‘A lottery ticket, not a guarantee’: fertility experts on the rise of egg freezing

Hannah Devlin

The Guardian

Originally posted 11 NOV 22

Here is an excerpt:

This means that a woman who freezes eggs at the age of 30 boosts her chances of successful IVF at 40 years. But, according to Dr Zeynep Gurtin, a lecturer in women’s health at UCL, this concept has led to a false narrative that if you freeze your eggs “you’ll be fine”. “A lot of people who freeze their eggs don’t get pregnant,” Gurtin said.

First, only a fraction opt to use the eggs down the line – some get pregnant without IVF, others decide not to for a range of reasons. For those who go ahead, HFEA figures show that, as an average across all age groups, just 2% of all thawed eggs ended up as pregnancies and 0.7% resulted in live births in 2018. For each IVF cycle, this gives a 27% chance on average of a birth for those who froze their eggs before the age of 35 and a 13% for those who froze their eggs after this age. The most common age for egg freezing in the UK is 38 years old.

A recent analysis by the Nuffield Council on Bioethics found women often felt frustrated at having received insufficient information on success rates, but also reported feeling relief and a sense of empowerment.

Egg freezing, Gurtin suggested, should be viewed as “having a lottery ticket rather than having an insurance policy”.

“An insurance policy suggests you’ll definitely get a payout,” she said. “You’re just increasing your chances.”

As lottery tickets go, it is an expensive one. The average cost of having eggs collected and frozen is £3,350, with additional £500-£1,500 costs for medication and an ongoing expense of £125-£350 a year for storage. And clinics are not always upfront about the full extent of costs.

“In many cases, you’re going to spend a third more than the advertised price – and you’re spending that money for something that’s not an immediate benefit to you,” said Gurtin. “It’s a big gamble.”

“When people talk about egg freezing revolutionising women’s lives, you have to ask: how many can afford it?” she added.

Travelling abroad, where treatments may be cheaper, is an option but can be logistically problematic. “When it comes to repatriating eggs, sperm and embryos, it is possible, but it’s not always that straightforward,” said Sarris. “You need to follow a process, you don’t just send them with DHL.”

The info is here.

First synthetic embryos: the scientific breakthrough raises serious ethical questions

Savulescu, J., Gyngell, C., & Sawai, T.

The Conversation

Originally posted 11 AUG 22

Here is an excerpt:

Artificial wombs

In the latest study, the scientists started with collections of stem cells. The conditions created by the external uterus triggered the developmental process that makes a fetus. Although the scientists said we are a long way off synthetic human embryos, the experiment brings us closer to a future where some humans gestate their babies artificially.

Each year over 300,000 women worldwide die in childbirth or as a result of pregnancy complications, many because they lack basic care. Even in wealthy countries, pregnancy and childbirth is risky and healthcare providers are criticised for failing mothers.

There is an urgent need to make healthcare more accessible across the planet, provide better mental health support for mothers and make pregnancy and childbirth safer. In an ideal world every parent should expect excellent care in all aspects of motherhood. This technology could help treat premature babies and give at least some women a different option: a choice of whether to carry their child or use an external uterus.

Some philosophers say there is a moral imperative to develop artificial wombs to help remedy the unfairness of parenting roles. But other researchers say artificial wombs would threaten a women’s legal right to terminate a pregnancy.

Synthetic embryos and organs

In the last few years, scientists have learned more about how to coax stem cells to develop into increasingly sophisticated structures, including ones that mimic the structure and function of human organs (organoids). Artificial human kidneys, brains, hearts and more have all been created in a lab, though they are still too rudimentary for medical use.

The issue of whether there are moral differences between using stem cells to produce models of human organs for research and using stem cells to create a synthetic embryo are already playing out in law courts.

One of the key differences between organoids and synthetic embryos is their potential. If a synthetic embryo can develop into a living creature, it should have more protection than those which don’t.

Synthetic embryos do not currently have potential to actually create a living mouse. If scientists did make human synthetic embryos, but without the potential to form a living being, they should arguably be treated similarly to organoids.

