Why freeze oocytes as a prevention of one’s fertility?
If you were 20, 25 or 30, would you freeze your eggs? Is this a hypothesis that you would evaluate? As for me, given everything I have read in recent years, if I had a suitable age (less than 34 years) I would probably think about it.
Of course, it is not a simple choice, you need not only money but also the willingness to undergo a treatment that is not trivial: ovarian stimulation and egg retrieval, in sedation. Without forgetting the cryopreservation of oocytes that must be paid annually until it is deemed most appropriate.
Why have we come to the point where we feel the need to cryopreserve our oocytes?
We live in a society that is progressively aging. Fewer and fewer children are being born, and more and more advanced in years.
There are several reasons for this:
- The organization of today’s society, from a social and working point of view, is such that it is really complicated for women to be able to have a child at the age when she is most fertile (18-25 years).
- Women with higher education have increased
- Job opportunities for women with higher career opportunities have increased.
- the use of contraceptive methods such as the pill has increased
- you seek economic stability before having a child
- The increase in separations is followed by the formation of new nuclei at a later age: search for a child with the new partner
All these conditions led to pregnancy research in the age group 30-35 years and later. It is not up to us to say whether it is right or wrong, the reality of the facts is this and the data on births in Italy confirm it: children less and less and more and more later.
Few, however, are aware of the fact that with increasing age of the woman decreases the quality of oocytes and their number.
By decrease in quality we mean that these aged oocytes can be carriers of chromosomal abnormalities, and therefore give rise to embryos with chromosomal abnormalities. Aged oocytes are also less competent, i.e. they have less chance of being fertilized and developing into an embryo.
The possibility of accessing PMA techniques also suggests that you can get pregnant at any age, but this is not the case. PMA does not work miracles when the problem is the age of the woman, (unless you choose to resort to heterologous, but this is an even more complicated road for several reasons).
Are there women at risk for whom it would be essential to be able to preserve fertility?
They are all those women who could face an early depletion of their ovarian reserve:
- women familiar with early menopause
- women who suffer from endometriosis or who are familiar with endometriosis
- heavy smokers
- women suffering from pelvic inflammatory disease (PID)
What other motivations can lead to preserve one’s fertility for the future?
There are economic and social reasons.
The lack of a partner, a job, economic stability are all valid reasons for postponing a pregnancy; but the woman’s biological clock cannot be stopped.
If the conditions for having a child arrive late, at age 40 or more, that woman’s oocytes may no longer be able to be fertilized or allow her to carry on with the pregnancy and have a baby in her arms.
In that case, how to become a mother? Adoption, foster care or heterologous (egg donation) if the ovarian reserve is so low that it does not allow you to have a chance of success with a homologous assisted reproduction treatment (with your own oocytes).
However, not all women and couples are able to accept these forms of parenting.
So does it make sense to think about your reproductive future in advance? Yes , if society does not act in such a way as to favor pregnancy in biologically more suitable times.
Freezing oocytes in case of cancer
Currently, women diagnosed with cancer are given the option of freezing their eggs.
A considerable percentage of women and men suffer from a tumor whose treatment can permanently undermine fertility.
According to AIOM (Italian Association of Medical Oncology) and AIRTUM (Italian Association of Cancer Registries) data , in 2018 in Italy just over 373,000 new cases of malignant tumors were diagnosed, of which about 194,000 in men and 178,000 in women. Overall in Italy every day about 1,000 people receive a new diagnosis of infiltrating malignant tumour.
Thanks to medical progress, fortunately more and more people are able to recover from cancer and therefore have the possibility of continuing their life normally and, if of childbearing age, of having children.
However, chemotherapy treatments can undermine, in some cases permanently, the fertility of a man and a woman.
- 10% of women under the age of 35% go through menopause after chemo to treat cancer.
- 50% of women aged 35-40 go through menopause after chemotherapy
- 85% of women aged 40-45 go through menopause after chemotherapy.
Even if menstrual cycles were to resume, it is not said that the woman is fertile again.
When a patient is diagnosed with cancer, cryopreservation of oocytes and sperm should be offered. So that the woman and the man, once healed, have the possibility of using their gametes if their fertility is permanently damaged by the therapies.
Oocyte cryopreservation is no longer considered an experimental technique since 2012.
Freezing the oocytes in advance prevents heterologous in many cases
Does it make sense to consciously freeze eggs to preserve one’s fertility?
Preventive cryopreservation of oocytes, done all over the place on all women, would have several advantages.
- If a couple decides to have a child after an illness that has required chemotherapy, they can use cryopreserved oocytes and sperm in advance without having to resort to heterologous
- If a couple decides to have a child after the age of 40, their cryopreserved oocytes at a young age dramatically increase the chance of pregnancy
- the cryopreserved oocytes that a woman decides not to use anymore, because perhaps she has already had her children, could, with the consent of the donor of course, be donated to those who cannot have children, overcoming the problem of the shortage of oocytes that are currently purchased by PMA centers at a high price from foreign countries (Spain in the first place)
Ethical implications
Surely it is a theme that must be deepened from all points of view.
Is it better to freeze the oocytes to look for work and economic stability or is it better that the woman has the opportunity to have a pregnancy at a young age?
Is it right to postpone a pregnancy after the age of 40? Or around 50? Are there no greater risks for the woman and the child? What social impact will this continuous postponement of parenthood have?
Is it right to postpone pregnancy because the employer imposes contracts that oblige the woman to postpone her desire for motherhood?
Does it make sense for medicine to intervene to remedy problems (age-related ovarian aging) caused by social facts (impossibility of having the appropriate economic-social conditions to have a family??)
What to do with all those oocytes that will never be used? Can donation really be a solution? Not all women feel like donating their eggs to a couple of strangers. If on the one hand you give a couple the opportunity to have a child, on the other you can not hide the fact that the donor will have one or more children biologically proper to the world and that probably will never know
Why it’s important to talk about it
I am aware that in this article there are more questions than answers, but I think it is right that we start talking more and more about preventive fertility preservation or social freezing that is, in all its aspects, positive and negative.
Just in these days, in August 2019, a pilot study conducted among 930 female students of the University of Padua was published, recently published in Life Sciences, Society and Policy.
The results are very interesting. One fact above all can be noted: 42% of the girls interviewed at the University of Padua have never heard of cryopreservation of female gametes. These are girls who are at an age when they should already start thinking about their reproductive future. Already at this age through a simple ultrasound can be highlighted an early depletion of the ovarian reserve in predisposed women. These women, if they are looking for a child between the ages of 30-35, may no longer have a chance of having a child genetically of their own.
Furthermore, 73% of respondents think that they will never have a pregnancy after the age of 40, while we know that the pregnancy rates in this age group are constantly increasing.
So free to make your own choices but in a conscious way. And awareness is achieved by properly informing.
Who should pay for social freezing?
Considering the costs of PMA, there are some interesting studies that have calculated the costs of treatments to have a baby in your arms after the age of 42 or 45. These are numbers with 5 zeros.
Given these numbers, given that in some regions PMA treatments are offered up to 50 years of age under the NHS, and considering the costs of heterologous treatment to be able to recover oocytes abroad, the State should probably make careful socio-economic assessments in terms of fertility and its prevention. Other than fertility day…
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.