Advertisement
JOGC
COMMENTARY| Volume 37, ISSUE 1, P64-67, January 2015

Left Out in the Cold: Arguments Against Non-Medical Oocyte Cryopreservation

      Key Words

      On October 21, 2014, following a week of media headlines about Apple’s decision to include oocyte cryopreservation in its employee benefit package,
      • The Current
      • Friedman D.
      • BBC News
      • Walden R.
      • Tsigdinos P.M.
      the Canadian Fertility and Andrology Society (CFAS) published its one-page “Position Statement on Egg Freezing.”
      • Canadian Fertility and Andrology Society
      The CFAS statement, like that issued by the Practice Committee of the American Society for Reproductive Medicine (ASRM),
      • The Practice Committees of the American Society for Reproductive Medicine
      • the Society for Assisted Reproductive Technology
      Mature oocyte cryopreservation: a guideline.
      stipulated that oocyte cryopreservation is no longer considered experimental. Unlike the ASRM, however, the CFAS endorsed oocyte cryopreservation as a legitimate strategy for women “to preserve their fertility in the face of anticipated decline … through the natural aging process.”
      • Canadian Fertility and Andrology Society
      With this endorsement, the CFAS effectively legitimized a service that has been offered at some Canadian fertility clinics since 2010. A study conducted by Liu and Greenblatt between December 2010 and February 2011 (in which 20 of the then 28 Canadian fertility clinics participated) reported that 16 clinics offered oocyte cryopreservation, mostly to:
      • 1.
        patients undergoing fertility-reducing treatments such as chemotherapy and radiotherapy, and
      • 2.
        women and couples undergoing IVF when the sperm sample was unexpectedly unavailable.
      Nine of these 16 clinics also offered oocyte cryopreservation for non-medical reasons (i.e., so that women might avoid future age-related infertility).
      • Liu K.
      • Greenblatt E.
      Oocyte cryopreservation in Canada: A survey of Canadian ART clinics.
      In sharp contrast to the CFAS, the ASRM was (and remains) concerned about engendering false hope among women who think of oocyte cryopreservation as a “really good insurance policy.”
      • Motluk A.
      Growth of egg freezing blurs ‘experimental’ label.
      In 2012, when the ASRM practice committee lifted the experimental designation on oocyte cryopreservation,
      • The Practice Committees of the American Society for Reproductive Medicine
      • the Society for Assisted Reproductive Technology
      Mature oocyte cryopreservation: a guideline.
      it cited preliminary data on the efficacy (clinical pregnancy and live birth rates) and safety (perinatal outcomes) of mature oocyte vitrification and warming. In making this policy change, however, the ASRM specifically cautioned against oocyte cryopreservation for non-medical reasons owing to the absence of relevant data on safety, efficacy, ethics, emotional risks, and cost-effectiveness. Specifically, the ASRM practice committee concluded: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women.”
      • The Practice Committees of the American Society for Reproductive Medicine
      • the Society for Assisted Reproductive Technology
      Mature oocyte cryopreservation: a guideline.
      Surprisingly, without reference to new (or for that matter, any) data specific to non-medical oocyte cryopreservation, the CFAS aligned itself with those who would use this technology to circumvent reproductive aging. Indeed, the ASRM’s professional caution is not only set aside by the CFAS, it is also ignored by technology behemoths Facebook and Apple. Consistent with their corporate priorities, these high-tech companies aim to keep their talented young employees at the office doing their job, not at home caring for babies. A modern means to this capitalist end is to “empower” women in their late twenties to late thirties (typically less than 37 or 38 years of age) to “choose” delayed childbearing. Not to put too fine a point on this, Facebook and Apple want a productive, not a reproductive, workforce.
      So it is that in the past year, each of these companies has, in turn, elected to include oocyte cryopreservation in their employee benefit package. According to media reports, from January 1, 2015, Apple will pay up to $US20 000 per person for oocyte cryopreservation and storage for all full-time and part-time employees. Facebook introduced a similar benefit for its employees in the United States in January 2014, and pays up to US$20 000 for both medical and non-medical oocyte cryopreservation.
      • Barbato L.
      In this way, young female employees at Facebook and Apple can be helped to pursue their careers (thereby presumably contributing to their respective company’s bottom line), while their company has paid to put their reproductive material and their reproductive plans “on ice.”
