Why the experimental label should be removed from egg freezing.

Analyzing the latest research affecting women.
March 15 2010 10:19 AM

Is Egg Freezing Unfairly Marginalized?

Why the experimental label should be removed from the procedure.

Early last decade, a procedure became available to aging women that allowed doctors to extract and freeze their eggs in the hopes of preserving their fertility. At that point, there were plenty of reasons to be cautious. Egg survival rates were low and inconsistent. The long-term health of babies born from frozen eggs was unknown. Many doctors offering the procedure had never thawed eggs, let alone injected them with sperm, grown them into embryos, and transferred them back to their patients. So it wasn't surprising when, in 2004, the fertility field's professional organization, the American Society for Reproductive Medicine (ASRM), declared egg freezing "experimental." That means physicians have to obtain permission from an institutional review board before offering the procedure and must inform patients that it is not an established medical practice.

Six years later, a growing number of doctors are insisting that the time has come to welcome egg freezing to the mainstream. In an unprecedented paper calling for the removal of the experimental label, three of the world's most prominent researchers in egg freezing claim the technology has vastly improved and is safe: Frozen-egg babies, so far, have no more health problems than the rest of the population. Doctors who support the experimental classification argue that more research is needed and say they're still uneasy offering the technology to vulnerable women who might unwisely be counting on their frozen eggs years after extraction. But such caution continues at too great a cost. Experimental medicine carries a stigma: Fewer doctors study egg freezing, fewer OB-GYNs recommend it to patients, and fewer women regard it as a viable option when making decisions about their reproductive futures.

Published last month in the Journal of Assisted Reproduction and Genetics, the paper makes the case that egg freezing, known scientifically as ooctye cryopreservation, has been unfairly singled out. By comparison, the adoption processes of other breakthroughs in fertility medicine, such as freezing embryos, injecting sperm into eggs to help men with low sperm count, or screening embryos for abnormalities, have been more informal. Researchers tinkered in their labs, published papers, and trained others in the field. "The procedures were initially conducted under ethics boards with informed consent," explains John Jain, a fertility doctor who runs an egg-freezing program in Santa Monica. "But the ASRM did not assign them the term 'experimental.' "

In fact, egg freezing received such an outsized institutional smackdown that the ASRM pointedly said it "should not be marketed or offered as a means to defer reproductive aging." Why the special treatment? Many members were concerned that inexperienced doctors would exploit women at the end of their baby-making years by giving them unfounded hope for future pregnancy with an unproven technology. They also feared women would use egg freezing as "baby insurance" by paying $8,000 to $13,000 per cycle to stash away some good eggs in case their fertility is gone by the time they're ready to become mothers.

Consider the hypothetical example of a 39-year-old freezer, suggests Glenn Schattman, ASRM practice committee member and associate professor of reproductive medicine at Cornell's Weill Medical College. "She says, 'I have time. I don't have to be a single mom. I can use my frozen eggs when I'm 45,' " he says. "Now at 45, she's with a partner and wants to become pregnant. But they might not work, and she has absolutely no chance of becoming pregnant on her own. She's made life decisions that might have been wrong because she got a false sense of security." Simply put, few fertility doctors want to feel they contributed to those life decisions, which might leave their patients empty-handed and bitterly disappointed. It's more rewarding to be a hero to infertile patients who showed up with nothing to lose in the first place.

However, it's important to distinguish doctors' discomfort with how the science is used from an assessment of the science itself. In the paper, the pro-egg-freezing authors argue that many IVF programs are achieving the same success rates using frozen eggs as they normally would with fresh eggs. In one example, 18 of 32 women who froze their eggs became pregnant (six with twins) at New York University's program, which is co-run by lead author Nicole Noyes. Such statistics might be glowing, but they're generated by only a handful of clinics. Other practitioners have less stellar results. Many have no data at all because they've never thawed the eggs they've frozen. Although 54 percent of American clinics now offer the procedure, only 1,500 babies have been created from frozen eggs in the world. Many of those are from Italy, where religious opposition to embryo freezing, a common practice in IVF to save fertilized eggs for later implantation, spurred the development of the technology to freeze unfertilized eggs.

Until more doctors produce good data, can the experimental label really protect women from inexperienced doctors? In theory, yes. Doctors must disclose their clinic outcomes, including the survival, fertilization, and embryo development statistics for thawed eggs and birth rates. The idea is that doctors' transparency would help women make better choices. But it doesn't always work that way. That's because in experimental medicine, consumers don't often expect doctors, apart from the pioneers, to have a lot of practice. This is compounded by another variable that's unique to egg freezing: Because a woman is freezing her eggs to be used years later—perhaps when she's found a partner and failed to conceive the old-fashioned way—she may reason that her doctor will have gained more expertise turning eggs into babies. This lag effect excuses inexperience.

In the mainstream marketplace, inexperience doesn't sell as well, especially as more doctors who had been deterred by the experimental label get into the business. Patients shopping for doctors would be more likely to hold them accountable by demanding positive data. Doctors looking for patients would have more incentive to invest in quality research before hanging out their shingles. With more competition, professional standards would rise and the price might even go down.

Ideally, as doctors churn out clinical results the field can find a middle ground, preserving the relevant elements of the experimental label—such as informed consent—while enjoying the medical and social acceptance of the mainstream. Here are some benefits of mainstreaming: OB-GYNs once hesitant to acknowledge an experimental procedure might broach the subject with their patients and recommend respected practitioners rather than leave women on their own to comb the Internet looking for doctors' ads or fast-track their romantic relationships. Women might stop thinking about the procedure as a questionable, extreme act and stop waiting until the last days of their fertility to undergo it. Rather, they might embrace egg freezing as a credible layer of reproductive choice and freeze their eggs in their early to mid-30s, when the quality would be better and they have an increased chance of success. With less handwringing, more energy could be spent encouraging women to educate themselves about the risks and do their due diligence before selecting a clinic. Several industry efforts are under way to establish frozen-egg birth registries so patients could compare doctors' track records.

An experimental label won't protect women from putting too much faith in a technology that might not work for them. Some undoubtedly will, and the ASRM can't stop them. In the meantime, the doctors' organization shouldn't scare women from taking advantage of the good science out there.

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