Following the #ExtendTheLimit campaign and petition led by the Progress Educational Trust (PET), the UK Government announced proposals to increase the time limit on storage of frozen eggs, sperm and embryos from ten years to a renewable ten-year limit capped at a maximum of 55 years, irrespective of medical need (see BioNews 1111). This is an important step forward, bringing the law up to speed with scientific advances and promoting reproductive choices.
The latest PET event, '#ExtendTheLimit: What Now For Egg Freezing?' gave an informative insight into the future of egg freezing. Chaired by Sarah Norcross, director of PET, the event brought together experts from various fields, including the Government, regulatory bodies, clinicians, patients, and Parliament. Norcross set the tone, asking the panellists and audience to ponder some pressing questions about the Government's recent proposals.
The webinar began with Steve Pugh, the team leader for assisted conception and embryology at the Department of Health and Social Care (DHSC). He outlined the policy development process, highlighting the impact of COVID-19. Crucially, Pugh clarified that those with embryos or gametes currently in storage will not lose out on the Government's proposals, allowing many to breathe a sigh of relief. He explained that the next steps will involve a short technical consultation to explore the proposals' impacts, prior to enacting primary legislation 'as soon as Parliamentary time allows'.
As the Government will have to work with the regulator, the Human Fertilisation and Embryology Authority (HFEA), it was fitting that Joanne Anton, the head of policy at the HFEA followed. The HFEA welcomed the Government's proposals, which will be in agreement with the scientific evidence about the safety of storage. With an increasing number of people freezing their eggs younger, Anton emphasised the need for a robust framework in place to preserve fertility, while accounting for capacity, patient communication, and consent. Some of the outstanding issues from a regulatory perspective related to the use of stored gametes and embryos, such as intergenerational storage and posthumous use.
Providing a clinical point of view, Mark Wilcox, the group medical director for CARE Fertility, started by discussing the difficulties with the concept of 'premature infertility,' as it excludes a large swathe of the population interested in gamete storage. He discussed the British Fertility Society welcoming the proposed changes, reassured by the safety provided by scientific evidence. Similar to Anton, he noted the trend of younger people freezing their eggs, allowing him to highlight some of the clinical issues that emerge as a result. The proposed regulatory changes shift consent for storage extension from doctors to patients; Wilcox discussed the potential significant psychological impacts on patients in making decisions about continued storage. He addressed the concern that extending the storage limit may encourage people to start a family later in life, proposing gender-neutral child welfare considerations which take into account whether the future parents would be present until adulthood.
Professor Jason Kasraie, chair of the Association of Reproductive and Clinical Scientists and head of fertility services and lead embryologist at Shropshire and Mid-Wales Fertility Centre, discussed more practical clinical difficulties emerging out of the proposed changes. He explained that patient communication is already a difficult task for fertility clinics, and the new limits would add a layer of complexity to those responsible for storage coordination and communication. Despite the considerable work and costs emerging from the proposed extension, Professor Kasraie was quick to emphasise that we should celebrate the scientific advances in survival and success that have allowed this, given the immense benefits to patients.
Sharon Jones, the penultimate speaker, provided her personal perspective on the issue, as the patient face of the #ExtendTheLimit campaign and petition. When Jones decided to look into egg freezing, she had to weigh up the increased success rate with younger eggs with the ten-year limit. She pointed out how quickly the ten-year limit creeps up: had she frozen her eggs at 27, when her journey started, her embryos would be destroyed in just six months' time from now. Sharon was clear the current arbitrary ten-year limit, without any scientific backing, was inappropriate, given the mounting financial costs and decision-making.
The final speaker was Baroness Ruth Deech, a crossbench peer in the House of Lords and former chair of the HFEA. Baroness Deech called for an immediate moratorium on the destruction of gametes and embryos – especially in light of the two-year COVID extension – while the Government legislates on the proposals. Unconvinced by any attempt to delay these proposals, she could not see the value in the Government's plan for further consultation and felt that if the legislation is enacted 'when Parliamentary time allows' this did not consider the very real impact the delays will have on people's lives. She noted, contrary to the DHSC, the possibility of including these proposals within the Health and Care Bill, rather than requiring separate primary legislation. This echoes Professor Emily Jackson's policy briefing paper suggesting that secondary legislation would be sufficient for these proposals.
While there are very few arguments against increasing the limits for gamete and embryo storage, there are very real issues that must be addressed prior to legislation. While lifting this limit allows for increased reproductive choice, alleviating the current pressure placed (primarily) on women, the practical clinical considerations must be accounted for, to ensure no inadvertent restrictions on those able to freeze their eggs ensues. Furthermore, the implications on third-party reproduction, such as surrogacy, must be explored fully. Some of these concerns were noted during the Q&A session.
In summary, the two-hour event demonstrated the need for a robust, carefully planned regulatory framework to be put in place, ensuring that many of the ethical and moral issues are considered, with engagement from all stakeholders.
PET is grateful to the British Fertility Society, CooperSurgical, the London Egg Bank, the Senior Infertility Nurse Group and TMRW Life Sciences for supporting this event. Our next online events will be:
'Advances in Assisted Reproduction: What Can We Expect?' this week on Wednesday 6 October 2021, register here.
'Newborn Screening: What Should Be Screened for and How?' on Wednesday 3 November 2021, register here.
'Reproducing Regulation: Who Regulates Fertility and How?', PET's Annual Conference on Wednesday 1 December 2021, register here.