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The debate about social egg freezing

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ou may have heard of the term "social egg freezing". This means that women have their eggs frozen so that they can later be used for artificial insemination (IVF). But how does egg freezing actually work? Can women really postpone having children so easily? And do you know what the legal situation is regarding social egg freezing in Austria? Let's take a look at this and more in this article.

The history of egg freezing

Without the possibilities of artificial fertilisation (IVF) there would probably be no egg freezing as we know it today. This is because the breakthrough of IVF technology in the second half of the 20th century was to a certain extent also a "gatekeeper" for further research and developments in the field of reproductive medicine. As early as the 1970s, doctors succeeded in freezing sperm and successfully thawing them again as part of artificial insemination. The breakthrough came just a few years later, when embryos created in the laboratory could be frozen and implanted in women as part of IVF treatment.

However, the freezing process is much more difficult with the female egg cell. This is because the egg cell is the largest cell in the human body and also has a high water content, which is why it can easily form ice crystals during the freezing and thawing process, which destroy the egg cell. The first "slow freezing methods" were also unreliable, because even if the egg cells survived the thawing process, this often led to damage to the chromosomes and thus to poor embryo development and low chances of survival.

This only changed in 2005, when a new "flash freezing method" called "oocyte vitrification" was developed by a Japanese embryologist. Vitrification is a process in which the oocytes are first treated with cryoprotectants and then immersed in liquid nitrogen. The egg cells cool down to -196°C at lightning speed so that they "vitrify", i.e. take on a glass-like structure. Compared to the older "slow freezing methods", which often took hours, vitrification only takes a few minutes and the chances of survival of the thawed egg cells have also been significantly increased.

The difference between social egg freezing and medical egg freezing

In principle, there are two categories of egg freezing: Medical egg freezing and social egg freezing. Medical egg freezing was to a certain extent the original form of egg freezing. The medical field that had a need for a method such as egg freezing was oncology. Women of reproductive age who develop cancer and therefore have to undergo treatment such as radiotherapy or chemotherapy have an increased risk of their egg reserves being reduced or even destroyed as a result of the treatment. If a woman has her eggs frozen before undergoing cancer treatment, she can use them later and still give birth to children who are genetically related to her. This method of freezing sperm already existed for male cancer patients. Egg freezing was soon extended to women with all kinds of fertility problems. These included, for example, severe cases of endometriosis, malignant ovarian tumours, etc.

However, the real "boom" in egg freezing only began when the first "healthy" women started to register for clinical studies on egg freezing. In 2012, both the American Society for Reproductive Medicine (ASMR) and the European Society of Human Reproduction and Embryology (ESHRE) officially approved egg freezing for medical and non-medical purposes.

Because that female fertility is unfortunately limitedis not a new scientific finding. A woman is born with the "final" quantity of eggs. Over time, both the number and the quality of the remaining eggs continue to decline. The decline in the number of eggs begins in the early 30s and from 37 the rate of decline in the number of eggs increases rapidly. Using social egg freezing, women can therefore "preserve" their fertility and theoretically have children well into their 40s and even after the menopause. Women can therefore easily extend their fertile window, come closer to the longer-lasting fertility of men and take control of their life and family planning more easily and without time pressure. Right?

The chances of success with social egg freezing

Unfortunately, it's not quite as nice and easy in practice as it sounds in theory. Because egg freezing is no guarantee for later baby happiness! As egg freezing is a relatively new technology, there are not yet many comprehensive studies on this topic and the information available, especially on the actual probability of pregnancy with the frozen eggs, is not particularly clear. For example, one Styrian fertility clinic on its website refers to an unspecified study which states that 60- 85% of women who use their frozen eggs for fertilisation become successfully pregnant.

Larger-scale studies from the USA, however, speak a different language. The scientific publication "Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility centre" from the New York University Langone Fertility Center, which analysed the data from the New York Fertility Institute over the last 15 years, came to the sobering conclusion that the chances of a successful pregnancy were only 39% on average. This was mainly due to the older age of the women who had their eggs frozen. The average age was around 38 years. If the women were under the age of 38 at the time of egg freezing, the chances were 51%. The quantity of eggs frozen also played a significant role. For example, women under the age of 38 who had 20 or more than 20 eggs frozen had a 70% chance of pregnancy.

The study by Marcia C. Inhorn also shows that it is not always so easy to have children despite egg freezing. For her book "Motherhood on Ice", she accompanied more than 150 women on their social egg-freezing journey and looked in particular at the socio-cultural reasons that led women to make this decision.

