In the UK, there is a limit on how long you can freeze-store your eggs, sperm and embryos. Should there be?
In light of the disruptions caused by COVID-19, the UK government last week gave a two-year extension on how long people can keep their eggs, sperm and embryos in the deep freeze. The previous 10-year limit has now been extended to twelve.
That's right: in the UK, frozen gametes and embryos are issued a use-by date. If they aren't used within a decade, they have to be destroyed. There are exceptions — young cancer patients, for instance, or people who find themselves prematurely infertile — but getting those involves a fair amount of paperwork and are granted in 10-year increments. (The absolute maximum storage time is 55 years.)
There is, of course, a history to why the limit exists. The original Human Fertilisation and Embryology Act came into force in 1990, a time when freezing techniques weren't as established as they are now. There was concern about how long reproductive material could safely remain frozen. There was also concern, as there still is, about when is the right time to part with reproductive materials and to leave behind all the potential they embody.
The 10-year storage limit has recently come under fire. Last year, Ruth Deech, a member of the House of Lords (and before that the chair of the Human Fertilisation and Embryology Authority, the UK's fertility regulator) introduced a private members' bill to challenge the limit. The Progress Educational Trust, a prominent infertility and genetics charity, launched a campaign called #ExtendTheLimit. Then in February this year, the government opened a consultation on the issue. It asked whether the storage period should be lengthened, shortened or abandoned altogether. That consultation closes today.
The idea of a mandated time limit on storing gametes has always struck me as odd. As you can imagine, the debate is particularly intense when it comes to eggs. Below, I summarize some of the key arguments.
Arguments in favour of the limit are in bold, and arguments against are in italics.
There are still uncertainties about the safety of long-term storage. For example, is there degeneration of the material after many decades? Will we see an increase in genetic problems? The health of people born from frozen embryos and gametes must remain top of mind.
Freezing technology has changed a lot since 1990. There is evidence that reproductive materials — even eggs — can be frozen for long periods of time without causing damage. The 10-year limit is arbitrary and unscientific.
The limit actually helps people decide what to do. People are often reluctant to discard gametes and embryos, even if they have decided against using them or donating them. Without a limit of any kind, many people will choose to keep them much longer — in some cases, indefinitely.
Over time, storage facilities may lose touch with people. Fees will go unpaid. Clinics cannot destroy the material before the maximum storage limit is reached, unless there is written consent, but someone will have to foot the bill.
Abandoning limits would mean greater need for storage without necessarily helping people come to a decision they are at peace with.
Some women feel they are forced to act even if they're not ready. Some opt to fertilize their eggs with donor sperm just because time is running out. Others ship their eggs out of the country, so they can be kept frozen somewhere else.
Time limits don't actually help with decision making.
Removing the limit may increase the number of people becoming pregnant when they are older, with the increased risk of complications for both mothers and babies.
Society already pushes women to have children later in life.
"The forced destruction of a woman’s eggs undoubtedly represents a breach of her human rights, more specifically, her right to respect for her private and family life," says Emily Jackson, an expert in medical law at the London School of Economics. "Of course, interferences with human rights can sometimes be justified, in order to protect the rights and freedoms of others. But it is hard to see how anyone else is harmed by permitting a 35-year-old woman to pay to store her eggs for another 10 years."
"The government has considered whether the existing legislative provisions remain compatible with human rights legislation and believes that the scheme treats all equally, regardless of their circumstances."
Eggs frozen at a younger age have a greater chance of leading to live birth. But the 10-year limit discourages women from freezing eggs early. If a woman freezes eggs in her twenties, she will need to use them sometime in her thirties — very possibly before she decides she needs them. The 10-year limit acts as a "perverse incentive" for women to delay freezing their eggs until they are older — when their egg quality is declining, says Sarah Norcross, director of Progress Educational Trust. It "promotes poor clinical practice – women seeking fertility preservation treatment in their late 30s or 40s typically need more ovarian stimulation and fertility treatment cycles to have a chance at success."
The 10-year limit is complicated and hard to understand, says fertility lawyer Natalie Gamble. "When we advise patients about extended storage, we always need to trawl the case history and dates of storage as well as any medical evidence; understand the patients' personal circumstances and review two different sets of regulations either or both of which may apply." Gamble says that many clinics advise their patients incorrectly about when the storage period will expire. "One of the big difficulties is that, since the new regulations require the conditions for extended storage to be met before the current storage period expires, it may be too late to put the required consent and medical evidence in place in retrospect. In some cases, patients may be forced to destroy their gametes or embryos against their wishes because of a historic paperwork gap, even if they comfortably meet the medical criteria for extension and want their gametes or embryos to remain stored."
"Why the UK Government should modernise the law on embryo and gamete storage." BioNews. 24 Feb 2020.
"Fertility experts call for ditching of UK's 10-year limit on egg-freezing." The Guardian. 22 Jan 2019.
"PET launches egg freezing #ExtendTheLimit campaign." BioNews. 04 Nov 2019.
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