to the companies’ new policy has focused on important concerns including the high failure rates of IVF, the pressure to defer childbearing that the policy represents, and Silicon Valley companies’ lack of attention to family-friendly workplace policies, including paid leave and schedule flexibility that would enable work-family balance.
So far, however, there has been little focus on a critical concern: egg retrieval poses serious health risks to women. “Getting your eggs frozen is neither a simple nor a safe procedure,” said Marcy Darnovsky, PhD, executive director of CGS. “Retrieving multiple eggs involves injections of powerful hormones, some of them used off-label and never approved for egg extraction. The short-term risks range from mild to very severe, and the long-term risks are uncertain because they haven’t been adequately studied – even though the fertility industry has been using these hormones for decades.”
The hormonal drugs used to hyper-stimulate ovary production can cause what is known as ovarian hyperstimulation syndrome (OHSS) in the short term. Mild cases of OHSS are characterized by nausea, bloating, and discomfort. Serious cases are relatively infrequent but can require hospitalization for complications including intra-abdominal bleeding, ovarian torsion, and severe pain. Deaths, fortunately rare, have been reported.
The severity and frequency of long-term risks, including infertility and cancer, are not well established because of inadequate follow-up studies of women who have undergone egg retrieval. The risks to children born from frozen eggs are also under-studied, although the chemicals used in the freezing process are known to be toxic.
Furthermore, encouraging egg freezing may commit more women to undergoing IVF, which has been linked to an increase in stillbirths, cesarean sections, preterm deliveries, multiple gestations, and higher rates of fetal anomalies.
Both the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine have issued guidelines explicitly discouraging women from utilizing egg freezing for elective, non-medical reasons.
“Why are Facebook and Apple endorsing a technique that encourages their employees to put their health at risk?,” Darnovsky asked. “Paying for egg freezing is being presented as a benefit for women, but it may be that discouraging women from balancing work and family is really a benefit to the companies.” ”