Laboratory scene

Debate: Fertility on Ice

Specialists at the University of Zurich are thoroughly investigating the topic of social egg freezing — whereby egg cells are frozen as a precautionary measure with a view to a pregnancy at a later date. Increasing numbers of women in Switzerland are also interested in the idea. Legal expert Andrea Büchler and physician Bruno Imthurn discuss reasons and benefits, but also the possible constraints of the new method. Their concern is that women should make well-informed decisions.

Interview: Maja Schaffner; English Translation by Toby Alleyne-Gee

Andrea Büchler, Bruno Imthurn, when and how did you first hear about social egg freezing?

Andrea Büchler: I’m frequently in the United States, where social egg freezing has already been an issue for some time. That’s where I probably first heard about it. Later, as President of the National Ethics Committee, I explored the subject in depth: The Ethics Committee published a statement on social egg freezing, including recommendations. The issue is also relevant to my research on the interface between family and medical law.

Bruno Imthurn: I also came across the topic in the US. Social egg freezing was discussed at a conference — as a kind of lifestyle method. Several clinics in Las Vegas were already freezing mature, unfertilized egg cells about 10 years ago. Once the idea arrived in Switzerland, it was also presented in the media primarily as a lifestyle method and career booster. People wondered: Do we really need technologies that make it possible for women to have children at the age of 60 or 70? For my part, I was critical of the method.

What changed your attitude?

Imthurn: Talking with a science journalist, it became clear to me that social egg freezing has ethical advantages over egg donation. Egg donation treatment is applied to women who no longer have any egg cells, or none that can be fertilized, and therefore have to rely on another woman’s egg cells. Egg donation is illegal in Switzerland, but the reality is that hundreds of couples go abroad to receive the treatment each year. In the process, the stress of extracting the egg cells is delegated to another woman. With social freezing, on the other hand, the potential recipient takes that burden upon herself. This argument and the fact that fewer complications arise when women use their own egg cells convinced me of the method. In certain cases, it could replace egg donation. What’s more, it offers the opportunity for women to have children that are genetically their own, even in problematic cases.

Does social freezing have other advantages?

Büchler: I think we have to start by examining the reasons that lead to the demand for such treatment. The fact that we are getting older and older is key. However, the period during which women are fertile has remained the same. That means that women today, compared with their life span, become infertile at an early age. At the same time, the age of women giving birth to their first child is constantly rising. Nowadays they’re 31 years old. In 1970, they would have their first child at 25.

Imthurn: That’s also how I see it. 100 years ago, the average life expectancy was 50 years. Today, a woman can expect to live well beyond 80. This means that people’s life plans extend over more decades than they used to. The unfair thing is that the life expectancy of all body cells has risen to more than 85 years — except in the case of egg cells. Just as before, the number of egg cells thus decreases rapidly from the age of 35, and on average, egg cell production dries up when women reach the age of 51. Social egg freezing now offers an opportunity to reduce the disparity between the unchanged period of fertility and our longer life expectancy.

Büchler: Women’s life plans have also changed. Women spend more time in education, have professional ambitions, and want to test various options before committing themselves. They also expect more of their relationships. Nowadays, women look for the “right partner” — one who is prepared to take on responsibility and share the task of bringing up children on an equal footing. All the surveys have shown that the most common reason for social egg freezing is the fact that precisely that partner is missing.

Imthurn: I can confirm that. In daily clinical practice, I typically encounter women between 34 and 38 who have been in a long-term relationship and were about to start a family, but the relationship has broken up. And I can really understand that these women aren’t prepared to set aside their desire to have children.

Büchler: This can cause pressure: The biological clock is ticking. The partner must also want to be a father. And he isn’t under the same kind of pressure. He might want to give himself some more time, go on a world trip, or have to go abroad for a certain period for professional reasons. Social freezing can relieve that pressure. The woman gains more time to reproduce.

Zurich University Hospital’s Fertility Center staged an information event on social egg freezing in June. Who was your target audience?

Imthurn: In principle, everyone, but especially women interested in the method. There’s a great demand for information. Women who come to us at the clinic are often interested in social egg freezing, but have completely the wrong idea: They think that they could drop by tomorrow quickly to have some egg cells extracted; the whole thing costs a few hundred francs, and that they will then be guaranteed to have a child at any age they want. Of course, none of that is true. That’s why we want to provide reliable and realistic information about the possibilities, procedures, risks and costs, as well as alternatives.

Büchler: It’s essential to provide comprehensive information. Women need to know what’s involved in this procedure and what they can realistically expect. They must be aware of the risks involved in extraction, and also when the egg cells are used. Social freezing is an invasive procedure. In other words, women must be able to make informed decisions.

Is social egg freezing relevant to women in Switzerland?

Imthurn: Yes, it is. Increasing numbers of women are aware of it. We can see that directly in the clinic: Four years ago, we carried out one egg cell extraction procedure for social freezing per year, then one a month. It’s now one every week. The intervention is thus still relatively rare, but it’s still a huge increase.

Büchler: Of course, women need to be informed at a very early stage. If a woman really does want to have her egg cells frozen as a precautionary measure, she must arrange for it in good time.

Imthurn: I’ve always said that schoolchildren should not only be informed about contraception, but also about the development of fertility. Well-educated women today are usually aware that they won’t remain fertile forever, but frequently have the wrong idea: If there are problems I can go to a fertility clinic, and everything will be OK. But we can only take the opportunities that a couple still has at that age. We can’t turn back the wheel of time. The chances are best if we can freeze the woman’s egg cells by the time she is 35. If this is done later, the chances of her having a child will decrease significantly. And because her egg cells are less fertile, more of them will be necessary – providing there are enough of them left at all.

