Bryan McIntosh, Associate Professor, Health Sciences, University of Stirling
The recent proposal from the Shadow health Secretary Miles Briggs MSP, to make ‘egg freezing’ available to all women in Scotland, is a progressive one. Currently, egg freezing is only provided to young women who receive it as part of a package of care for certain types of cancer; normally it is inaccessible to women without substantial financial resources. This proposal would enable all women regardless of background or circumstance the same rights to access.
There would be major challenges in implementing this proposal. At a time of limited resources, could the cost be justified? In 2019, the Human Fertilisation and Embryology Authority (the independent regulator) noted that the average cost of egg collection and freezing was £3,350. With medication, it increased by £500-£1,500, storage costs were between £125 and £350 per year, thawing eggs and transferring them to the womb costs an average of £2,500. It would not be unreasonable to consider that these costs can be reduced both by increased scale, competition and negotiation. Indeed, in this instance, an Any Qualified Provider (AQP) initiative may be best suited to increase choice whilst reducing costs.
The Royal College of Obstetricians and Gynaecologists has highlighted relatively low success rates and side effects associated with egg freezing and IVF treatment. They noted that 90% of eggs survived thawing, of which approximately 75% were capable of being fertilised but only 7% of those developed into embryos which resulted in a viable pregnancy. In addition, the evidence suggests that egg freezing appears unsuitable for women in their later thirties as they generally have eggs of less good quality and don’t respond so well to ovarian stimulation. It is unlikely that in this group, with current practices, that the outcomes would be worthwhile either financially or emotionally.
While these disappointing figures speak strongly, it could be argued that they must be located within a cultural narrative which women’s choice, expectations and aspiration to control their lives must be factored against. Women have more options; professionally, socially, and educationally, than they have had previously; paired with widespread access to reliable birth control, egg freezing becomes in part by design or default part of that dialogue. One in which services and – more telling – we as a society need to be both cognisant of and be able to respond to meaningfully.
There are several questions that need to be considered; is it the right thing to do? If so, can the current financial and emotional costs be justified? Could this inadvertently mislead women to leaving planned pregnancy until even later, increasing the risks of failure and pregnancy related health problems? If this policy comes to pass, extensive education is needed as part of this package of care, to enable a balanced understanding of risk.
All of this needs to be framed within possibly an even wider dialogue in relation to the provision of IVF and wider fertility treatments. As all these services in one shape or form are interlinked and, in reality, cannot be reviewed or considered in isolation. If this proposal sparks these debates then it would already have been successful.
Dr Bryan McIntosh is Associate Professor in the Faculty of Health Sciences and Sport, at the University of Stirling. This article first appeared in Scotland on Sunday, 28th April 2019.