Social freezing

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Social freezing describes the precautionary freezing of unfertilized egg cells for no medical reason. This possibility gives women who are currently unable to fulfill their desire to have children greater chances of conceiving beyond the age of about 35 years. Reasons for opting for social freezing can include the lack of a partner or the desire to prevent future fertility . Egg preservation was originally intended for young patients with cancer who had to undergo chemotherapy .

Thanks to improved methods, it is now possible to achieve high survival (80–90%) and fertilization rates (60–70%) that increase the likelihood of pregnancy. The decisive factor for a successful treatment is above all the age of the woman at the time of collection. The younger it is, the less damage the egg cells show.

When the companies Facebook and Apple announced in October 2014 that they would cover the costs of social freezing for their employees , the term became a catchphrase of great media reception and (work) ethical controversy .

ova

A girl is born with 1–2 million egg cells, of which around 400,000 are left at puberty . A woman loses around 1,000 egg cells every month. The number is therefore reduced by 12,000 from year to year. At the same time, the quality of the egg cells decreases with age. This makes conception more difficult and increases the likelihood of a miscarriage or a mentally or physically impaired child. The fertility of a woman begins to decline with mid 20th A drastic drop can be observed from mid-30s. If you are over 40, the chance of getting pregnant within one cycle is less than 5%.

method

Although the first report of a successful pregnancy after cryopreservation of unfertilized egg cells appeared as early as 1986, for more than 25 years it remained a major challenge in reproductive biology to establish a process for preservation that would achieve survival rates above 50% and more than 1– 2% produced successful pregnancies.

The “slow freezing” method has been used since the 1970s and is a time-consuming process as the freezing speed is only around 3 K / min. The survival rates after thawing the egg cells are accordingly not particularly high. For some years now another method has been used, so-called vitrification . Extremely high freezing speeds of up to over 10,000 K / min are achieved.

The cell material is immersed in liquid nitrogen , which has a temperature of minus 196 ° C. The egg cell is transformed into a glass-like (amorphous) state without crystals being able to form. This halts all physical processes and the cell can be safely stored for decades. The main disadvantage of vitrification is that higher concentrations of anti-freeze agents, some of which are toxic for the cells, such as dimethyl sulfoxide (DMSO), have to be used.

In October 2012, the American Society for Reproductive Medicine announced that egg cryopreservation is no longer considered an experimental process.

treatment

The process of social freezing essentially corresponds to the first phase of fertility treatment. A hormone treatment is carried out to stimulate the ovaries, with the growth of the follicles being monitored by means of an ultrasound examination . The egg cells are then removed in what is usually a short procedure.

To do this, the ovaries are punctured with a needle through the vagina and the egg cells are suctioned off. These are examined for their quality and then vitrified. The side effects of hormone treatment, including nausea, mood swings, and weight gain, are relatively minor. Occasionally (<1% of all cases) hormonal overstimulation (OHHS) can occur.

success

The success of egg screening mainly depends on the age of the woman at the time of collection: by the age of 30, every second to third egg cell is capable of fertilization, while in a 40-year-old it is only every fifth to sixth. The rate of live births therefore also steadily decreases with increasing age of the woman, regardless of the freezing method.

Since the egg cells have been vitrified, the results are encouraging. The birth rate of preserved and fresh egg cells with subsequent in vitro fertilization is comparable. According to a study of over 900 children, babies born from cryopreserved egg cells do not have increased birth defects or intellectual disabilities compared to those born naturally. Researchers have also shown that vitrification has no clinically relevant impact on pre-natal and pre-natal problems such as diabetes or high blood pressure during pregnancy . The birth weight, mortality rate or gestational age are also unchanged compared to fresh egg cells.

costs

To get the recommended number of 10 to 15 eggs, some women have to expect several treatment cycles. The costs per cycle are currently quoted as 3,000 to 4,000 euros per egg collection including all necessary medication if the treatment is carried out in German IVF centers. There are also costs for storage. Since 2015, a private cryobank has been offering a complete package for the first time , which includes the storage of the egg cells.

If a woman uses her preserved egg cells, the cost of artificial insemination must be added.

history

Egg freezing was originally thought to be a way for young women with cancer to have a genetically own child after chemotherapy. If irradiation of the ovaries and uterus cannot be avoided, it can lead to infertility . Even if pregnancy occurs, women after radiation therapy have a higher risk of miscarriages and premature births because the genetic material has been damaged and the tissue of the uterus loses elasticity and has poorer blood circulation. Therefore, if there is enough time, women can have their eggs removed and frozen before the irradiation.