In your day-to-day work, do you also receive inquiries from women wanting to freeze their egg cells for career reasons?

Imthurn: No, we don’t see that here at all. I’ve also wondered why — unlike in the US — no women come to us for career reasons. Perhaps because some progress has been made with regard to equality in recent years — and it has become easier to combine a career with family life thanks to better childcare services?

Büchler: I don’t think so. The advanced age of women giving birth to their first child and the low birth rate per woman in Switzerland are also linked to the fact that it isn’t easy to reconcile career and family in this country. In France and Sweden, where women have the highest birth rates in Europe, there are also considerably better support structures for families and childcare services.

And if it were easier to reconcile having children with a career: Would social egg freezing no longer be necessary at all?

Büchler: I’m not sure about that. Longer life expectancy, more time spent in education, more options, having children no longer being a question of fate, but a conscious decision, high expectations of partnerships – all of that is still there. However, I’m very much in favor of discussing the issue in depth and carefully evaluating the procedure. Social egg freezing mustn’t become a substitute for equality policies. In Switzerland, we have a special situation in that the employment rate of women is very high, but that the majority of women only work part time. At the same time, division of labor in households is still predominantly traditional, and state support is anything but ideal. There is a lot of pressure on women.

In this environment, will women decide in favor of or against social egg freezing?

Büchler: JAt any rate, decisions are not taken in a vacuum, but in a social context. And if a new service such as social egg freezing is offered, it will in turn have an impact on society. New options may not only increase autonomy, but also give rise to new expectations and constraints, such as the expectation that the option be used in order to remain fully operational in the workplace. Apparently, it is becoming increasingly common in the US for parents to give their children social egg freezing procedures as a graduation present.

Could social freezing be a solution for female academics who are under pressure in their jobs between the ages of 30 and 40?

Imthurn: We don’t have any statistics on our patients’ education, but I do think that there is an above-average number of graduates among those interested in this procedure. However, I don’t ascribe this to pressure in the workplace, but rather to the fact that academic women are better informed.

Büchler: No, social egg freezing can’t be the answer. We definitely need other solutions for the rush hour between 30 and 40, which is an important age for both professional development and starting a family. What we need above all is comprehensive research into the social, psychological, economic, ethical and medical aspects of social egg freezing.

Imthurn: Social freezing certainly isn’t aimed at actively postponing the desire to have children until later in life. If only because of the increased likelihood of complications in pregnancy. That’s why egg cells stored by social freezing should be used for IVF treatment as soon as possible. However, according to the Swiss Federal Law on Reproductive Medicine, this is only permitted when all other avenues have been explored or offer no prospects.

Are there other ethical issues?

Büchler: Social egg freezing is ambivalent: On the one hand, the procedure offers women more options and gives them more independence in terms of family planning – people are talking about them gaining reproductive autonomy. On the other, social freezing is also a further step towards the medicalization of the female body — some would even describe it as “hegemony”. They’re referring to the implicit financial interests of corporations in social freezing. These two viewpoints are also dividing the women’s movement.

Imthurn: I think it’s very important to discuss the advantages and disadvantages, and what we really want and don’t want. That makes me think of pre-implantation diagnostics: This was prohibited in Switzerland for years due to possible abuses and excesses. Most methods are neither good nor bad by definition – it always depends on how they are applied.

Büchler: Prenatal diagnostics is a good example. The new non-invasive prenatal tests, which make genetic screening of the embryo possible with a simple blood test of the pregnant woman, enable women to make their own decisions because they have more information at their disposal. However, if these tests become a routine matter, it is no longer a matter of autonomy. If a woman doesn’t want to have such a diagnosis, she could suddenly have difficulties in deciding against it. With all these new procedures, one thing is very important: Autonomy is essential, but is also very demanding and involves assuming responsibility.

What advice would you give your daughters about social egg freezing?

Imthurn: If there are no medical reasons, such as my daughter having very few egg cells at a young age, then I would wait before undergoing the social egg freezing procedure. If she had no children and no suitable partner by the age of 35, I would inform her – as I would advise my patients – as best I could, so that she could make the best decision for herself.

Büchler: Women should take the step to motherhood when they feel ready for it – and not postpone it for too long. Irrespective of planning, having children is an adventure.

Social egg freezing is no guarantee for a child

Social egg freezing gives women the option to freeze their own egg cells in younger years in order to use them at a later date should they wish to have children once their fertile years are over. If a woman chooses this option, the chances of having a child in later years are the greatest if she does so up to the age of 35. In order to gain egg cells, the ovaries are stimulated with hormones. In Switzerland, the egg cells, frozen at minus 196 degrees Celsius, may be stored for 10 years. The later use of the egg cells is strictly regulated by the Law on Reproductive Medicine: The woman in question must, among other criteria, live in an established, heterosexual relationship and be infertile. The procedure, which has been applied for about 10 years, involves certain risks, such as hyperstimulation of the ovaries. It is said that children conceived using this method run an increased risk of high blood pressure and cardiovascular diseases. The real chances of conceiving a child by means of social egg freezing depend, among other things, on a woman’s age when the egg cells were extracted and the quantity available. Although the method is often compared to an insurance policy, social egg freezing is no guarantee for a child.