      Regrettably, some describe this corporate decision-making in positive terms. They congratulate the companies for ‘taking the lead.’ In this way, they both endorse the decision and encourage others to follow. Already, Virtus Health in Australia has announced that it too will pay for oocyte cryopreservation for its female employees. According to the Medical Director of Virtus “… if it’s good enough for Apple and Facebook, it’s good enough for us.”
      • Francis H.
      Ironically, this statement mirrors one aimed at women: “If it’s good enough for Sofia Vergara, Kim Kardashian, and Maria Menounos, it’s good enough for you.”
      • Mohapatra S.
      Using egg freezing to extend the biological clock: fertility insurance or false hope?.
      Others, however, insist that providing oocyte cryopreservation as an employee benefit is not only counterproductive but offensive. It not only fails to empower young women, it actually disempowers them by overtly entrenching the otherwise subtle message that women who have babies are not serious about their careers.
      In my view, it is one thing for individual, healthy, young women to pursue oocyte cryopreservation for personal reasons (such as not having a partner, not being in a stable relationship, wanting to pursue higher education, or wanting to pursue a career). It is quite another thing for an employer to promote oocyte cryopreservation among its healthy female employees, as a result of which employees may feel pressured to postpone pregnancy and childbirth.
      I offer seven reasons why Facebook and Apple employees should reject non-medical oocyte cryopreservation as an employee benefit.
      First, ovarian stimulation and oocyte retrieval to collect oocytes for freezing are both onerous and risky. The required daily hormone injections (for up to two weeks) to stimulate oocyte development are known to be painful and uncomfortable. There can be cramping, abdominal pain, nausea, and vomiting. More serious possible side effects include rapid weight gain and damage to organs close to the ovaries.
      • Maxwell K.N.
      • Chost I.N.
      • Rosenwaks Z.
      The incidence of both serious and minor complications in young women undergoing oocyte donation.
      • Bodri D.
      • Guillén J.J.
      • Polo A.
      • Trullenque M.
      • Esteve C.
      • Coll O.
      Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles.
      More serious still is the risk of severe ovarian hyperstimulation syndrome which can require hospitalization and rarely has resulted in death.
      • Newmark B.
      • Balen A.
      As well, there are reports suggesting a link between ovarian stimulation and certain cancers.
      • Rizzuto I.
      • Behrens R.F.
      • Smith L.A.
      Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility.
      • Calderon-Margalit R.
      • Friedlander Y.
      • Yanetz R.
      • Kleinhaus K.
      • Perrin M.C.
      • Manor O.
      • et al.
      Cancer risk after exposure to treatments for ovulation induction.
      • Schneider J.
      Fatal colon cancer in a young egg donor: a physician mother’s call for follow-up and research on the long-term risk of ovarian stimulation.
      In addition to the potential harms of ovarian stimulation, there are the potential harms of oocyte retrieval. There can be mild internal bleeding and scar tissue around the ovaries and the fallopian tubes. Tubal scarring can interfere with natural conception.
      Second, contrary to popular belief, oocyte cryopreservation does not set back (rewind) a woman’s biological clock. While it is certainly true that oocytes from a younger woman are more likely to generate a healthy embryo, healthy pregnancy, and healthy birth than oocytes from an older woman, it very much matters that the body into which the embryos will be transferred is the body of an older woman. Considered from a purely biological perspective, it is in the interest of women to have their children while they are younger. Considered from a personal perspective, it is also possible that having children earlier may be more rewarding.
      A third issue is the limited efficacy of oocyte cryopreservation and the concerns about safety. A 2014 fact sheet prepared by the ASRM confirms that “Even in younger women (i.e., < 38 years old), the chance that one frozen egg will yield a baby in the future is around 2% to 12%.”
      • American Society for Reproductive Medicine
      This is considerably lower than the chance of pregnancy among young healthy women having unprotected intercourse. More generally, oocyte cryopreservation is not insurance for future fertility. As Ronald Feinberg, a reproductive endocrinologist, says, “insurance means you are guaranteed to receive a financial payout or service to compensate you for a loss if a bad event occurs … [E]gg freezing as it exists today does not protect women from infertility nor does it guarantee them a pregnancy in the future.”
      • Feinberg R.F.
      Moreover, we don’t yet know with confidence that oocyte cryopreservation is completely safe for the children born of this technology. Preliminary, short-term safety data appear reassuring. Long-term safety data are not available.
