MARGARET WARNER: We turn to new guidelines and questions surrounding freezing eggs to treat infertility.
Doctors started freezing and then thawing eggs for in vitro fertilization, or IVF, years ago, but in very few cases, and the procedure has been considered experimental.
Today, the American Society for Reproductive Medicine shifted its position, saying the process shouldn’t be labeled experimental any longer. It said babies born from frozen eggs are as healthy as those from fresh eggs. But the committee said the procedure should be limited in its use.
It’s estimated there have only been about 1,000 births from frozen eggs, compared to nearly five million babies born through traditional IVF.
We look at what’s changed and the thicket of questions it raises now with Dr Eric Widra. He co-chaired the committee that made the recommendation change. He’s with the Shady GroveFertilityCenter.
And Marcy Darnovsky is the associate executive director of the Center for Genetics and Society in Berkeley, Calif.
Welcome, both of you.
Dr. Widra, beginning with you, on what basis did your group, your committee conclude that this shouldn’t be considered experimental anymore, that it works as well as using fresh eggs?
DR. ERIC WIDRA, ShadyGroveFertilityCenter: There’s been a fair amount of pressure from patients and practitioners over the last years to remove this label of experimental from egg-freezing and thawing.
But there had been very little data published comparing the technique using frozen eggs and fresh eggs and looking at the outcome of the pregnancies.
And over the last several years, there have been a couple of studies, mainly out of Europe, but some out of the U.S. as well, that have demonstrated near equivalence using fresh eggs from younger woman to frozen eggs in terms of establishing pregnancies and a large series looking at the outcomes of these pregnancies, and that the children seem to be doing as well as peers that are born without reproductive technology.
MARGARET WARNER: Yet you are limiting its applicability. You’re not recommending it for all women who might want something like this. Explain the limitations and why.
DR. ERIC WIDRA: Sure. What we’re saying is three fairly specific points.
One is, is that we do think we should be recommending this procedure for women who may become infertile from medical treatment, such as cancer and chemotherapy.
We think that it is a reasonable technology to use in centers that provide egg donation services to their patients, but that we need to monitor that very closely as that is still a very young technology.
And we think it’s premature to recommend that women freeze their eggs to preserve their own fertility for later. But we recognize that there is a strong impetus to do so that and if centers proceed with that service that we carefully counsel the patients as to the pros and cons.
MARGARET WARNER: So, in other words, you’re talking about what you would call elective…
DR. ERIC WIDRA: Correct.
MARGARET WARNER: Something that is elective. You’re not really afraid of losing your fertility, other than from age.
But if this procedure delivers as many babies or produces as many babies and as healthy ones, why not — why doesn’t that also apply to older women who may want to delay — let’s say they are in their mid-30s and still aren’t married and want to preserve the option of having a baby?
DR. ERIC WIDRA: There is no question in our mind that that could be a huge benefit to women and to families, that if this technology is safe and effective across the age range, that that could really be a boon to women who are in a position where they’re not prepared to have children yet, but don’t have other alternatives.
So we would love to say, yes, please go and do this. But it comes with both personal and societal and scientific ramifications that we aren’t prepared to say we understand yet.
MARGARET WARNER: Does the data — and then I want to get to you, Ms. Darnovsky — but does the data — do you have data showing how safe and effective it is for older women?
DR. ERIC WIDRA: No, we really don’t. The relatively small number of women who freeze their eggs electively or even for cancer therapy often won’t need those eggs for many years. And those that have frozen them may conceive on their own.
So we have a very small subset of women who have frozen their eggs for a reasonable period of time and wanted to use them again.
MARGARET WARNER: Marcy Darnovsky, what is your reaction to this recommendation?
MARCY DARNOVSKY, Center for Genetics and Society: Well, our concern is that a lot of fertility clinics, hundreds really, are already aggressively marketing this procedure for elective purposes, for what is sometimes called social egg freezing.
And we think that that is really not a good thing. It’s — the experimental label may be removed, which would enable insurance companies to cover the costs for women who might become infertile because of cancer treatments, for example, but it’s still an experiment.
And as attractive and tempting as it is to — we all want to expand choices for women, so they can have children when they want to. But I don’t think any woman wants to experiment with her own health or experiment with her children’s — with her child’s health. And we really don’t have the data. And the new guidelines from the fertility industry organizations say that the data is not adequate to assess the effectiveness or the safety of this procedure for social purposes.
MARGARET WARNER: So are you saying that you aren’t persuaded that for any woman, this has been proven to be safe, health wise?
MARCY DARNOVSKY: Right. There are risks to the children. We don’t know yet. We hope they are all OK, and they seem to be so far. But they’re still very young.
There are risks to women, because egg extraction is actually a fairly invasive procedure. And, surprisingly, and really dismayingly, even though hundreds of thousands of women have undergone it in the years since IVF has become an option for family formation, we don’t have adequate data about either the short-term risks or The long-term risks of egg extraction. And there are some troubling results that we do have.
And that’s something that the fertility clinics are often — they put in the fine print. And that’s a real concern. And especially when you look at the situation, it’s kind of hard to talk about babies and business in the same breath, I think, a lot of times.
But the fertility industry is a business. And this egg freezing if it should become something that young women do in order to have this insurance policy, this really expands the customer base, and a profit center for the fertility industry.
And I really hope that the fertility industry will, you know, step up to the plate and really make it clear that they’re not recommending this at the current time for elective purposes, and that they hold the toes to the fire of their members who are advertising it that way and marketing it that way.
MARGARET WARNER: Dr. Widra, you are with a fertility clinic. What do you say both to the health concerns and the concerns that it will just become a marketing tool now that it’s not experimental?
DR. ERIC WIDRA: As a practitioner and as representative, I certainly am worried about the marketing aspects.
But I think there are four important points that need to be addressed here, very briefly. One is we are not an industry. We’re a medical practice, like oncologists and obstetricians. Second, there have been hundreds of papers on the outcomes after egg retrieval for women both short-term and long-term and it is generally accepted as safe.
And the reality is, yes, many medicine has uncertain outcomes down the road. But unless you actually do it, you don’t know. So unless we can freeze eggs and see what happens later, we will never really know whether it’s safe or not.
MARGARET WARNER: Marcy Darnovsky, finally, before we go, what about the sort of ethical, societal implications? I mean, what message is this sending in terms of particularly the trend or has been a trend for women to delay childbearing?
MARCY DARNOVSKY: Yes. Yes. And I think as a society, that’s something we have to step up to the plate about.
We shouldn’t be asking women to bear these risks just so they can have a family.
We should be putting in place policies that make sure women have equal pay for the work that they do, to make sure that they don’t hit glass ceilings, that there are family-friendly policies in workplaces, and that we’re not assuming that women are the sole or the major caretakers for children.
And all these kinds of policies would really go a long way toward addressing the anxiety that women feel about being able to have children.
MARGARET WARNER: What do you say to that, Dr. Widra?
DR. ERIC WIDRA: Couldn’t agree with that more.
This is not a technology that should be used to cure societal ills or societal pressures. We do live in an unfortunately complex society, where women often do have to make these choices. But the reality is, the number one factor in infertility is delayed childbearing.
MARGARET WARNER: All right, well, Dr. Eric Widra and Marcy Darnovsky, thank you very much.
MARCY DARNOVSKY: Thank you.