Oprah still needed for emerging debate about egg freezing

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Oprah Winfrey announced today she’ll be leaving her show in 2011 to start her own cable network. Also today, the November, 2009 issue of Fertility and Sterility (“The Official Journal of the American Society of Reproductive Medicine”) made it to the top of my “to read” pile.

Coincidence? New age law of attraction? Who knows!

Because right there at the start of the journal was  a provocative discussion of egg freezing, a still experimental procedure in which a woman donates eggs to herself; the oocytes (not fertilized embryos) are then cryopreserved (frozen) and later thawed, fertilized, and used to  to create a pregnancy.

Self-donation of oocytes offers promise as the twenty-first-century equivalent to the oral contraceptive. Its potential to “level the playing field” for women by permitting them time-unlimited control over their reproductive destiny has captured the public imagination and initiated widespread debate.

via Egg freezing, procreative liberty, and ICSI: the double standards confronting elective self-donation of oocytes.

There are lots of reasons for self-donation; a medical treatment that might destroy or interfere with later fertility, an ambitious woman might want to focus on career, someone decides to wait until she meets the mate she wants, another woman just wants the same additional time before family that men have always enjoyed. If ever there were issues that needed Oprah’s reasoned empathy these are they. I can hear the audience applause, and feel myself joining in, while she helps tell these stories.

But more choice always means lots of questions about what to do with that choice, what it might mean for individual women, for families, for society, and even for men. And technology always has unintended consequences. Even those advocating removing the experimental label from oocyte self-donation procedures so those procedures can become routine medical care see huge social change ahead.

We acknowledge that widespread deferral of childbearing via egg freezing may transform society in unforeseen ways, akin to some of the unintended consequences, such as more sexually transmitted infection, wrought by the oral contraceptive and the sexual freedom it empowered.

via Egg freezing, procreative liberty, and ICSI: the double standards confronting elective self-donation of oocytes.

But this may be premature. In response, the Practice Committee of ASRM unambiguously stated that the science demonstrating safety and efficacy is just not here yet. We do not know if the procedures work well enough for routine use. The research has also not yet demonstrated sufficient safety for routine use. How terrible would it be if a generation of women decided to wait like men have been able to wait only to discover that technology had offered nothing more than an empty promise, or even worse, a dangerous one.

Clearly, oocyte cryopreservation has great promise for applications in oocyte donation and fertility preservation and for decreasing the number of unused cryopreserved embryos. The Practice Committee has and will continue to review the published medical literature relating to oocyte cryopreservation at regular intervals and is prepared to reconsider its position when evidence warrants.

via ASRM Practice Committee response to Rybak and Lieman: elective self-donation of oocytes.

So it seems the technology is not ready, yet. But even with uncertain technology we can still be sure of two things. First, that the technology will soon be here muting the biological clock many women hear ticking. We should begin now imaging the social consequences of this inevitability (and if there’s interest, we can imagine that here, as well as talk more about the state of the science in subsequent posts).

Second, we will miss Oprah Winfrey; more often than not she brought empathic reason to thorny life questions, despite occasional marketing gaffes and new age excess (let me tell you the real “secret”, finding Fert and Stert at the top of today’s pile was just a coincidence, it really was, there was no attraction). Discussions of whether and how a young woman should freeze her eggs as insurance against the steady ticking of that biological clock will be diminished by her absence. Here’s hoping her new cable network goes the way of empathy and reason rather than becoming another venue for bloviating polarizing pundits.