      • The Practice Committees of the American Society for Reproductive Medicine
      • the Society for Assisted Reproductive Technology
      Mature oocyte cryopreservation: a guideline.
      Indeed, these facts about oocyte cryopreservation and concern about the risk of instilling false hope about future fertility in young women are among the reasons cited by the ASRM not to pursue oocyte cryopreservation for non-medical reasons.
      Fourth, oocyte preservation is at best a halfway technology. As Ken Cadesky of Life Quest once acknowledged “In essence, it’s half an IVF cycle.”
      • Lunau K.
      Oocytes in storage are of no personal value to a woman who wants to make a baby unless she chooses to reproduce using IVF. In many ways, therefore, consenting to oocyte cryopreservation is but a first step on the path to future IVF. IVF is a costly reproductive option. We know that Facebook and Apple are willing to pay up to US$20 000 to keep their young female employees “unpregnant.” What, if anything, are they willing to pay to have these women, at a later date, use their cryopreserved oocytes to become pregnant?
      Fifth, normalizing oocyte cryopreservation does nothing to correct the fundamental social injustice experienced by young women in the workplace who are effectively forced to choose between having a career and raising children. This is not a choice demanded of young men. The working assumptions are that young men can be fathers and productive employees, but that young women can either be mothers or productive employees. Media pronouncements to the contrary, oocyte cryopreservation does not create a level playing field for women and men precisely because it does nothing to ameliorate the social context in which women make reproductive choices. It does not cancel out the children-or-career dilemma for highly educated professional women, which Marcia Inhorn describes as the “fertility penality.”
      • Inhorn M.
      Sixth, providing women with the option of oocyte cryopreservation does not meaningfully enhance women’s reproductive decision-making. The choices available to women remain significantly (and inappropriately) constrained and distorted by the social context. To meaningfully enhance women’s reproductive decision-making, society needs to overtly value family-making. As well, the state and employers need to provide benefits and supports that make the options of reproducing and delaying reproduction equally appealing. Finally, partners in childbearing need to share equally the responsibilities of childrearing.
      Seventh, there are many negative downstream effects of encouraging oocyte cryopreservation for non-medical reasons. One of these negative effects is the probable accumulation of unused cryopreserved oocytes because many of the young women who cryopreserve their oocytes are unlikely to use them. This means that the personal and social harms outlined above will have been incurred without the prospect of personal benefit from oocyte cryopreservation. Imagine, for the sake of argument, that it takes 10 years in the workplace to successfully establish one’s career in the high-tech industry. Now imagine an educated career-driven woman in her mid- to late twenties who decides to cryopreserve her oocytes. In her mid- to late thirties, with her career well-established, she decides it is time to start a family. If she has a partner with whom she wants to have children, and they prefer to conceive their children naturally and not in vitro, there may be no need for cryopreserved oocytes. Alternatively, if she doesn’t have a partner with whom she wants to have children and she doesn’t want to be a single mother, there will be no need for cryopreserved oocytes.
      Facebook and Apple employees (both women and men) should reject oocyte cryopreservation for non-medical reasons, and should also lobby their respective companies to provide them with an employee benefit package that is truly family-friendly. At minimum, this package should include a year of paid family leave following the birth of a child or the legal adoption of a child, reliable, on-site subsidized daycare, flexible work policies and practices (including telecommuting), and support for re-entry into the workplace. Of note, the company contribution to paid family leave will vary from one jurisdiction to another.
      More generally, we all need to think carefully about the negative downstream effects of encouraging oocyte cryopreservation for non-medical reasons. These downstream effects include the further medicalization and commercialization of women’s reproductive labour, the risk of stigma among those who choose not to cryopreserve their oocytes, the possible increased use of adjunct reproductive technologies such as prenatal genetic diagnosis and contract pregnancy, and the probable accumulation of unused cryopreserved oocytes. For these reasons, we should all lobby for family-friendly benefits for young people who want to have children so that they can freely choose to reproduce or not.