In 1997 the first baby was born from a cryopreserved egg. In total, an estimated 5,000 children have been born through social freezing so far. In Germany there were around 750 egg freezing procedures for non-medical reasons in 2014.

Fertility medicine now also offers egg cell care to women who are looking for a life partner and child's father or who want to pursue their professional wishes before starting a family. Women between 35 and 38 years of age in particular nowadays (as of 2014) opt for social freezing, although from a medical point of view it would make sense to have the egg cells removed and frozen between the ages of 25 and 30, or at the latest by the age of 35.

ethics

In countries like Spain or Belgium, women can use egg donation if they have few or no eggs themselves. In Germany, this option is only available for male sperm cells, not for egg cells. The main ethical discussion here is not whether or not a woman should be allowed to freeze her own eggs, but how long a woman can use it. In Israel, for example, the maximum age is 55. In contrast to Germany, egg cell care is considered preventive medicine, even with non-medical indicators, because it is intended to avoid egg donation and ineffective fertility treatments at an advanced age. This legal situation points to an ethical pluralism.

In addition to the pill and in vitro fertilization, the possibility of social freezing is a further step in controlling reproduction. In the opinion of many who are positive about contraception methods and birth control, a ban would "represent an ethical contradiction". Overall, there is no consensus today in the field of reproductive medicine or even the question of abortion. This fact points to a moral pluralism in relation to the values ​​of the population. This pluralism often leads to the rejection of actions and types of actions (e.g. social freezing). And such a rejection must be understood in such a way that the value of autonomy is interpreted inconsistently. Morally, the situation is contradictory, so that many would not see an "ethical" contradiction in a ban. But one has to be ethical: what is not forbidden should be considered allowed to us. In need of justification, ethicists and lawyers are prohibited from doing so - not permission. In many areas of modern high-performance medicine, prohibitions can no longer be justified in a consensual manner. This is decades of experience of sometimes bitter discussions. The question of whether social freezing should be banned can in fact be answered negatively and refers to the value of self-determination in matters of reproduction. It goes without saying that, morally and ethically, the unreasonable demands made on proponents of the ban and those who see a particular need for regulation must be appropriately weighted. It is just that the basic values ​​of modern Western constitutions can neither insist on consensus on moral issues nor substantially restrict the value of self-determination. Basically, social freezing, like the pill and other contraceptive methods, can probably be viewed as morally unproblematic. However, the picture can also overturn argumentatively.

A representative survey by Forsa was published in January 2015 , which showed that there is a trend among young Germans: 64 percent of 18 to 30 year olds are open to social freezing. It should be noted, however, that there is a great deal of uncertainty among the public about the medical problems of social freezing and, in particular, about the efficiency of this technology in terms of self-determined and successful planning of reproduction (cf. van der Ven, Pohlmann, Hößle, eds., 2017). The extraction of egg cells is not without medical dangers for women. The statistical success of social freezing as an output on healthy born babies is relatively low and decreases sharply the older the people involved are. The reproductive autonomy gain suggested by the technology is possibly much less than one thinks. In any case, it is insignificant when compared with the gain in autonomy through the pill or condom as a contraceptive method.

