Social egg freezing: risk, benefits and other considerations

• Published in: Canadian Medical Association journal (CMAJ) 2015-06, Vol.187 (9), p.666-669
• Main Authors: Petropanagos, Angel, Cattapan, Alana, Baylis, Françoise, Leader, Arthur
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Analysis; Cryopreservation; Cryopreservation - economics; Cryopreservation - ethics; Female; Fertility; Fertility Preservation - adverse effects; Fertility Preservation - economics; Fertility Preservation - ethics; Fertilization in Vitro - adverse effects; Fertilization in Vitro - economics; Fertilization in Vitro - ethics; Forecasts and trends; Humans; Laws, regulations and rules; Oocyte banks; Oocyte Retrieval - adverse effects; Oocyte Retrieval - economics; Oocyte Retrieval - ethics; Practice guidelines (Medicine); Reproductive Behavior; Reproductive health; Risk Assessment; Social aspects; Women
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.141605

In late 2012, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) announced that they would no longer consider oocyte cryopreservation (i.e., egg freezing) to be experimental. In their joint practice guideline, published in early 2013,1 the ASRM and SART specifically cautioned against the use of egg freezing as a guard against age-related fertility decline, owing to limited data about the safety, efficacy, cost-effectiveness and emotional risks of egg freezing for healthy women of reproductive age. In 2014, the American College of Obstetricians and Gynecologists (ACOG) endorsed the ASRM-SART guideline. Notwithstanding these cautions, the use of social egg freezing (i.e., nonmedical egg freezing) is increasing in the United States. This increase has been linked to a number of complex and interrelated reasons for delayed childbearing, including personal, professional, financial and psychological factors.2 Recent media attention has contributed to the increasing public awareness of egg freezing in Canada. Consider, for example, media interest in announcements by Facebook and Apple that they would provide limited insurance coverage for the cost of egg freezing as an employee benefit.4 With growing public awareness of social egg freezing, Canadian women may increasingly approach physicians in search of information and advice about the procedure. Family physicians are uniquely positioned at the front lines of medical care to provide information to women who ask about egg freezing. This paper outlines medical, financial and societal implications of social egg freezing that are relevant in providing accurate and balanced information for such discussions. Egg freezing is a process that involves the hormonal stimulation of the ovaries, followed by transvaginal retrieval and subsequent freezing and storage of a woman's viable eggs.1 Although egg freezing can occur using slow-freezing or vitrification (flash-freezing) protocols, the latter technology has increased oocyte survival post-thaw and improved pregnancy rates,1,5 and is the method recommended by the relevant professional medical associations. Vitrification involves the use of cryoprotectants and ultrarapid cooling in an effort to solidify the cell to avoid the formation of ice crystals. The ASRM-SART practice guideline estimates that the survival rate of oocytes after vitrification and thawing is 90%-97%, the fertilization rate is 71%-79% and the i