IVF

A Daily Telegraph article last week asked: ‘Motherhood on ice: has the egg-freezing generation of working women been misled?

That’s an easy question to answer: Yes!

The massively profitable egg-freezing industry has an appallingly low ‘success’ rate, yet still tempts thousands of women to take this route because they know their ‘biological clock’ is running down.

Both the number and quality of a woman’s eggs reduce over time. So freezing eggs for future use, while a woman is younger but not ready to have a child (most commonly, because of a lack of a partner), is heavily marketed as a solution to bypass the ‘biological clock’ of motherhood or, as this Lancet article says, to ‘overcome an age-related decline in fertility’. The Lancet also proposes it as a solution to preserve fertility in patients with cancer.

Some companies now offer to freeze women’s eggs as part of their work package (to save the standard cost of £3,000 for three years storage). There have been media campaigns encouraging women to freeze their eggs to bypass the ‘biological clock’, such as a pop-up shop last year set up in central London ‘in response to a growing interest in social egg freezing’. The organisers of the pop-up shop (the Wellcome Trust and London School of Economics) claimed that:Social egg freezing is a relatively new offer but one that could soon become as revolutionary to women’s life choices as the Pill’.

A Guardian article advocates that: ‘All women should have the chance to freeze their eggs or ovarian tissue in their 20s or early 30s to avoid having fertility problems later in life, experts say.’

Not surprisingly therefore, the number of eggs frozen in fertility clinics has almost tripled in recent years. And attitudes have correspondingly changed as reflected in a 2016 poll that found that 59 per cent of young women thought that women should be encouraged to use egg freezing as a way to give them more reproductive autonomy.

Yet recent Parliamentary answers on the ‘success rates’ for egg freezing are striking. Figures provided by the The Human Fertilisation and Embryology Authority here, show that the marketing message is getting through, that eggs can be frozen for a patient’s (I use the term ‘patient’ advisedly) future use, or eggs can be frozen and donated for other women to use.

Eight years ago 2,367 eggs were frozen for patient’s own use and just 117 were frozen for donation.  By 2014, only six years later, 7,190 eggs were frozen for a patient’s own use and 2,497 for donation.

That’s a 300 per cent increase in women freezing eggs for themselves, but a 2,100 per cent increase in women freezing eggs for others in just six years!

So the marketing is working, but what is the ‘take home baby rate’ from this (to put it crudely)?

First, how many frozen eggs were successfully thawed, fertilized and implanted into women using IVF?  In other words, how many pregnancies resulted (not ‘take home’ births)?

Taking 2014 as an example year, as the most recent year with full figures, 948 eggs were thawed for a patient’s own use, then of these 420 were fertilised. Of these, only 155 were actually transferred to a woman. And of these only 19 pregnancies resulted.

And the key question: how many live births were there from the original 948 thawed eggs?  Just nine. That’s a success rate of 0.95 per cent!  Presumably the other ten miscarried.

Hence my answer ‘Yes’ to the Daily Telegraph’s question.

The figures are almost as poor for patients who use donated frozen eggs. In 2014, 852 donated eggs were thawed. 481 were fertilised. The number of pregnancies was 37 but this time there were 20 births. So, 20 births from 852 thawed donated eggs (ie. the ones that were successfully thawed – we have not been given figures for eggs that were not successfully thawed).

Why we do not hear more about these stunningly poor success rates and why this is being marketed to women as a backup (see, for example, the fertility doctor in this short film) when it so clearly is not?

Why are companies being allowed to falsely raise hopes in this way?

Why are they trading on the hopes and fears of childless women?

Moreover, the Telegraph article (and all marketing) neglect to mention the physical dangers of egg extraction, an invasive process that carries a risk of ovarian hyper-stimulation syndrome. In 2015 60 women were admitted to hospital with severe OHSS, a 40 per cent increase from the previous year, according  to a recent Guardian report. (Although, having said that, the Government and HFEA have both admitted in the past that they have no definitive data on the number of women who have been hospitalised for OHSS, and even less data for the less severe incidents of OHSS. So reporting of OHSS is mainly voluntary and the data is extremely unreliable).

Extracting eggs from women is a painful, invasive and risky procedure, requiring high doses of powerful drugs. It is not a procedure to be undertaken lightly.

Yet heavy marketing is also being directed to young women, especially students (via Facebook and social media) encouraging them to ‘donate’ their eggs (with decent ‘compensation’ provided, of course) in order to supply quality eggs for older women – not for any therapeutic benefit for themselves.

None of these groups of women are told how risky egg extraction is to their health, and how little is known about it. Nor is there any systematic research or follow up of women on the receiving end of these drugs.

Are market pressures conflicting with best and safest practice?

Are financial payment structures, lack of appropriate cycle monitoring and competition within the HFEA’s ‘league table’ conflicting with best and safest practice?

And I’ve not even touched on the ethics of egg donation! This story is a thought provoking start though.

So, we have a 300 per cent to 2,100 per cent increase in the numbers of women freezing their eggs, yet a 0.95 per cent pregnancy success rate! Clearly, far more realism is needed about how unsuccessful egg freezing is, along with its financial and physical costs, but government, employers, partners, media, fertility groups, need to take some responsibility too. Please make it easier for women to have children younger, before it’s too late.

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