Analysis by Dal professors shows debate persists over women freezing their eggs

HALIFAX – A new analysis piece released Monday by the Canadian Medical Association Journal and co-authored by Dalhousie University professors is renewing the debate over women who freeze their eggs and the reasons why.

Researchers said doctors need to counsel women that egg freezing isn’t insurance against future infertility and point out the high cost and medical risks of in-vitro fertilization.

Social egg freezing: risk, benefits and other considerations was written by lead author Angel Petropanagos, a post-doctoral fellow at Novel Tech Ethics at Dalhousie University, and Françoise Baylis, the Canada Research Chair in Bioethics and Philosophy at Dalhousie University.

The analysis focuses on the role general physicians could play in better informing women about the risks, benefits and consequences of age-related egg freezing, also known as social egg freezing. This type of egg freezing is fertility preservation in absence of a medical situation, such as disease, and is sometimes used by women who put their career first. The flash frozen eggs can then be used at a later date and can lower the risk of giving birth to a child with abnormalities.

Petropanagos said it is oftentimes in the best interests of an employer to keep a young, talented women in the workplace longer, which is where the appeal of egg freezing comes in.

However, she cautions against women putting all their hopes and efforts into it.

“If a woman decides to stay in the workforce and delays child-bearing, it’s taking a gamble in some ways because using social egg freezing isn’t a guarantee in having children later on,” she said.

Tweet This Click to share quote on Twitter: "If a woman decides to stay in the workforce and delays child-bearing, it's taking a gamble in some ways because using social egg freezing isn't a guarantee in having children later on," she said.

“It might be the case that for some women this seems like a really great option and they’re fortunate enough if things work out, they’re able to delay child-bearing and then have a family later on. But it’s not going to be the case for all women.”

Baylis said the topic of age-related egg freezing is more of a societal issue than a biological issue when climbing up the corporate ladder is involved.

“You buy into this new way of being socialized into thinking that what’s really important is for you to stay active and in the workplace up until your 30s and 40s when in fact that may not be in your best interest,” she said.

“We say to women, it’s your responsibility, go out, freeze your eggs, get your life together and then you can seriously think about having a family. I think that’s problematic.”

Tweet This Click to share quote on Twitter: "We say to women, it's your responsibility, go out, freeze your eggs, get your life together and then you can seriously think about having a family. I think that's problematic."

Baylis said there is inequity in the workforce and changes need to be made so women can have the best of both worlds earlier rather than later. She cites examples such as subsidized daycare, improved maternity and paternity programs and greater flexibility in the workplace.

“What’s a way we can encourage young people to have families at a younger age, which we know at least for women is certainly, from a medical point of view, a better option,” she said.

Tweet This Click to share quote on Twitter: "What's a way we can encourage young people to have families at a younger age, which we know at least for women is certainly, from a medical point of view, a better option," she said.

Should family physicians become involved?

Baylis said she believes women can make their own decisions when it comes to egg freezing but she worries they are not properly informed about the costs and risks involved. Petropanagos said that is where family physicians could come into play.

“Family physicians should be better positioned to acquire accurate information and disseminate it or share it with women who ask about it,” she said.

“What doctors should be telling them is they should be discussing the medical risks and the potential benefits as well as the financial costs of going this route. We hope these conversations are going to happen within a broader framework of reproductive health – to tell women there is this one option but there are also these other options that might be better for you.”

“What we’re hoping to do is get some ideas out there that family physicians can engage with and think about and discuss with others,” Baylis said.

“You want them to be thinking through why is it that I’m thinking about pursuing this technology. How does it fit with my life goals and objectives in the context of trying to stave off, if you will, a negative consequence of a health intervention?”

However, Dr. Heather Shapiro, the vice president of the Canadian Fertility and Andrology Society, said she does not support that idea. She said a specialist in reproductive endocrinology would be better suited to fulfill that duty.

“The person who is providing the service should be the one to provide informed consent and while family doctors are very important, I think at some level it would be unfair to put this burden of counseling on them,” she said.

Criticism of analysis piece

Shapiro was critical of the CMAJ analysis and said it is not a physician’s role to judge why a woman is pursuing a specific procedure.

“It’s your job to decide if it’s appropriate for them and that appropriateness includes both medical and pyscho-social and other aspects as well,” she said.

Tweet This Click to share quote on Twitter: "It's your job to decide if it's appropriate for them and that appropriateness includes both medical and pyscho-social and other aspects as well," she said.

Shapiro, who is also a member of the fertility centre at Mount Sinai Hospital in Toronto, said it is an oversimplification to say women have to make a choice between their careers or their family lives.

“I think some women find themselves in the situation where there’s a degree of uncertainty as to how their personal life will go and there’s a degree of uncertainty as to how their biological future will [go]. When people find themselves at that crossroads, they sometimes have choices to make,” she said.

Tweet This Click to share quote on Twitter: "I think some women find themselves in the situation where there's a degree of uncertainty as to how their personal life will go and there's a degree of uncertainty as to how their biological future will [go]. When people find themselves at that crossroads, they sometimes have choices to make," she said.

“They want to ‘leave the door open’ and I think having that opportunity and understanding it is an uncertainty is an option that should be made available to women.”

Pressure placed on young women

Lianne Leger, 26, is a first year pharmacy student at Dalhousie University and said there is pressure on women in their mid to late 20s,

“A lot of people … think you should be married, you should have kids soon at this time because you’re only getting older,” she said.

Tweet This Click to share quote on Twitter: "A lot of people … think you should be married, you should have kids soon at this time because you're only getting older," she said.

“Women feel the pressure from society that they should be having kids soon. That might skew their opinion on freezing their eggs.”

Leger said she is focused on her studies and her career right now. She admits that she had not considered freezing her eggs but adds she expects her career to be quite busy.

“Time constraints is definitely going to be one of the hardest things. The job is very demanding. A lot of the job opportunities that we have are shift work,” she said.

She understands the appeal of egg freezing but said she hopes women don’t feel forced into it.

“I hope [women] don’t think they have to. I really hope women realize they have a choice.”

Tweet This Click to share quote on Twitter: "I hope [women] don't think they have to. I really hope women realize they have a choice."

Some U.S. companies including Facebook and Apple have offered to cover limited insurance coverage for the cost of egg freezing for their employees.

– With files from Canadian Press