Jan 2, 2015 - headlines about Apple's decision to include oocyte cryopreservation in its employee benefit package,1â5 the. Canadian Fertility and Andrology ...
COMMENTARY
Left Out in the Cold: Arguments Against Non-Medical Oocyte Cryopreservation Françoise Baylis, PhD, FRSC, FCAHS Novel Tech Ethics, Faculty of Medicine, Dalhousie University, Halifax NS
O
n October 21, 2014, following a week of media headlines about Apple’s decision to include oocyte cryopreservation in its employee benefit package,1–5 the Canadian Fertility and Andrology Society (CFAS) published its one-page “Position Statement on Egg Freezing.”6 The CFAS statement, like that issued by the Practice Committee of the American Society for Reproductive Medicine (ASRM),7 stipulated that oocyte cryopreservation is no longer considered experimental. Unlike the ASRM, however, the CFAS endorsed oocyte cryopreservation as a legitimate strategy for women “to preserve their fertility in the face of anticipated decline . . . through the natural aging process.”6 With this endorsement, the CFAS effectively legitimized a service that has been offered at some Canadian fertility clinics since 2010. A study conducted by Liu and Greenblatt between December 2010 and February 2011 (in which 20 of the then 28 Canadian fertility clinics participated) reported that 16 clinics offered oocyte cryopreservation, mostly to: 1. patients undergoing fertility-reducing treatments such as chemotherapy and radiotherapy, and 2. women and couples undergoing IVF when the sperm sample was unexpectedly unavailable. Nine of these 16 clinics also offered oocyte cryopreservation for non-medical reasons (i.e., so that women might avoid future age-related infertility).8 In sharp contrast to the CFAS, the ASRM was (and remains) concerned about engendering false hope among women who think of oocyte cryopreservation as a “really good insurance policy.”9 In 2012, when the ASRM practice
Key Words: Oocyte cryopreservation, egg freezing, IVF, fertility preservation, delayed childbearing, ethics
committee lifted the experimental designation on oocyte cryopreservation,7 it cited preliminary data on the efficacy (clinical pregnancy and live birth rates) and safety (perinatal outcomes) of mature oocyte vitrification and warming. In making this policy change, however, the ASRM specifically cautioned against oocyte cryopreservation for non-medical reasons owing to the absence of relevant data on safety, efficacy, ethics, emotional risks, and cost-effectiveness. Specifically, the ASRM practice committee concluded: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women.”7 Surprisingly, without reference to new (or for that matter, any) data specific to non-medical oocyte cryopreservation, the CFAS aligned itself with those who would use this technology to circumvent reproductive aging. Indeed, the ASRM’s professional caution is not only set aside by the CFAS, it is also ignored by technology behemoths Facebook and Apple.10 Consistent with their corporate priorities, these high-tech companies aim to keep their talented young employees at the office doing their job, not at home caring for babies. A modern means to this capitalist end is to “empower” women in their late twenties to late thirties (typically less than 37 or 38 years of age) to “choose” delayed childbearing. Not to put too fine a point on this, Facebook and Apple want a productive, not a reproductive, workforce. So it is that in the past year, each of these companies has, in turn, elected to include oocyte cryopreservation in their employee benefit package. According to media reports, from January 1, 2015, Apple will pay up to $US20 000 per person for oocyte cryopreservation and storage for all full-time and part-time employees. Facebook introduced a similar benefit for its employees in the United States in J Obstet Gynaecol Can 2015;37(1):64–67
64 l JANUARY JOGC JANVIER 2015
Left Out in the Cold: Arguments Against Non-Medical Oocyte Cryopreservation
January 2014, and pays up to US$20 000 for both medical and non-medical oocyte cryopreservation.10,11 In this way, young female employees at Facebook and Apple can be helped to pursue their careers (thereby presumably contributing to their respective company’s bottom line), while their company has paid to put their reproductive material and their reproductive plans “on ice.” Regrettably, some describe this corporate decision-making in positive terms. They congratulate the companies for ‘taking the lead.’ In this way, they both endorse the decision and encourage others to follow. Already, Virtus Health in Australia has announced that it too will pay for oocyte cryopreservation for its female employees. According to the Medical Director of Virtus “ . . . if it’s good enough for Apple and Facebook, it’s good enough for us.”12 Ironically, this statement mirrors one aimed at women: “If it’s good enough for Sofia Vergara, Kim Kardashian, and Maria Menounos, it’s good enough for you.”13 Others, however, insist that providing oocyte cryopreservation as an employee benefit is not only counterproductive but offensive. It not only fails to empower young women, it actually disempowers them by overtly entrenching the otherwise subtle message that women who have babies are not serious about their careers. In my view, it is one thing for individual, healthy, young women to pursue oocyte cryopreservation for personal reasons (such as not having a partner, not being in a stable relationship, wanting to pursue higher education, or wanting to pursue a career). It is quite another thing for an employer to promote oocyte cryopreservation among its healthy female employees, as a result of which employees may feel pressured to postpone pregnancy and childbirth. I offer seven reasons why Facebook and Apple employees should reject non-medical oocyte cryopreservation as an employee benefit. First, ovarian stimulation and oocyte retrieval to collect oocytes for freezing are both onerous and risky. The required daily hormone injections (for up to two weeks) to stimulate oocyte development are known to be painful and uncomfortable. There can be cramping, abdominal pain, nausea, and vomiting. More serious possible side effects include rapid weight gain and damage to organs close to the ovaries.14,15 More serious still is the risk of severe ovarian hyperstimulation syndrome which can require hospitalization and rarely has resulted in death.16,17 As well, there are reports suggesting a link between ovarian stimulation and certain cancers.18–20 In addition to the potential harms of ovarian stimulation, there are the potential harms of oocyte retrieval. There can be mild
internal bleeding and scar tissue around the ovaries and the fallopian tubes. Tubal scarring can interfere with natural conception. Second, contrary to popular belief, oocyte cryopreservation does not set back (rewind) a woman’s biological clock. While it is certainly true that oocytes from a younger woman are more likely to generate a healthy embryo, healthy pregnancy, and healthy birth than oocytes from an older woman, it very much matters that the body into which the embryos will be transferred is the body of an older woman. Considered from a purely biological perspective, it is in the interest of women to have their children while they are younger. Considered from a personal perspective, it is also possible that having children earlier may be more rewarding. A third issue is the limited efficacy of oocyte cryopreservation and the concerns about safety. A 2014 fact sheet prepared by the ASRM confirms that “Even in younger women (i.e.,
