David Ogutu MRCOG
Medical Director and Consultant Gynaecologist
There have been many articles in the press over the last couple of years on social egg freezing. Media coverage of company sponsored egg freezing (US companies such as Apple and Facebook offer free egg freezing to their female employees who would like to postpone motherhood but maintain fertility) intensified the debate about it. Was this a publicity stunt as most cynics observed or a responsible employer looking out for the welfare of their female workforce? The debate continues.
Women are born with a set number of eggs and the quality and quantity declines over time. The main determinant of fertility is the age and therefore the quality of the eggs. The younger the age at which eggs are used, the higher the chances of future conception. This is the same case with spontaneous conception as well as with fertility treatments. The chances of conceiving decline over time, whilst rate of miscarriage increase with time. Women who are not in a position or not ready to conceive may plan to freeze their eggs at a younger age as insurance, in case they have difficulties conceiving in future.
A study by the Human Fertilisation and Embryology Authority (HFEA) of women who used their frozen eggs in 2014 found that only 14% of implantation cycles were successful. What the study did not tease out was the age of the patients at egg freezing and the egg freezing technology used. Most women that froze eggs used them many years later, meaning most would have been frozen by the older slow freezing technology. This had a much lower survival rate and pregnancy rate compared to the new Vitrification technology. The age of the women when freezing eggs is also significant, with a larger proportion of older women thus lower success rates.
Data from egg donation programs using the new Vitrification technology is showing similar success rates with frozen eggs as we find with fresh eggs. This shows that when eggs are frozen in the late twenties to mid-thirties, the success rates should be similar to fresh IVF / ICSI cycles performed in that age group.
At Herts and Essex Fertility Centre, we believe that the women should be empowered with all the necessary information to make an informed choice. We do encourage those in a stable relationship who are considering freezing eggs for social reasons to either reconsider their plans and start a family or consider freezing embryos (fertilised eggs) as these have better survival rates and possibly success than unfertilised eggs. However, if a decision to freeze eggs is made, realistic expectations of success rates, especially specific to the woman’s age should be discussed. We would not necessarily stop, but dissuade those over 40 years of age from freezing eggs for future use. Their best chances would be to use the eggs now, or consider donor eggs in future. However, we respect every woman’s right to make the best decision for her circumstances after being provided with clear information. We believe that society has to respect women’s’ right to determine what is best for their fertility, within the law and without compromising patient safety.