Back in 2013, the American Society for Reproductive Medicine (ASRM) Ethics Committee removed the “experimental” label from egg freezing, basing their decision on technological advances and research in the field. Though ASRM still advised caution when using egg freezing to “electively” defer childbearing, this change made the procedure more widely available to more women.
Now, in the November 2018 issue of Fertility & Sterility, the Committee has issued new guidelines which take into consideration updated research and understanding about so-called “elective” egg freezing (including a change to that moniker itself). Here’s what you need to know about ASRM’s new guidelines:
They’ve changed the recommended terminology to reflect the real considerations women make when freezing their eggs.
“Observers have criticized terms like ‘social egg freezing,’ ‘freezing for nonmedical reasons,’ and ‘elective’ OC as trivializing and insufficiently respectful of the fact that the treatment is being undertaken to avert infertility that, if it arises, will in fact be a medical condition,” the Committee writes. The terminology they suggest instead? “Planned oocyte cryopreservation,” to distinguish this procedure from egg freezing before cancer treatment or in similar emergency situations.
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How will this change affect the experience of women freezing their eggs? Well, for the most part, it won’t, as clinics and services that provide egg freezing typically just call it “egg freezing.” But this shift in terminology reflects a shift in thinking by doctors, researchers, and other experts toward seeing egg freezing as a smart, proactive, and even preventative action.
They acknowledge the unequal burden women carry when it comes to fertility and sexist beliefs about motherhood.
“Planned OC may also promote social justice by reducing the obstacles women currently face because their reproductive window is smaller than men’s,” the Committee writes. “By extending the time when women may start a family, planned OC can lessen the effects of educational and workplace constraints that disparately burden one sex; thus, oocyte cryopreservation can contribute to equality of men and women.” We couldn’t agree more. Along with initiatives such as paid parental leave, access to egg freezing has the potential to give women more control over their bodies and their futures, which (we know from history) contributes to gender equality.
The statement also highlights some specifically sexist criticisms of egg freezing. “Expressions of concern about older parenthood,” for example, “may be tinged with sexism when one considers that parenthood by older men rarely draws the same criticism.” Great point, Ethics Committee. Great point.
They recognize the real reasons women consider egg freezing.
The Committee acknowledges that women are already having children at older ages than ever before, because of a wide variety of societal conditions. “Sometimes this trend is described as women ‘delaying’ or ‘postponing’ childbearing, a statement that suggests affirmative choice or even blame that women have brought the difficulty upon themselves,” they write. However, “many women report that their life circumstances (partnership, marriage, finances) are not as they want them, or as society supports or regards as acceptable, and these circumstances are what prevent them from starting a family at an earlier time.”
Translation? It’s not like most women have the option to have a baby with a perfect partner right now, but choose egg freezing instead. Young women today are more likely to be single or dealing with financial issues like unstable income or student loan debt—circumstances that make it a less-than-ideal time to think about having a baby—so we shouldn’t put the onus on them for “delaying” starting a family.
They advocate for giving women thorough information and trusting them to make the proper decision.
A common concern among critics is that egg freezing will give women a false sense of security about their fertility, or that, as the Committee writes, “that women may rely too confidently on their preserved oocytes” because they don’t understand that egg freezing isn’t a guarantee.
As the Committee writes, it’s absolutely crucial to provide education and thorough counseling to women considering egg freezing. That’s part of the idea behind “informed consent,” and it’s central to the way we interact with our patients and why we founded the Center for Fertility Research and Education.
But, as the Committee notes, many patients choose medical treatment with uncertain results. The idea that women considering egg freezing are less able than other patients to understand their chances of success seems paternalistic at best, outwardly sexist at worst—especially when studies show that most women make the decision to freeze their eggs carefully and rationally. As the Committee writes, “Patients should be trusted to comprehend information when full and appropriate medical counseling is presented and should not have options removed due to potentially biased underestimation of their capabilities.”