RCOG suggests caution over social egg freezing
The procedure does not guarantee success and there are high private treatment costs, as well as the side effects associated with egg freezing and IVF treatment, says the RCOG. But with improving success rates over the years, egg freezing does offer some women the opportunity to delay pregnancy until later in life.
The RCOG call comes as two groups of fertility specialists, writing in BJOG: An International Journal of Obstetrics and Gynaecology, debate the benefits and risks associated with social egg freezing and IVF treatment for women in their late thirties – when female fertility typically declines considerably.
In an argument for social egg freezing, Dr Jara Ben Nagi from the Centre for Reproductive and Genetic Health and colleagues argue that it can extend the window of opportunity for single women to find the right partner and offer them hope when their fertility may be in decline.
They point to a study which showed that of 1,382 women who underwent social egg freezing, 120 (8.7%) returned to use their eggs after a mean duration of 2.2 years. Forty-five of the 95 women who were single at the time of egg freezing had a partner when they returned, which demonstrates the benefit of egg freezing for single women.
They also point to evidence which shows the survival rate of the frozen egg using the vitrification method – a new freezing technique with a higher success rate – was 85%, with pregnancy rates of 27%. This is similar to a 23% success rate for IVF in women aged 35-37.
“Women should no longer be punished with childlessness for not finding a partner, nor should they feel pressured into a relationship because of their declining ovarian reserve”, they argue.
They recommend “extensive fertility and preconception counselling, including risk of age related complications during pregnancy and birth, as well as future unsuccessful treatment. Good clinical practice of IVF is needed to ensure best outcomes and reduce any complications for women and their babies.”
Meanwhile, Dr Timothy Bracewell-Milnes from Imperial College London and co-authors from Chelsea and Westminster Hospital in London warn that the majority of women are taking measures to preserve their fertility too late, as a ‘last ditch effort’, instead of a planned and informed choice in their early to mid-thirties.
Research has shown young people are not aware of the natural limits of female fertility and significantly overestimate the success rates of assisted reproductive technologies, they argue.
In addition, they highlight that of the 1,173 egg freezing cycles that took place in 2016, only 32% of women freezing their eggs were aged 35 years or below. This is despite the fact that the highest predictive factor for successful egg freezing is age below 36 years.
Because of lower success rates per egg with increasing age, women in their late thirties would need approximately 30 eggs to have a good chance of achieving pregnancy. These women would, therefore, require on average three cycles of ovarian stimulation to produce enough eggs, at a cost of around £15,000 overall. This excludes an annual storage fee of £200-400 and the cost of future fertility treatment to use her frozen eggs.
They argue “egg freezing should be available to single women in their late thirties who accept the high costs and low successes, but these women and their partners must be provided with accurate and balanced information on the safety and likelihood of success.”
However, they conclude “future focus should be on providing accurate information from an early age to enable women and their partners to plan their families and present to fertility clinics at a younger age and therefore improve chances of having a healthy pregnancy and birth.”
Adam Balen, Professor of Reproductive Medicine and Spokesperson for the Royal College of Obstetricians and Gynaecologists, said:
“Success rates for egg freezing have improved significantly in recent years so offer an opportunity for women to freeze their eggs for social reasons if they’re not ready to have children yet. However, it must be stressed that egg freezing does not guarantee a baby in the future. Women should also be aware that in the UK the storage limit for eggs frozen for social reasons is currently limited to 10 years.
“While women should be supported in their choices, they must be informed about the relatively low success rates, high costs and side effects associated with egg freezing and IVF treatment. If a woman does decide to freeze her eggs for social reasons, she should have counselling with a reproductive specialist and choose a clinic that has plenty of experience. The clinic should provide a realistic idea of potential success related to her age. Evidence suggests that the best time to freeze eggs is in a woman’s early twenties and certainly under the age of 37 years old.
“It is extremely important to provide accurate and balanced information about fertility and how it changes with increasing age. Relationships and sex education, particularly for young people, must include information to enable women and their partners to make informed decisions about when to start a family to ensure the healthiest outcomes.”
Note to editors
Public link to papers:
Social egg freezing should be offered to single women approaching their late thirties FOR: Women should not suffer involuntary childlessness because they have not yet found a partner
Social egg freezing should be offered to single women approaching their late thirties AGAINST: Women should be freezing their eggs earlier
Egg freezing is a procedure to preserve a woman’s eggs to enable women to delay conception and pregnancy until a later time. The eggs are extracted, frozen and stored. Women may choose to have the eggs thawed, fertilized via IVF, and transferred to the uterus as embryos to enable a pregnancy.
Since 2010, 471 babies have been born from frozen eggs in the UK, according to HFEA.
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG’ or ‘BJOG: An International Journal of Obstetrics and Gynaecology’ when referring to the journal. To keep up to date with our latest papers, follow @BJOGTweets.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.