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The social pioneers of egg freezing are facing tough choices

30 July 2018
Appeared in BioNews 960

As the phenomenon of egg freezing grows, with increasing numbers of women electing to freeze their gametes in the UK each year (see BioNews 943), so do discussions of the ethical and social aspects of this practice. Currently, one of the most urgent questions concerns the 10-year storage limit for frozen eggs. 

This question, first raised by Professor Emily Jackson in 2016, has important consequences not only for the UK's first cohort of egg freezers, who are rapidly nearing the end of their storage period but also for the for the future of the technology. We know that the success rates of egg freezing would be significantly improved if women were able to freeze healthier, younger eggs, yet the current law acts as a strong disincentive to doing so. Women are only permitted a limited time-frame to use their eggs, rendering the 10-year storage limit distinctly 'not fit for purpose'

To date, solutions have been sought through direct appeals to the Human Fertilisation and Embryology Authority (HFEA); questions raised in Parliament by MP Tonia Antoniazzi; and, most recently, by starting a campaign, led by Joyce Harper and colleagues, to pressure Parliament to review the time limit (see BioNews 946). Unsurprisingly, the petition accompanying this campaign has already gained the signatures of many leading figures within the fertility sector, from clinicians and embryologists to academics and fertility counsellors.

However, there has so far been one perspective missing from this growing and much-needed debate: the experiences of the 'social pioneers' who froze their eggs in the early days of vitrification. These are the people most directly affected by the 10-year storage limit. In this piece, we attempt to address this omission to some degree, by providing anonymous details of some of our patients' experiences at the London Women's Clinic over the past year. 

Extension of Storage

Some of our patients nearing the end of their storage limit have sought extensions through the HFEA. In some cases, we have been able to demonstrate that our patients had become prematurely infertile (since freezing their eggs), meaning they would be eligible for the 55-year medical storage limit. However, there has been no leeway for patients who do not meet those medical criteria. The case is often not clear, as many health care professionals disagree over what qualifies as premature infertility, causing patients extra anxiety. 

Thawing to attempt conception

In one case, Caroline* thawed ten of her 21 eggs, created embryos using donor sperm, and gave birth to a wonderful boy last July. While this was a very happy outcome, Caroline now faces the difficult decision of whether to thaw her remaining 11 eggs to try for a sibling before the end of her storage period this autumn. She must balance her desire for a second child against the demands of solo-mothering two children under two years old.  

Moving frozen eggs overseas

Some of our patients have decided to export their frozen eggs overseas, where they can continue to store them beyond the 10-year UK limit. This potential solution, although laborious and bureaucratic, has worked reasonably well in two cases. In one case, the patient had moved overseas herself and was, in effect, bringing her eggs to her new home country. In the other, the patient had existing strong links with a country that would accept her eggs for future treatment. 

We are very aware, however, that taking eggs abroad is not a feasible solution for many patients. Undergoing fertility treatment is stressful and costly at the best of times. We therefore feel it is deeply unethical to effectively force women not only to move their eggs overseas in the first place, but also to face the added stresses and burdens of seeking cross-border reproductive care in a foreign country.

Discarding and donating

Sadly, some of our patients have felt they have had no choice but to discard their eggs, even though this was not their first choice. One patient has chosen to donate her frozen eggs to research.

Indecision regarding the fate of frozen eggs

Understandably, we have several patients in a state of indecision about what to do as they near their storage limit. In one case, a patient came for several consultations at the clinic, with both consultants and our counsellor. She eventually became unresponsive to the clinic's efforts to get in contact as her storage deadline approached. We do not wish to make any assumptions about the thoughts and feelings of this patient, but we are aware of the sensitivities regarding disposal decisions and feel it is not in the best interests of our patients to be pressured into making these.

Another of our patients, Miranda*, is currently struggling with how to respond to the end of her storage limit, recently told us: 'My personal experience, whether I get to use these eggs or not, is that I am proud and glad that I went through the process, because I gave myself an opportunity that I would not otherwise have had.' 

However, Miranda added that she was strongly dissatisfied with the storage limit. 'I come back to the point that they [the frozen eggs] don't cease to have more or less value depending on what a woman decides to do… Technology is changing all the time. So, too, our expectations about lifespan. And therefore, we have to be socially progressive. Ten years is arbitrary, other countries do not have any limit at all. Let's make it dependent on a woman's health.'

We agree wholeheartedly with Miranda, and hope that soon our patients will not have to face the difficult dilemmas arising from this arbitrary 10-year storage limit. It is an undeniable reality that this issue is going to affect increasing numbers of women each year, and it is in the interests not only of patients, but also of clinics and the HFEA to seek a resolution as soon as possible. We are cautiously optimistic that, with current momentum, the storage limit may soon be extended, and hope that this matter is addressed in the HFEA's upcoming egg freezing report. 

* All patients names have been changed for reasons of confidentiality.

13 August 2018 - by Dr Sam Sherratt 
Women who freeze their eggs for social reasons need to be better informed about the potential difficulties of the process, experts from the Royal College of Obstetricians and Gynaecologists have warned...
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