The info is here.

Freezing Eggs and Creating Patients: Moral Risks of Commercialized Fertility

E. Reis & S. Reis-Dennis

The Hastings Center Report

Originally published 24 Nov 17

Abstract

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg-freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women of various ages. We argue that although reproductive technology, and egg freezing in particular, promise to improve women's care by offering more choices to achieve pregnancy and childbearing, they actually have the potential to be disempowering. First, commercial motives in the fertility industry distort women's medical deliberations, thereby restricting their autonomy; second, having the option to freeze their eggs can change the meaning of women's reproductive choices in a way that is limiting rather than liberating.

Here is an excerpt:

Egg banks are offering presumably fertile women a solution for potential infertility that they may never face. These women might pay annual egg-freezing storage rates but never use their eggs. In fact, even if a woman who froze eggs in her early twenties waited until her late thirties to use them, there can be no guarantee that those eggs would produce a viable pregnancy. James A. Grifo, program director of NYU Langone Health Fertility Center, has speculated, “[T]here have been reports of embryos that have been frozen for over 15 years making babies, and we think the same thing is going to be true of eggs.” But the truth is that the technology is so new that neither he nor we know how frozen eggs will hold up over a long period of time.

Some women in their twenties might want to hedge their bets against future infertility by freezing their eggs as a part of an egg-sharing program; others might hope to learn from a simple home test of hormone levels whether their egg supply (ovarian reserve) is low—a relatively rare condition. However, these tests are not foolproof. The ASRM has cautioned against home tests of ovarian reserve for women in their twenties because it may lead to “false reassurance or unnecessary anxiety and concern.” This kind of medicalization of fertility may not be liberating; instead, it will exert undue pressure on women and encourage them to rely on egg freezing over other reproductive options when it is far from guaranteed that those frozen eggs (particularly if the women have the condition known as premature ovarian aging) will ultimately lead to successful pregnancies and births.

The info is here.

The female problem: how male bias in medical trials ruined women's health

Gabrielle Jackson
The Guardian
Originally posted 13 Nov 19

Here is an excerpt:

The result of this male bias in research extends beyond clinical practice. Of the 10 prescription drugs taken off the market by the US Food and Drug Administration between 1997 and 2000 due to severe adverse effects, eight caused greater health risks in women. A 2018 study found this was a result of “serious male biases in basic, preclinical, and clinical research”.

The campaign had an effect in the US: in 1993, the FDA and the NIH mandated the inclusion of women in clinical trials. Between the 70s and 90s, these organisations and many other national and international regulators had a policy that ruled out women of so-called childbearing potential from early-stage drug trials.

The reasoning went like this: since women are born with all the eggs they will ever produce, they should be excluded from drug trials in case the drug proves toxic and impedes their ability to reproduce in the future.

The result was that all women were excluded from trials, regardless of their age, gender status, sexual orientation or wish or ability to bear children. Men, on the other hand, constantly reproduce their sperm, meaning they represent a reduced risk. It sounds like a sensible policy, except it treats all women like walking wombs and has introduced a huge bias into the health of the human race.

In their 1994 book Outrageous Practices, Leslie Laurence and Beth Weinhouse wrote: “It defies logic for researchers to acknowledge gender difference by claiming women’s hormones can affect study results – for instance, by affecting drug metabolism – but then to ignore these differences, study only men and extrapolate the results to women.”

The info is here.

IVF couples could be able to choose the ‘smartest’ embryo

Hannah Devlin
TheGuardian.com
Originally posted May 24, 2019

Couples undergoing IVF treatment could be given the option to pick the “smartest” embryo within the next 10 years, a leading US scientist has predicted.

Stephen Hsu, senior vice president for research at Michigan State University, said scientific advances mean it will soon be feasible to reliably rank embryos according to potential IQ, posing profound ethical questions for society about whether or not the technology should be adopted.

Hsu’s company, Genomic Prediction, already offers a test aimed at screening out embryos with abnormally low IQ to couples being treated at fertility clinics in the US.

