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expert reaction to HFEA report on trends in egg freezing

A Human Fertilisation and Embryology Authority (HFEA) report on the value, success rate and increase of egg freezing.

 

Dr Raj Mathur, Clinical Lead for Reproductive Medicine at Manchester University NHS Foundation Trust said:

Egg freezing is a technology that may benefit women with a diverse range of fertility-related concerns. These include medical conditions and treatments that may put women’s future fertility at risk, such as cancer or recurrent ovarian cysts requiring surgery. In these circumstances, egg freezing is good preventive medicine, helping to preserve fertility and the possibility of genetically-related offspring. The NHS should fund egg freezing in these cases on a fair and equitable basis across the NHS. There are barriers to women accessing this treatment in some areas due to lack of automatic funding, which can be a problem where time is of the essence, for instance if cancer chemotherapy is due to start imminently. Fertility professionals are keen to work with their colleagues in Oncology and NHS managers to set up pathways that help these women get timely advice and intervention, and there are examples of good practice across the country.

“So called ‘social’ egg freezing represents a different group of patients, but is of no less significance given the demographic changes in society. As the HFEA shows, the outcome of egg freezing is better if eggs are frozen at a younger age, certainly under the age of 35. The maximum duration that we are allowed to store eggs in women without a diagnosed fertility problem is 10 years, and many clinicians feel a longer duration would serve these women better.

“It would also be useful for the regulator to record the reason for egg freezing, so that future research can take into account the diverse reasons why women choose to freeze eggs and the possible differences in utilisation rates and outcome between them”

 

Dr Jane Stewart, Chair of British Fertility Society (BFS), said:

“As the potential for successful egg storage has increased it is unsurprising that so too has its application in the clinical field.  Whilst for some this represents the benefit of future choice, the HFEA has quite rightly highlighted significant areas for caution.  The balance of cost benefit, however funded, may be considered different for a woman about to lose her fertility to sterilising medical treatment compared with a woman considering a back up for a possible delay in starting her family.  Moreover, that backup may in fact be of little benefit to an older woman where more eggs are needed but fewer are likely to be collected and the chance of a successful outcome is limited.  The statutory 10 year storage limit may not be long enough for a younger woman to exploit potential benefits of egg storage since she may still have a very good chance of successful natural fertility 10 years after her eggs have been stored.  A key factor remains when contemplating egg storage – how many eggs are required to “make a baby” for a woman at any given age and thus how many ovarian stimulation cycles might she need to contemplate to make provision for that and is that then realistic and affordable?”

 

Prof Richard Anderson, MRC Centre for Reproductive Health, University of Edinburgh, said:

“Egg freezing is an important aspect of preserving a woman’s fertility and it is becoming more successful.   More women are choosing to freeze their eggs for non-medical reasons, but often not until they are in their late 30’s, or even later. This is critically important, because increasing age causes such a big fall-off in how successful it is in later enabling her to have a baby later on.  Ideally, women who are thinking of freezing their eggs should do so as young as possible, and by their mid 30’s. But this needs both women and men to be well informed about the effect of age on female fertility, and sadly that is often not the case.  The current limit of 10 years for storing frozen eggs is also very unhelpful and needs to be changed to allow women to store their eggs at the best time and use them when they want to.”

 

Dr Stephen Harbottle, Consultant Embryologist at Cambridge IVF, said:

“We have seen an increase in social egg freezing here in Cambridge in line with what the HFEA are reporting.  Egg freezing is clearly being regarded by some women as an effective mechanism to defer parenthood until later in life and mitigate to some extent against the natural decline in fertility over time.  Women need to be aware of the risks of egg freezing and that freezing eggs does not constitute a ‘baby in waiting’. They also must be careful not to freeze too early and be mindful that current UK legislation limits the storage of eggs for social reasons to a maximum period of 10 years.  They should also be mindful to choose a provider with a proven track record and expertise in oocyte cryopreservation as egg survival rates vary from centre to centre.  A survival rate in excess of 90% should be expected in a competent centre.”

 

Prof Alan Thornhill, Professor of Reproductive Genetics, University of Kent, said:

“This is an interesting report that will be helpful to patients but which holds no real surprises. I agree with the broad and sensible conclusion that social egg freezing should be undertaken for women under the age of 35 years as they are most likely to have good quality and numbers of eggs. Given high quality reports coming from overseas donor egg programmes, it is clear that success rates can be high with vitrification techniques and it is important to work with a clinic that has experience and performs this technique frequently.  Unfortunately, it is difficult to draw accurate conclusions about the likelihood of success from the HFEA data since the overall cycle numbers are small, the annual number of freezing cycles outweighs by far the thawing cycles and the database is not able to clearly define outcomes for the age at which eggs were frozen (which is the critical parameter – not the age of thaw). Finally, it is clear that women in the UK are leaving social egg freezing too late; the average age at freeze is 38 years, which we know is likely to result in reduced success rates even if using fresh eggs. For social egg freezing to become a truly mainstream option for younger women, a combination of funding, creative pricing and a change in the law to allow storage beyond the current 10 year limit is sorely needed.”

