The rain and mist were thick in Edinburgh on the evening of 15 June, when the Progress Educational Trust (PET) held its first-ever debate in Scotland. But despite the weather – and the fact that the subject of the debate was egg freezing – the atmosphere in the Great Hall of the Royal College of Physicians of Edinburgh could not have been warmer.
The debate, 'Can Women Put Motherhood On Ice?', organised in partnership with the Scottish Government, covered the many medical and social aspects of egg freezing. It also discussed how best to ensure that women are neither pressured to freeze eggs nor denied the option of doing so.
The speaker panel was made up of two specialists in reproductive medicine and two specialists in bioethics, with an additional biomedical expert – Professor Jane Norman, director of Tommy's Maternal and Fetal Research Centre at the Royal Infirmary of Edinburgh – as chair.
The debate was a satellite event of World Congress of the International Association of Bioethics, which took place nearby. Many of the delegates from the congress – bioethicists from around the world – attended, together with a wide variety of patients, professionals, academics and others. This made for an especially lively and productive discussion.
David Baird, emeritus professor of reproductive endocrinology at the University of Edinburgh, gave an overview of the biology of human egg production in the fetus and the gradual reduction of eggs by cell death or ovulation until the menopause. He made a point that was referred to repeatedly throughout the evening – research shows that the most common reason for women to delay attempting pregnancy is, quite simply, the lack of a partner with whom they want to raise a family.
There seemed to be few palatable solutions to this problem. The approach that was most strongly supported by speakers and attendees was fertility education – encouraging men and women alike, from a young age, to understand fertility and to start considering these issues early on.
Dr Sarah Martins Da Silva, consultant gynaecologist at Ninewells Hospital and Medical School, discussed the increasing trend towards delayed childbearing. She pointed out that while egg freezing may improve the quality of oocytes available to a woman seeking to have genetic offspring, pregnancy at an older age still carries increased risks to both mother and child. This prompted a debate about whether it is necessary, desirable or ethical to recommend a maximum age to attempt pregnancy. Most of the panel agreed, with caveats, that the decision to attempt pregnancy must ultimately be up to the individual.
Dr Ainsley Newson, associate professor of bioethics at the University of Sydney in Australia, posed some incisive questions about companies paying for employees to freeze their eggs. If unaccompanied by parent-friendly policies, are such offers simply a way for companies to mask their lack of meaningful support for employees who wish to have children? What happens if a woman whose frozen eggs are stored at the expense of the company wishes to leave – does this give the company undue leverage over the employee?
Dr Angel Petropanagos, research associate in the impact ethics team at Dalhousie University in Canada, stressed the importance of understanding the social pressures that can force women to pursue or avoid pregnancy at different times in their lives. She pointed out that the high social value placed upon biological reproduction, for women in particular, is a factor that can significantly constrain women's choices.
Both Dr Petropanagos and Dr Newson discussed the importance of language in shaping the debate. Though the faintly pejorative 'social egg freezing' is commonly used in the media, the distinction between medical and social egg freezing is technologically and biologically fairly meaningless. The distinction can unhelpfully polarise the debate around egg freezing.
Many issues were raised during questions and comments from the audience, including the UK's current ten-year legal limit on social egg freezing. This means that eggs frozen by a woman in her early 20s would lead to eggs that were unusable by her mid-30s. This only adds to the ethical repercussions of marketing egg freezing to younger women.
Full education of young people of all sexes about their reproductive options and constraints was a popular topic. The Scottish Government's funding of Infertility Network UK's work in this area was lauded, as was its recent announcement that it will expand the provision of publicly funded IVF (see BioNews 855).
This may have been PET's first debate in Scotland, but it was by no means the last. Having debated fertility preservation for non-medical reasons, PET will next be debating fertility preservation for medical reasons at its event 'Frozen Assets? Preserving Sperm, Eggs and Embryos' in Edinburgh on Tuesday 25 October.