“Accurate IQ predictors will be possible, if not the next five years, the next 10 years certainly,” Hsu told the Guardian. “I predict certain countries will adopt them.”

Genomic Prediction’s tests are not currently available in the UK, but the company is planning to submit an application to the Human Fertilisation and Embryology Authority by the end of the year, initially to offer a test for risk of type 1 diabetes.

The info is here.

Beyond safety questions, gene editing will force us to deal with a moral quandary

Josephine Johnston
STAT News
Originally published November 29, 2018

Here is an excerpt:

The majority of this criticism is motivated by major concerns about safety — we simply do not yet know enough about the impact of CRISPR-Cas9, the powerful new gene-editing tool, to use it create children. But there’s a second, equally pressing concern mixed into many of these condemnations: that gene-editing human eggs, sperm, or embryos is morally wrong.

That moral claim may prove more difficult to resolve than the safety questions, because altering the genomes of future persons — especially in ways that can be passed on generation after generation — goes against international declarations and conventions, national laws, and the ethics codes of many scientific organizations. It also just feels wrong to many people, akin to playing God.

As a bioethicist and a lawyer, I am in no position to say whether CRISPR will at some point prove safe and effective enough to justify its use in human reproductive cells or embryos. But I am willing to predict that blanket prohibitions on permanent changes to the human genome will not stand. When those prohibitions fall — as today’s announcement from the Second International Summit on Human Genome Editing suggests they will — what ethical guideposts or moral norms should replace them?

The info is here.

First gene-edited babies claimed in China

Marilynn Marchione

Associated Press
Originally posted today

A Chinese researcher claims that he helped make the world’s first genetically edited babies — twin girls born this month whose DNA he said he altered with a powerful new tool capable of rewriting the very blueprint of life.

If true, it would be a profound leap of science and ethics.

A U.S. scientist said he took part in the work in China, but this kind of gene editing is banned in the United States because the DNA changes can pass to future generations and it risks harming other genes.

Many mainstream scientists think it’s too unsafe to try, and some denounced the Chinese report as human experimentation.

The researcher, He Jiankui of Shenzhen, said he altered embryos for seven couples during fertility treatments, with one pregnancy resulting thus far. He said his goal was not to cure or prevent an inherited disease, but to try to bestow a trait that few people naturally have — an ability to resist possible future infection with HIV, the AIDS virus.

The info is here.

Are embryos people? The answer will determine the future of reproductive medicine

Eric Forman
Statnews.com
Originally posted July 24, 2018

Here is an excerpt:

The goal of this process is to achieve a healthy child, which now occurs at a remarkably high rate. For specific genetic disorders, preimplantation genetic testing can reduce the odds of having a child with a lethal disorder from 25 to 50 percent to less than 1 percent.

Medicine’s ability to culture embryos and select healthy ones has improved dramatically in the last few years. A clinical trial that I led several years ago showed that transferring a single genetically tested normal embryo resulted in the same delivery rate as transferring multiple untested embryos. When genetic testing is performed, it is now standard of care to transfer just a single embryo at a time — gone are the days of risky triplet and high-order multiples after IVF. Actual babies, not embryos, are being spared from dying from the complications of genetic diseases and severe prematurity thanks to the increased use of single-embryo transfer afforded by preimplantation genetic testing.

The information is here.

Genetically modified babies given go ahead by UK ethics body

Ian Sample
The Guardian
Originally posted July 17, 2018

The creation of babies whose DNA has been altered to give them what parents perceive to be the best chances in life has received a cautious green light in a landmark report from a leading UK ethics body.

The Nuffield Council on Bioethics said that changing the DNA of a human embryo could be “morally permissible” if it was in the future child’s interests and did not add to the kinds of inequalities that already divide society.

The report does not call for a change in UK law to permit genetically altered babies, but instead urges research into the safety and effectiveness of the approach, its societal impact, and a widespread debate of its implications.

“It is our view that genome editing is not morally unacceptable in itself,” said Karen Yeung, chair of the Nuffield working group and professor of law, ethics and informatics at the University of Birmingham. “There is no reason to rule it out in principle.”