Of the more than 150 women during Inhorn's research period, 10 ultimately decided to use their frozen eggs for artificial fertilisation. Unfortunately, 8 of these women lost all of their frozen eggs in the process, meaning that no successful fertilisation took place. Only 2 of the women gave birth to healthy frozen egg babies. To summarise, egg freezing is no guarantee of a baby. Dr Cedars, President of the American Society for Reproductive Medicine, puts it this way: "The pregnancy rate is not as high as many women think. I always tell my patients: Just because you've frozen your eggs doesn't mean you have a 'baby' in the freezer. You only have a chance of getting pregnant".

The reasons for social egg freezing: self-realisation vs. "the mating gap"

As we mentioned at the beginning of this article, there is a lot of criticism of social egg freezing, claiming that it causes women to postpone having children indefinitely in order to focus on their careers. Marcia C. Inhorn also started her comprehensive egg freezing study with this assumption, only to be proven wrong.

In her numerous interviews with women who underwent social egg freezing treatment, it quickly became clear that most of them took this step because they simply did not have the right partner and were afraid that they would no longer be able to fulfil their desire to have children, as they would simply run out of time. Inhorn refers to this phenomenon as the "mating gap". According to her, well-educated, successful and well-off women in particular find it difficult to find a partner at "eye level" who also has a similar level of academic education, etc. In their opinion, the popularity of social egg freezing is therefore due to "dating problems" rather than "self-fulfilment reasons".

Social egg freezing in Germany and Austria & the costs

If you live in Germany and have already considered having your eggs frozen, then you can definitely do this if you are prepared to spend the necessary small change. As a brief overview: The average cost of the treatment is around €2,220 and must be paid privately, as statutory health insurance companies do not cover this. This includes the consultation, ultrasound, stimulation treatment, egg retrieval, cryopreservation of the eggs and the anaesthetic. In addition, there are the storage costs for the frozen eggs. These amount to around €300 per year.

For comparison: In the USA, you pay around €15,000 for social egg freezing.

If you live in Austria and are also toying with the idea of having your eggs frozen, then unfortunately we have to disappoint you: Social egg freezing is prohibited in Austria and you can only have this treatment carried out abroad. This means that Austria is only one of 8 countries worldwide that prohibit social egg freezing, alongside Bangladesh, China, Malaysia, Norway, Senegal and Singapore. In Austria, only "medical egg freezing" is permitted, i.e. only if there is a medical reason. However, even if there are medical reasons, Austrian health insurance companies do not pay for the treatment and the costs must be borne privately. In Austria, these amount to around €4,000 including the storage fee for the first year.

Petitions

We think that the ban on social egg freezing in Austria is completely outdated and demand that every woman should be allowed to take her reproductive care into her own independent hands! Bettina Toth, head endocrinologist and reproductive medicine specialist at MedUni Innsbruck, also says that social egg freezing is also a very personal decision that women do not make lightly, especially as the procedure, like any medical intervention, is associated with risks.

 We are not alone in calling for the ban on social egg freezing to be abolished; there are petitions across Austria that also want this to happen. The topic of social egg freezing was already discussed in the Austrian parliament in June 2023 as a result of a citizens' initiative, but so far without result.

However, the majority of the Austrian Bioethics Commission has already spoken out in favour of social egg freezing. This committee consists of 24 members and advises the Federal Chancellor on medical and ethical matters. The commission's opinion, which was submitted to the parliamentary committee for petitions and citizens' initiatives, states: "A general ban on the aforementioned methods to support family planning seems objectively inappropriate in a modern liberal and pluralistic society." 

Would you also like to make your voice heard in favour of social egg freezing?

Click here for the open petition of the initiative "Zukunft Kinder! - For self-determined family planning.

What do you think about social egg freezing? Let us know in the comments or on our Instagram know.

Sources:

Inhorn, Marica C. (2023). Motherhood on Ice: The Mating Gap and why women freeze their eggs. New York University Press

Cascante, Blakemore, DeVore et. al (18/05/2022). Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility centre

Kolata (06/07/2023). 'Sobering Study'shows Challenges of Egg Freezing

SOCIAL FREEZING - Determine the optimal time for your desired child (16.04.2024)

Egg freezing (16.04.2024)

Luttenberger (12/11/2023). Freezing still prohibited

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Tina is the Marketing Manager at femSense and firmly believes that great things happen when women support and empower each other, because in this "men's-world" there clearly needs to be more sisterhood. She lives in harmony with her superpower aka her cycle and writes about all the topics that matter.

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