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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.
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.
Is too much hope placed in egg freezing?
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.
I’m 29: should I freeze my eggs?
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.
Outcomes of Fresh and Cryopreserved Oocyte Donation
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.
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.
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,
Listen to Angel Petropanagos interview
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.
An Egg Freezing Cartoon by John Darkow
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…
Read
Facebook and Apple’s egg freezing “benefit” is ill-advised for multiple reasons
” 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.” ”