The info is here.

The Next Best Version of Me: How to Live Forever

David Ewing Duncan
Wired.com
Originally published March 27, 2018

Here is an excerpt:

There are also the ethics of using a powerful new technology to muck around with life’s basic coding. Theoretically, scientists could one day manufacture genomes, human or otherwise, almost as easily as writing code on a computer, transforming digital DNA on someone’s laptop into living cells of, say, Homo sapiens. Mindful of the controversy, Church and his HGP-Write colleagues insist that minting people is not their goal, though the sheer audacity of making genome-scale changes to human DNA is enough to cause controversy. “People get upset if you put a gene from another species into something you eat,” says Stanford bioethicist and legal scholar Henry Greely. “Now we’re talking about a thorough rewriting of life? Hairs will stand on end. Hackles will be raised.”

Raised hackles or not, Church and his team are forging ahead. “We want to start with a human Y,” he says, referring to the male sex chromosome, which he explains has the fewest genes of a person’s 23 chromo­somes and is thus easier to build. And he doesn’t want to synthesize just any Y chromosome. He and his team want to use the Y chromosome sequence from an actual person’s genome: mine.

“Can you do that?” I stammer.

“Of course we can—with your permission,” he says, reminding me that it would be easy to tap into my genome, since it was stored digitally in his lab’s computers as part of an effort he launched in 2005 called the Personal Genome Project.

The article is here.

New fertility procedure may lead to 'embryo farming', warn researchers

Ian Sample
The Guardian
Originally posted January 11, 2017

A new lab procedure that could allow fertility clinics to make sperm and eggs from people’s skin may lead to “embryo farming” on a massive scale and drive parents to have only “ideal” future children, researchers warn.

Legal and medical specialists in the US say that while the procedure – known as in vitro gametogenesis (IVG) – has only been demonstrated in mice so far, the field is progressing so fast that the dramatic impact it could have on society must be planned for now.

“We try not to take a position on these issues except to point out that before too long we may well be facing them, and we might do well to start the conversation now,” said Eli Adashi, professor of medical science at Brown University in Rhode Island.

The creation of sperm and eggs from other tissues has become possible through a flurry of recent advances in which scientists have learned first to reprogram adult cells into a younger, more versatile state, and then to grow them into functioning sex cells. In October, scientists in Japan announced for the first time the birth of baby mice from eggs made with their parent’s skin.

The article is here.

Netherlands to grow human embryos for research

By www.rt.com
Originally posted May 26, 2016

The Dutch government will allow labs to grow human embryos to be used for research in a limited number of fields, it announced on Friday. Currently scientists have to rely on a limited supply of leftover embryos from in vitro fertilization patients.

The ban on the cultivation of embryos [has] hampered research which could help with the treatment of diseases on the short to medium-long term," the government said in a statement, justifying the ethically controversial move.

The new regulations would not change the so-called “14-day rule”, which demands that any human embryo kept in a lab be destroyed no later than two weeks after fertilization.

The article is here.

Left Out in the Cold: Seven Reasons Not to Freeze Your Eggs

By Françoise Baylis
Impact Ethics
Originally posted October 16, 2014

Here is an excerpt:

These professional cautions are of no consequence to Facebook or Apple, however. Both of these companies have decided to include egg freezing in their employee benefit package. As an alternative, they could have decided to improve the health benefits offered to all employees. Or, to stay focused on the issue of reproduction, they could have included a full year of family leave in the benefit package. Instead, they chose to pay up to $20,000 for egg freezing. Now call me crazy, but I think this choice just might have to do with their corporate priorities – which include keeping talented workers in their 20s to early 30s in the workplace, not at home caring for babies.

(cut)

Second, contrary to popular belief, egg freezing does not set back a woman’s biological clock. While it is certainly true that eggs from a younger woman are more likely to generate a healthy embryo and a healthy pregnancy than eggs 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. From a purely biological perspective, it is in the interest of women to have their children while they are younger.

The entire story is here.