Individual evidence

  1. ↑ Social Freezing - instant freezing of egg cells. on: wissensschau.de
  2. ^ ASRM Patient Information Series: Age and Fertility . Elsevier, Birmingham, Alabama 2012.
  3. ↑ C. Chen: Pregnancy after human oocyte cryopreservation. In: The Lancet . 1, Apr 1986, pp. 884-886.
  4. ↑ F. Nawroth, R. Dittrich, M. Kupka, B. Lawrenz, M. Montag, M. Wolff: Cryopreservation of unfertilized egg cells for non-medical indications (“social freezing”). In: The gynecologist. 53, No. 6, 2012, pp. 528-533.
  5. ^ F. Nawroth, M. Montag, E. Isachenko, V. Isachenko, G. Rahimi, H. van der Ven, J. Liebermann: The vitrification. In: Gynecologist. 46, No. 3, 2005, pp. 214-218.
  6. ↑ J. Saragusty, A. Arav: Current progress in oocyte and embryo cryopreservation by slow freezing and vitrification. In: Reproduction. 141, No. 1, 2011, pp. 1-19.
  7. ↑ American Society for Reproductive Medicine: Mature oocyte cryopreservation: a guideline. In: Fertility and Sterility. 99 (1), Jan 2013, pp. 37-43.
  8. ^ German IVF register. In: J Reproduktionsmed Endokrinol. 9 (6), 2012, pp. 453-484.
  9. ↑ KN Goldman, NL Noyes, JM Knopman, C. McCaffrey, JA Grifo: Oocyte efficiency: does live birth rate differ when analyzing cryopreserved and fresh oocytes on a per-oocyte basis? In: Fertility and Sterility. 100, No. 3, Sep 2013, pp. 712-717.
  10. Jump up ↑ EJ Forman, X. Li, KM Ferry, K. Scott, NR Treff, RT Scott Jr .: Oocyte vitrification does not increase the risk of embryonic aneuploidy or diminish the implantation potential of blastocysts created after intracytoplasmic sperm injection: a novel, paired randomized controlled trial using DNA fingerprinting. In: Fertility and Sterility. 98, No. 3, 2012, pp. 644-449.
  11. ↑ M. von Wolff: "Social freezing" sense or nonsense? In: Gynecological Endocrinology. 11, No. 3, 2013, pp. 222-224.
  12. ↑ N. Noyes, E. Porcu, A. Borini: Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. In: Reprod Biomed Online. 18, No. 6, 2009, pp. 769-776.
  13. ^ A. Cobo, V. Serra: Obstetric and perinatal outcome of babies born from vitrified oocytes. In: Fertility and Sterility. 102, No. 4, Oct 2014, pp. 1006-1015.e4.
  14. ↑ fertiprotekt.de ( Memento of the original from November 4, 2013 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.fertiprotekt.de
  15. ↑ Freezing of egg cells In Potsdam, social freezing is now common practice. on: berliner-zeitung.de , March 30, 2015.
  16. ↑ uscfertility.org
  17. ↑ Number of interventions to freeze egg cells according to motivation from 2012 to 2014. Accessed on October 23, 2019 .
  18. ↑ Video Frontal 21: The Conserved Desire for Children (October 22, 2013, 9:00 p.m., 6:26 min.)  In the ZDFmediathek , accessed on February 9, 2014.
  19. ↑ F. Nawroth, R. Dittrich, M. Kupka, B. Lawrenz, M. Montag, M. Wolff: Cryopreservation of unfertilized egg cells for non-medical indications (“social freezing”). In: The gynecologist. 53, No. 6, 2012, pp. 528-533.
  20. ↑ M. von Wolff: "Social freezing" sense or nonsense? In: Gynecological Endocrinology. 11, No. 3, 2013, pp. 222-224.
  21. ↑ Andreas Vieth: Contra Pros and Cons. What is it actually about. 1st edition. online, 2016 ( andreasvieth.de ).
  22. ^ Andreas Vieth: Pregnancy ethics. Moral, social and economic abuse . 1st edition. online, 2016 ( andreasvieth.de ).
  23. ↑ Young Germans want children - if necessary through social freezing. on: stern.de , January 11, 2016.

literature

  • ASRM Patient Information Series: Age and Fertility . Elsevier, Birmingham, Alabama 2012. (reproductivefacts.org)
  • American Society for Reproductive Medicine: Mature oocyte cryopreservation: a guideline. In: Fertility and Sterility. 99, No. 1, Jan 2013, pp. 37-43.
  • C. Chen: Pregnancy after human oocyte cryopreservation. In: The Lancet . 1, Apr 1986, pp. 884-886.
  • German IVF register. In: J Reproduktionsmed Endokrinol. 9, No. 6, 2012, pp. 453-484.
  • F. Nawroth, R. Dittrich, M. Kupka, B. Lawrenz, M. Montag, M. Wolff: Cryopreservation of unfertilized egg cells for non-medical indications (“social freezing”). In: The gynecologist. 53, No. 6, 2012, pp. 528-533.
  • F. Nawroth, M. Montag, E. Isachenko, V. Isachenko, G. Rahimi, H. van der Ven, J. Liebermann: The vitrification. In: Gynecologist. 46, No. 3, 2005, pp. 214-218.
  • J. Saragusty, A. Arav: Current progress in oocyte and embryo cryopreservation by slow freezing and vitrification. In: Reproduction. 141, No. 1, 2011, pp. 1-19.
  • KN Goldman, NL Noyes, JM Knopman, C. McCaffrey, JA Grifo: Oocyte efficiency: does live birth rate differ when analyzing cryopreserved and fresh oocytes on a per-oocyte basis? In: Fertility and Sterility. 100, No. 3, Sep 2013, pp. 712-717.
  • M. von Wolff: "Social freezing" sense or nonsense? In: Gynecological Endocrinology. 11, No. 3, 2013, pp. 222-224.
  • N. Noyes, E. Porcu, A. Borini: Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. In: Reprod Biomed Online. 18, No. 6, 2009, pp. 769-776.
  • Katrin van der Ven, Monika Pohlmann, Corinna Hößle (ed.): Oocyte cryopreservation. Springer VS, Wiesbaden 2017, ISBN 978-3-658-17941-0 .

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