The 34th Annual Meeting of the ESHRE (European Society for Human Reproduction and Embriology) in Barcelona took place in July with over 12,000 members from all over the world. It discusses 2 papers selected for their relevance in the debate on freezing oocytes for non-medical reasons. The ‘social freezing’ or elective freezing of the oocytes. We talk about this topic with Prof. Paolo Emanuele Levi-Setti, Director of the Humanitas Fertility Center, who was present at the conference with some collaborators.
Freezing of the oocytes
Dr. Marcia Inhorn, anthropologist at the University of Yale, presented the conclusions of the qualitative study on elective oocyte freezing; conducted on 150 subjects from four IVF clinics in the United States and three in Israel who were interviewed, after completing at least one cycle of freezing their oocytes for non-medical reasons and contrary to common thinking, women choose to freeze their eggs not for study or career reasons, but for reasons mostly related revolving around the lack of stable partnerships involved in a marriage and genital project. Medical literature and media coverage on cryopreservation of oocytes usually suggest that egg freezing is chosen to postpone or delay pregnancy in career women and aims to complete prolonged academic careers, while the study results suggest that the main motivation is instead the lack of a stable partner. In-depth interviews with 150 women who chose to freeze their eggs at clinics in the United States (114 women) and Israel (36 women) revealed ten main reasons that led women to freeze their eggs. Most of the women in the study (85%) were without partners at the time of egg freezing, reflecting six different circumstances of life (being single, divorced or in the process of divorce, had interrupted a relationship, worked abroad, was a single mother by choice or circumstance, and career planning). The choice of elective freezing of oocytes for career reasons was the least common of these six routes, even among women who worked for companies with freezing costs covered by insurance.
Women with a partner at the time of the freezing (15%) faced four different circumstances of life: a man who was not ready to have children, a relationship that was too new or uncertain, a partner who refused to have children, or a partner with multiple previous marital experiences. Most women had already completed their educational and career goals, but already over the age of 30 they did not have a lasting relationship with a stable partner, which included the search for a pregnancy. With one exception of having to work abroad this is the main reason that led to the freezing of eggs in these women, with few differences between American and Israeli women. The author recognized that these motivations could be different in other countries, but such a similarity between the two populations suggested that these data could be generalized to other countries. The elective freezing of the oocytes has had a tumultuous development in these years and its growth has taken off after the introduction of vitrification, a technology of rapid freezing that reduces the cells to a state similar to glass in a few seconds and reduces the damage created by previous methods of freezing to the microstructure of the oocyte.
Pasquale Patrizio, co-researcher of the study, added that about 5,000 egg freezing cycles were performed in the United States in 2013, but that an estimated 76,000 are performed in 2018. With such a significant increase in women who choose to freeze their eggs, the facilities and specialists involved in this work must know how the lack of a partner is the real priority for women who make this choice and this knowledge must also involve the companies that offer the freeze to their female staff as “a legitimate insurance benefit”. The author comments again that the career is not the reason why most women decide to freeze the oocytes, but the hope of finding a partner, or decide to become a single mother with sperm donor, although this method remains accessible to a few women. “But the freezing eggs keeps out the hope for many. The results that can be obtained, however, are not yet clearly defined and Pasquale Patrizio suggests, from data available so far, that in general it would seem advisable for women under 35 years of age the cryopreservation of 10-12 oocytes, while for women over 35 years of age about 20 oocytes would be necessary to obtain an egg with a reasonable chance of pregnancy.
Michel de Vos reported the Belgian experience of 563 women who froze their eggs between January 2009 and November 2017 with a total of 902 treatments. The average age of those who frozen their oocytes was 36.5 years with an average number of oocytes of 8.5, but only 7.6% had returned so far to use them. The survival of the oocytes at thawing was 73.4% demonstrating the good efficiency of the method and in 43 it was possible to proceed with embryo transfer, obtaining 32.6% (14/43) of pregnancies. De Vos also reported that women who returned for thawing had done so because they had found a stable partner, although it could not be defined how many would have achieved a pregnancy without the use of preserved eggs, noted that most of the social freezers who returned had found a suitable partner to pursue motherhood. But from the data he was unable to clarify “whether their previous decision to undergo cryopreservation oocyte has improved the probability of a live birth”. De Vos pointed out that women who have frozen their oocytes at an average age of 36 years and have returned to an average age of 42 years have had a 33% chance of getting pregnant, but in women who have frozen beyond this age the successes will certainly be lower.
The primacy of Humanitas
The freezing of eggs is a great possibility that is offered to cancer patients, before therapies that could forever compromise their ovarian reserve and lead to a menopause with costs totally borne by the public system – commented the professor. For women who have to postpone the search for a pregnancy, this is a small but real possibility. Our data agree with those of colleagues in other countries and indicate the lack of the ‘right’ partner with whom to have a child, the main reason that leads to this choice. In Italy, however, the lack of awareness of the issue of age on the probability of pregnancy is still enormous and it would be important that this could change through increasingly widespread campaigns of reproductive education. The number of women requiring an elective freeze is lower than in other countries, although this method has been tested and validated by Italian researchers. Humanitas was one of the first structures that gained experience in this field and presented data that convinced the international medical world to adopt this method.