Why Did Egg Freezing Wait So Long?
posted by Gaia Bernstein
Thank you to the permanent bloggers of Concurring Opinions for having me back. It is great to be here.
Egg freezing has become the new hot trend in the infertility industry. Although infertility practitioners first used egg freezing in the mid 1980s, it was only recently that success rates have significantly risen making this an attractive option for women. A woman can now freeze her eggs at any age and use it a few years later or much later with the sperm of her then chosen partner or a donor to have a baby through IVF. Using egg freezing technology, a woman can today have a baby at a time that best suits her career and family situation.
There is no doubt that egg freezing as a viable option is a huge revolution for women’s autonomy. But the big question is why only now? Why has egg freezing become a really viable option only during the first decade of the Twenty-First Century. We have known how to freeze sperm since the 1950s. And, embryo freezing was first tried out around the same time as egg freezing, during the mid-1980s. Yet, unlike egg freezing, embryo freezing became common practice soon thereafter. So why did we have to wait so long for effective egg freezing technology?
The answer usually given to this question is that it was just too complicated technologically and took a long time to develop. But were technological complications the only cause for delay? Is it really much harder to freeze and thaw eggs for later IVF use than to freeze and thaw embryos for later use? We tend to be taken by the illusion that science is value neutral — that scientific progress is not affected by choices directed by social values. But even if technological diffiuclties played a role in the delay, could egg freezing technology have been held back because resources were invested elsewhere? Unlike other forms of reproductive technology that promote the reproductive interests of both men and women, egg freezing promotes mainly the autonomy interests of women. Egg freezing’s impact on women autonomy can be compared only to the revolutionary effect of the birth control pill. At the same time, the infertility industry is comprised overwhelmingly by male practitioners. And while some have no doubt worked relentlessly to promote egg freezing technology, it may be time to stop assuming that technological complications held back this important women emancipating technology. It may be time to begin asking whether the advancement of egg freezing was placed on the back burner for years because of the type of interests it promotes?
December 7, 2012 at 10:26 am
Tags: egg freezing, infertility, IVF, oocyte cryopreservation, reproductive technology, women autonomy
Posted in: Family Law, Feminism and Gender, Health Law, Technology
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Responses (6)
Amanda Pustilnik - December 7, 2012 at 12:04 pm
Gaia, Great piece – interesting questions. I suspect that the causes you identify are right, but that the effects filtered indirectly through the researchers in the field. I suspect – based on no evidence, so it would need verification – that the researchers themselves would have been very interested in pursuing such technology but that they may have been dissuaded by a pragmatic assessment of the difficulty of commercializing such technology in decades past. So the cultural concerns could be orthogonal to the researchers’ own beliefs but influence them nevertheless through the market.
Gaia Bernstein - December 7, 2012 at 12:14 pm
Amanda, I completely agree. I don’t think it was researchers who unilaterally did not promote women autonomy. It was a reciprocal relationship with a society that was not ready to push for this and make it a lucrative option for researchers to choose this over other venues of research, like ICSI.
Jimbino - December 7, 2012 at 8:00 pm
My niece who underwent radiation therapy for Hodgkin’s Lymphoma chose to freeze eggs fertilized by her husband. What happens, I wonder, if she were to get divorced and married a different man who wanted children with her?
Brett Bellmore - December 7, 2012 at 10:26 pm
“Is it really much harder to freeze and thaw eggs for later IVF use than to freeze and thaw embryos for later use?”
It’s not the freezing, it’s the getting them out to freeze. Men can do that with a magazine and a little privacy. Women? I think it’s more than a little bit more complicated for them. A lot more complicated, actually.
So it’s really rather silly to deny that “technological complications” had nothing to do with the delay. They most certainly did play a part in it.
Jim Maloney - December 8, 2012 at 10:25 am
Brett: You may have a point, but it’s a little more subtle than you frame it. Harvesting eggs is not all that difficult,although it’s not risk-free or wholly noninvasive, either. It’s done by needle aspiration, not through the abdomen but through the vaginal wall (the ovaries are surprisingly close). Certainly the procedure was well-established by the early 1990s, by which time embryos and sperm–but not eggs–were being routinely frozen. Consider this, though: going through that procedure to harvest a single mature egg, which all that is produced in a normal single cycle, has a far different risk-benefit ratio than does harvesting as many as a dozen or more mature eggs. The latter has been the norm in assisted reproductive technology (ART) for decades. The way this is done (or at least was done when I was involved) is to shut down the natural hormonal cycle with a drug called Lupron, which blocks the gonadotropin-releasing factors at the pituitary, and then “hyperstimulate” the ovaries using other drugs and monitoring, so that many mature eggs, rather than just one, are generated in that cycle. The procedure is normally done in the context of an in vitro fertilization (IVF) attempt: the plan is to try to fertilize all viable eggs, and then if there are more embryos than should be transferred back to the uterus (the principal risk being extreme multiple births), the leftover viable embryos, if any, are frozen. Given that the usual situation that leads to egg harvesting involves short-term attempts to conceive, and given further that in such situations the optimal risk-to-return plan is to hyperstimulate, harvest as many eggs as possible, fertilize, then transfer and preserve embryos, it is unsurprising that the technology for freezing unfertilized eggs lagged behind.
Getting to the root questions (But were technological complications the only cause for delay? Is it really much harder to freeze and thaw eggs for later IVF use than to freeze and thaw embryos for later use?), I’ll begin with the second one. Bear in mind that a developing fertilized embryo is multicellular, whereas an egg is a single cell with a delicate membrane. If a small multicellular cluster of undifferentiated cells (an embryo) undergoes loss of a few cells in the thawing/freezing process, it has a much better chance of remaining viable than if an egg is damaged. So, yeah, unfertilized eggs are much more delicate than embryos. As for sperm, they are little packets of genetic material that are biologically prepared for transport, so they’re not nearly as delicate as eggs, and of course a frozen sperm sample usually has millions of those little packets, so freezing/thawing loss of even a relatively large number would generally be of little consequence. (Post-freezing motility might be an issue, but a technique that’s been around for decades, intra-cytoplasmic sperm injection (ICSI) can take care of even that.)
So, were technological complications the only cause for delay? Probably not. The considerations I outlined in my response to Brett, above, undoubtedly played a role. I don’t think it’s so much a manifestation of gender inequity, though, as a consequence of the relative characteristics of sperm, eggs, and embryos (including both viability considerations and the numbers produced) in the context of the setting in which the vast majority of such interventions occurred.
Brett Bellmore - December 8, 2012 at 3:32 pm
Another point is cost; Either sperm or egg freezing is an elective procedure, which will generally not be covered by insurance. In my case, insurance wouldn’t cover sperm freezing even though I was scheduled to undergo prostate surgery, and shortly become sterile for the rest of my life.
The cost turned out to be too much for my budget, (The very narrow window I had to do it in was a factor, too.) and so I went under the knife without having it done, and can only be thankful I had at least one child before this happened.
Keeping in mind just how little medical intervention is needed for sperm freezing, it’s no surprise that the starting price for egg freezing is quite a bit higher, about $6500, and potentially two or three times that. That’s quite a chunk of change to drop early in one’s career, when you don’t even know it will be necessary.
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