      ACKNOWLEDGEMENTS

      Funding in support of this research was provided by the Canadian Institutes of Health Research grant EOG111389 “A comparative study of assisted human reproduction patients’ views about the donation of eggs and embryos for scientific and clinical research” and the Canada Research Chair in Bioethics and Philosophy on “Impact Ethics: Making a Difference.”

      REFERENCES

        • The Current
        Facebook & Apple add egg freezing to employee benefit plans, spark controversy. Canadian Broadcasting Corporation, October 16, 2014 (Available at:) (Accessed November 3, 2014)
        • Friedman D.
        Perk up: Facebook and Apple now pay for women to freeze eggs. NBC News, October 15, 2014 (Available at:) (Accessed November 3, 2014)
        • BBC News
        Should employers pay for women to freeze their eggs? BBC News, October 15, 2014 (Available at:) (Accessed November 3, 2014)
        • Walden R.
        Why corporate promotion of egg freezing isn’t a “benefit” to all women. Our Bodies Ourselves, October 28, 2014 (Accessed November 3, 2014. [website]. Available at:)
        • Tsigdinos P.M.
        The sobering facts about egg freezing that nobody’s talking about. October 24, 2014 (Wired. Available at:) (Accessed November 3, 2014)
        • Canadian Fertility and Andrology Society
        Position statement on egg freezing. CFAS, Montreal2014 (Available at:) (Accessed November 3, 2014)
        • The Practice Committees of the American Society for Reproductive Medicine
        • the Society for Assisted Reproductive Technology
        Mature oocyte cryopreservation: a guideline.
        Fertil Steril. 2013; 99 (Available at:) (Accessed November 3, 2014): 37-43
        • Liu K.
        • Greenblatt E.
        Oocyte cryopreservation in Canada: A survey of Canadian ART clinics.
        J Obstet Gynaecol Can. 2012; 34: 250-258
        • Motluk A.
        Growth of egg freezing blurs ‘experimental’ label.
        Nature. 2011; 476: 382
        • Francis H.
        Facebook, Apple egg-freezing policy commodifies women: experts. October 16, 2014 (The Age. Available at:) (Accessed November 3, 2014)
        • Barbato L.
        Facebook and Apple will freeze your eggs if you work there, but working mothers still get a bad deal. Bustle, October 13, 2014 (Available at:) (Accessed November 3, 2014)
        • Francis H.
        Aussie IVF company joins Apple, Facebook by paying to freeze workers’ eggs. Sydney Morning Herald, October 16, 2014 (Available at:) (Accessed November 3, 2014)
        • Mohapatra S.
        Using egg freezing to extend the biological clock: fertility insurance or false hope?.
        Harvard Law & Policy Review. 2014; 8: 381-411
        • Maxwell K.N.
        • Chost I.N.
        • Rosenwaks Z.
        The incidence of both serious and minor complications in young women undergoing oocyte donation.
        Fertil Steril. 2008; 90: 2165-2171
        • Bodri D.
        • Guillén J.J.
        • Polo A.
        • Trullenque M.
        • Esteve C.
        • Coll O.
        Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles.
        Reprod Biomed Online. 2008; 17: 237-243
        • Newmark B.
        Ovarian hyperstimulation syndrome. Parliamentary Secretary, UK Cabinet Office, September 2014 (Available at:) (Accessed November 3, 2014)
        • Balen A.
        Ovarian hyperstimulation syndrome (OHSS): a short report for the HFEA. Human Fertilisation and Embryology Authority, London2008 (Available at:) (Accessed November 3, 2014)
        • Rizzuto I.
        • Behrens R.F.
        • Smith L.A.
        Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility.
        Cochrane Database Syst Rev. 2013 Aug 13; 8: CD008215
        • Calderon-Margalit R.
        • Friedlander Y.
        • Yanetz R.
        • Kleinhaus K.
        • Perrin M.C.
        • Manor O.
        • et al.
        Cancer risk after exposure to treatments for ovulation induction.
        Am J Epidemiol. 2009; 169: 365-375
        • Schneider J.
        Fatal colon cancer in a young egg donor: a physician mother’s call for follow-up and research on the long-term risk of ovarian stimulation.
        Fertil Steril. 2008; 90: 2016.e1-2016.e5
        • American Society for Reproductive Medicine
        Fact sheet: can I freeze my eggs to use later if I’m not sick? Society for Assisted Reproductive Technology, Birmingham (AL)2014 (Available at:) (Accessed November 3, 2014)
        • Feinberg R.F.
        Elective egg freezing: 10 thoughts from an REI. Rheumatology Network, October 16, 2014 (Available at:) (Accessed November 3, 2014)
        • Lunau K.
        Thirty-seven and counting: the harsh reality of women’s fertility decline. MacLean’s, October 27, 2012 (Available at:) (Accessed November 3, 2014)
        • Inhorn M.
        Women, consider freezing your eggs. CNN, April 9, 2013 (Available at:) (Accessed November 3, 2014)