Dutch medical associations support freezing oocytes for non-medical reasonsBMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4823 (Published 03 September 2010) Cite this as: BMJ 2010;341:c4823
Women in the Netherlands who wish to delay having children for non-medical reasons should be able to have their oocytes frozen if they want to, according to recommendations from two professional bodies in response to a government request for guidance.
The Dutch Association for Obstetrics and Gynaecology and the Association for Clinical Embryology make the recommendation in a new report on the issue, Vitrificatie van Eicellen [Vitrification of Oocytes] (www.nvog.nl). It follows plans last year by Amsterdam’s Academic Medical Centre to begin freezing oocytes on non-medical grounds, such as because women are single or cannot take a career break, which sparked questions in parliament.
The report recommends “conditional” permission for the procedure after finding that arguments for refusing the freezing of oocytes on non-medical grounds were unconvincing. It suggests that the age limit for reimplantation of fertilised oocytes should be set at 45 years, which is the same as for in vitro fertilisation with donor eggs, arguing that health risks increase after this age.
It also requires systematic follow-up of children born from frozen oocytes because the procedure, which uses rapid cryopreservation that does not damage the cells, is still considered experimental.
Doctors should agree to a woman’s request to have her oocytes frozen only after she has received counselling and examination of her case. “The doctor must be convinced that the request is based on what for the woman are considerable reasons,” the report states. The woman should not have unrealistic expectations of the chances of a successful pregnancy with frozen oocytes, it cautions.
The associations accept that greater access to freezing of oocytes could have the “undesirable” effect of promoting pregnancy at an older age, but they argue that this should not be a reason to ban it. They emphasise that the procedure should not be seen as “a simple prescription for delaying parenthood” but, instead, regarded as an “emergency” measure.
At the same time, they are calling for measures to reduce the social and financial pressures to delay parenthood.
Jan Kremer, professor of reproductive medicine at the St Radboud University Medical Centre, Nijmegen, who chaired the committee that drew up the report, told the BMJ, “You should not make an individual the victim of something that happens on a societal level. As gynaecologists we continue to stress that this is second best; the best is to become pregnant younger.”
But he added that the fact that eggs may be frozen for non-medical reasons needed to be seen in the context of routine in vitro fertilisation treatment where age is a factor in a significant number of the women.
He explained that the committee’s first instinct was to ban the freezing of oocytes for non-medical reasons. “But as we looked closely at all the arguments, nearly everybody changed their view. None of the arguments were sufficient to ban it,” he said.
Stef Groenewoud, director of the Lindeboom Institute for Medical Ethics, which is a Christian organisation, says that the new guidance undermines the policy in the Netherlands of reducing the average age at which women have their first child. “This leaves the door wide open for an enormous increase of the number of delayed pregnancies.” He added, “I think we should ask, what is the cause of that fertility problem? They put all cases in one basket including those where the cause of the problem is a choice the woman has made. I think that is one step too far.”
The ability to freeze oocytes for non-medical reasons does not require a change in Dutch law. Doctors are free to act on their professional bodies’ advice. However, members of parliament for the Christian Democratic party, who are currently in talks to form a coalition government, are opposed to the procedure.
The Academic Medical Centre, together with 10 other Dutch in vitro fertilisation centres, is resubmitting proposals to the Central Committee on Research Involving Human Subjects to allow them to offer the freezing of oocytes on both medical and non-medical grounds.
Cite this as: BMJ 2010;341:c4823