How the egg freezing industry took advantage of the infertility fear

Adam Ruins Everything – July 2017

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.

Woman delivers a baby 15 years after having frozen an ovary tissue before puberty

Baby born from ovary frozen in childhood

” 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.

Eggfreezing Techniques compared: vitrification Vs slow freezing

Is too much hope placed in egg freezing?

image of frozen-in-time
In the past five years, a new technique for freezing eggs called vitrification has been shown to be more effective than the older method, known as slow freezing. Vitrification involves a very rapid freezing process which is thought to cause less damage to the eggs and therefore increase the chances of achieving a pregnancy when the eggs are thawed. Frozen in time image by Ophelia photos.

2014 Study Abstract

BACKGROUND:
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.

OBJECTIVES:
To compare the effectiveness and safety of vitrification and slow freezing as oocyte cryopreservation techniques for fertility outcomes in women undergoing assisted reproduction.

SEARCH METHODS:
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).

SELECTION CRITERIA:
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.

MAIN RESULTS:
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.

AUTHORS’ CONCLUSIONS:
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

Investigating egg freezing: the new trend for women in the UK?

I’m 29: should I freeze my eggs?

Ice-Cube-Trays image
Moya Sarner and her boyfriend both know they want children – just not yet. Should she join the growing number of women in their 20s considering egg freezing? Inquiries into egg freezing at private fertility clinics in the UK surged by more than 400% in the past year… Colorful Ice Cube Trays image by cobalt123.

According to the NHS, around one-third of couples in which the woman is over 35 have fertility problems. This rises to two-thirds when the woman is over 40. No wonder more and more young women are looking into egg freezing: inquiries at private fertility clinics in the UK rose by more than 400% in the past year, with more than half coming from women under 35. Apple and Facebook now offer to pay for female employees to freeze their eggs as part of their benefits package. It’s starting to feel as if “investigate egg freezing” is just another thing to add to my to-do list.

Read I’m 29: should I freeze my eggs?, The Guardian, 14 August 2015.

IVF using frozen eggs associated with lower live birth rates

Outcomes of Fresh and Cryopreserved Oocyte Donation

ivf image
Compared to using fresh eggs for in vitro fertilization, use of frozen donor eggs in 2013 was associated with lower live birth rates, according to a new study in JAMA. Intothelight by Jon © all rights reserved.

Abstract

This study used data from the 2013 annual report of US in vitro fertilization center outcomes published by the Society for Assisted Reproductive Technology to compare live birth and cycle cancellation rates using either fresh or cryopreserved donor oocytes.

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.

Age-related fertility decline and failure rates for fertility preservation after oocyte vitrification

Fertility preservation for age-related fertility decline

Miriam Zoll image
Reproductive health and rights advocate Miriam Zoll is the author of Cracked Open – Liberty, Fertility, and the Pursuit of High-tech Babies.

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. ”

Sources: Miriam Zoll in The Lancet PIIS0140-6736(15)60199-4

Social egg freezing: risk, benefits and other considerations

Listen to Angel Petropanagos interview

egg on image image
Family physicians have an important role in advising women about the benefits and risks of egg freezing, argues an analysis in the Canadian Medical Association Journal.

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.
Press Play > to listen to the recording.

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.
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An Egg Freezing Cartoon by John Darkow

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Six things You need to know about Egg Freezing

High failure rates still associated across all age groups

The announcement that egg freezing becomes a no-cost, free option for Apple and Facebook female employees has many people talking about the risks and benefits of the procedure…

Live Science logo image
Live Science news covering top stories of the day in health, environment, animals, technology and space.
  • Egg freezing is better now than it used to be
  • Egg freezing is still not recommended for delaying childbearing
  • Egg freezing means a lot of trips to the doctor
  • Egg freezing at younger ages is best
  • Egg freezing is not a guarantee for pregnancy
  • Egg freezing poses health risks to women and possibly to children too

Read

  • Egg Freezing: 5 Things You Need to Know,
    LiveScience, October 22, 2014.
  • 5 Surprising Facts About Egg Freezing, LiveScience, June 17, 2016.
Related press releases:
  • The tough truth about egg freezing perks, fortune, October 22, 2014.
  • The facts don’t lie: We haven’t cracked egg freezing. Not even close, TheTelegraph, 17 Oct 2014.
  • Can I freeze my eggs to use later if I’m not sick?, asrm, 2014.

Egg Freezing poses Health Risks to Women and possibly to Children

Facebook and Apple’s egg freezing “benefit” is ill-advised for multiple reasons

Genetics and Society” press statement

Center for Genetics and Society logo image
The Center for Genetics and Society encourages responsible uses and effective societal governance of human genetic and reproductive technologies .

The decision by Facebook and Apple to offer their female employees a $20,000 benefit to freeze their eggs for later use with in vitro fertilization is ill-advised for numerous reasons, says the Center for Genetics and Society (CGS). These include the significant but under-studied risks of egg retrieval for women, and the dearth of evidence about potential long-term health risks to children born as a result of the egg-freezing process.

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.” ”

Sources and more information:
  • Egg freezing poses health risks to women, geneticsandsociety, October 15th, 2014.
  • Freezing Eggs Puts Women and Infants’ Health at Stake, NYTimes, 17 October 2014.
  • Silicon Valley offers egg freezing to employees – but is it safe?, MNT, 17 October 2014.