 

Prof Simon Fishel, President of the CARE Fertility Group (largest independent IVF provider in the UK), said:

“The HFEA report is descriptive of the activity relating to egg freezing in the UK, but much of the data needs to be put into to context to be understood:

“1) Egg freezing in the right circumstances can achieve a high chance of a live birth, not dissimilar to conventional IVF. However, as stated the biggest factor depends on the age of the woman as we know the efficiency of successful conception declines with age, and precipitously after 36. This is reflected in the HFEA data of 18% success overall and 30% for donor eggs, the latter being from younger women and compares very well with the national average after conventional IVF in women under aged under 35. Another factor is the skill and experience of the practitioners undertaking the technically challenging process of vitrification.

“2) The reason for egg freezing varies from cancer patients, those with benign disease and now an increasing number for non-medical, personal reasons. Hence the utilization of eggs is not a reflection of success rates but patient mix.  As freezing for medical reasons is so far the prime reason, then it is likely there will be a lower outcome, and this should not distort the real potential of freezing eggs for women of a younger age (<35).

“3) It is important to stress just how far egg freezing has developed, such that now, compared to a decade ago, such that in the right hands it really can be a realistic option for preserving fertility – although there can never be guarantees, just as in the conventional IVF procedure. However, the donor data clearly indicates the benefits that can potentially accrue from freezing eggs at a younger age -more can be obtained, and that plus younger age greatly improves the chances of a successful outcome.

“4) Eggs are not like embryos in that much fewer are destined to make babies, only about 10-30% of eggs are even competent to make a baby; so it is important that for fertility preservation to be successful around a minimum of 20 eggs should be stored if possible.

“5) Those that have criticised egg freezing have persistently mixed up the facts – related to patient mix, age, technological improvements, etc; and portray a more ‘doom and gloom’ than today’s reality that good practice and appropriate advice can provide opportunity and benefit to those seeking to preserve their fertility, for whatever reason.

“6) Both society and individual women would benefit from a change in the law. It is now unacceptable that we have situation where professional advice is to freeze eggs early (say 30), but current regulation would determine the eggs must be destroyed before the women is ready to utilize them (say at 42)!”

 

Sarah Norcross, Director of the Progress Educational Trust, said:

“Egg freezing is complex. On the one hand it offers women greater reproductive choice, but on the other it can lead to pressuring women into thinking that freezing their eggs is something they ought to do.

“As the number of women who have used egg freezing successfully is so small, we need to be careful not to oversell this as a solution to people who are postponing having a family. As with IVF, there are no guarantees with egg freezing.

“No doubt, some in the fertility sector will try to use this report to increase the number of customers who freeze their eggs. Women need to be canny consumers – before parting with their cash, they should press fertility practitioners for details of their expertise and for their success rates with egg freezing.”

 

Prof Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“The report highlights the still weak but rising success rates of vitrification of oocytes, this technical advance is a boon for those who are undergoing chemotherapy.

“For those who think it is a good idea for other reasons, deferred parenting there is less good news.

“Egg freezing is not risk free to the patient and the majority of those who have them frozen do not come back for their eggs at a later date (both in the UK and other countries). They may feel comfortable to defer an opportunity to have children but they are also deferring the decision.

“Egg vitrification is not the answer to fertility as the chances of pregnancy as stated in the report are still low. Particularily the woman’s own eggs.

“The risks of older maternity combined with the obesity epidemic are presenting big problems to women, and the obstetric units that care for them, the risks to the baby are substantially higher.

“We tend to perceive risk as a dichotomous variable coloured by personal experience and thus the alleged understanding of risk does not usually reflect reality. Thus it would be dangerous on the basis if this report whilst stating a minority of women are having their eggs frozen to suggest it should become de rigeur and yet another service one can (pay for) purchase.”

 

Mr Stuart Lavery, Consultant Gynaecologist, Department of Reproductive Medicine, Hammersmith Hospital said:

“This report from the UK regulator on the practice of egg freezing presents a timely, comprehensive and up to date overview of the use of egg vitrification both for medical reasons such as pre-chemotherapy and the use of elective egg banking or social egg freezing.

“The data is reassuring both in terms of effectiveness, but equally importantly in terms of safety.

“The emphasis on effectiveness being linked to ‘age at freezing’ is well-made.

“The tone of the report suggests a shift in the position of the regulator, from one of previous discouragement, to one of cautious support”

 

Declared interests

Dr Jane Stewart: “No Conflicts”

Prof Richard Anderson: “No conflict of interest.”

Dr Stephen Harbottle: “No Conflicts”

Prof Alan Thornhill:No conflicts; but I work for Igenomix UK (providing genetic testing to IVF community).”

Prof Simon Fishel:I’m a minor shareholder in the CARE Fertility Group.”

Sarah Norcross: “None to declare”

Prof Alastair Sutcliffe: “None to declare”

Mr Stuart Lavery: “I perform egg freezing for medical reasons in the NHS and private sector, and egg freezing for elective or social reasons in the private sector.”

None Others Received

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