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Published 20 October 2020

New guidance from ESHRE for maintaining safe fertility services during a dramatic spike in COVID-19 case numbers has realigned mitigation steps according to local levels of infection.

As countries throughout the world face up to a second wave of COVID-19 infections, ESHRE and others have upgraded safety guidelines for fertility clinics. ESHRE has reaffirmed its guidance from April on the reopening of clinics after lockdowns (‘phase 2’ of the pandemic), but has now in this latest phase added two further measures as complementary to that April guidance: more testing in addition to the triage questionnaires; and greater information to patients on COVID-19 and its prevention before and during pregnancy.(1)

The new guidance also advises that mitigation measures should be in place depending on the level of infection in a region. Thus, a first core step in this latest guidance is to recognise the current epidemiological status of the pandemic and to assess its likely impact on internal resources (such as staff and equipment) and on patients. The second step is to plan mitigation measures according to that assessment to reduce those risks. A local notification rate of 20 to 60 cases per 100,000 population (‘moderate impact’) might require no further measures than those already applied routinely. However, an area of ‘major’ (60-120 cases per 100,000) or ‘critical’ (>120 cases per 100,000) would require more intensive measures – such as more routine testing of patients and staff, remote consultations, no accompanying persons, routine use of PPE, and even a freeze-all transfer policy. The measures relative to the case notification rate are set out in clear diagrammatic form in the ESHRE guidance.

The guidance was made public just a few days after the ESHRE COVID-19 working group published its review of resuming fertility services with mitigation measures after the initial flare of the pandemic.(2) The paper describes the measures needed to restart safe routine treatments in fertility clinics and the rationale behind their application. The review (published as an ‘opinion’) covers patient selection and informed consent, staff and patient triage and testing, the modification of ART services, treatment planning and a code of conduct. The code of conduct, as set out in ESHRE’s April guidance on the second phase of the pandemic, remains an important component of this latest guidance on the third phase.

The ASRM, though without the same infection spikes in the USA as seen in Europe, has also updated its COVID-19 recommendations to reaffirm the ‘judicious’ delivery of reproductive care within a framework of careful preventive measures.(3) With COVID-19 case numbers still running high in the USA, the ASRM describes these measures as ‘critical in managing this ongoing pandemic’.

The worry for clinics back in Europe must be whether this second wave of infection becomes so critical in some countries that some centres might have to close once again. However, it now seems clear that the guidance on the resumption of routine treatments provided by ESHRE, the ASRM and other authorities has offered effective protocols for the safe provision of service. The paper from the ESHRE COVID-19 working group just published provides strong point-by-point evidence of that.(2) And it's on this basis that the UK’s HFEA, for example, on 13 October reassuringly reported that with such professional guidelines in place ‘a new national closure of fertility clinics should not be necessary’. However, as ESHRE’s latest guidance notes, the HFEA also recognises that staff sickness or patient restrictions may yet force some clinics to close. It’s likely that some countries may also requisition hospital beds for intensive care support.

Meanwhile, patients and staff may be further reassured by results from a case report from Spain in which two asymptomatic oocyte donors tested positive for SARS-CoV-2 infection before egg collection.(4) The eggs were subsequently donated for research for the presence of viral RNA. However, total RNA amplification from single cells of their vitrified-warmed oocytes failed to detect the presence of any viral RNA of SARS-CoV-2 in the cells. The authors thus concluded: ‘Our report suggests that vertical transmission in these women may not occur through their oocytes during treatment, and that handling of this material in the clinical embryology laboratory may not constitute a hazard for healthcare professionals.’

However, a meta-analysis just published in Nature Communications of 176 published cases of SARS-CoV-2 infections in neonates has found that the majority of them (around 70%) occurred postnatally, although vertical transmission ‘may be possible’ in around 30% of the cases, either intrapartum or congenital.(6) Some 9% of these latter cases were actually confirmed as vertical infections. Just over half the infected neonates went on to develop COVID-19, while the rest were asymptomatic. One of the investigators, Daniele De Luca from the Antoine Béclère hospital in Paris, said that it was important for doctors to be aware that neonates can be born with the virus or contract it while in hospital. ‘At the beginning of the pandemic, some argued that this would never touch babies,’ he reported. ‘It’s rare, but it does exist.’ Breastfeeding seemed not associated with SARS-CoV-2 infections, suggesting that viral transmission through the milk, if any, ‘should be rare’.

Further details on COVID-19 and pregnancy, including updates from ongoing registry studies, continue to be provided in detail by the UK’s RCOG.(5)

26 October 2020 - by Susan Tranfield-Thomas
Egg freezing has been around for 20 years now, originally as an intervention for women who were about to lose their natural fertility through cancer treatment and/or surgery. Somehow it has passed into collective consciousness as an accessible fertility 'fix' and is even on offer to women in the US as part of an employment package. It is now increasingly of interest to thirty-something women who have needed to defer the option of motherhood for other reasons. Some of the media have shaped this into a narrative of 'career women' being 'too busy' to have children but wealthy enough to access egg freezing as a convenient way to control personal biology. This predictably simplistic stereotype ignores the complex reasons why women choose this option.

Billed as a 'forum for civilized disagreement', this hour-long webinar, Egg freezing – what's the deal with fertility preservation?, offers an opportunity to understand what egg freezing is, how and why it is accessed and what its long-term implications are for the women who use it. In addition, its expert contributors offer much-needed insights into recent research, raising useful questions about the continuing marketisation of egg freezing and its ability to deliver what it promises.

Professor Frances Flinter starts the webinar by introducing findings from a report by the Nuffield Council on Bioethics, aimed at public engagement and highlighting a mismatch between the number of people having eggs frozen to those actually defrosted and used. The process, which is invasive and similar to IVF, tends to result in a one in five chance of a viable pregnancy from healthy defrosted eggs. However, a lack of transparency over the data, as well as the targeting of women through the use of algorithms and so-called 'Prosecco parties' may mean that women's anxieties are exploited into buying expensive and ultimately unnecessary procedures.

Dr Kylie Baldwin, a medical sociologist, describes it as a 'numbers game';  a single cycle and egg retrieval – at around £4000 a time, perhaps with one year's storage included – might, optimistically, result in ten eggs, of which five survive the freezing process, and ever-decreasing odds of fertilisation and viable pregnancy. The more eggs, the greater the odds, but this requires a robust bank account, and for a woman in her late thirties, the chances of producing good quality eggs is already dwindling considerably.

In the UK, the average age for freezing eggs is 38, according to Professor Joyce Harper, professor of reproductive science at University College London, so the opportunity to have several cycles and 'bank' the resulting eggs is curtailed quite considerably compared to a woman in her late twenties. Comparing it to IVF, she thinks it should be considered very much a 'plan B'.

We heard from Helen, who defied medical advice to go through a retrieval cycle prior to embarking on treatment for an aggressive, hormonally-driven cancer. Her account of being pressured into daily scans (at £300 a time) on top of a £4000 fee is a reminder of the way commercial interests can abandon pretence at ethical treatment at a time when a patient is at their most vulnerable. Happily, four years after treatment for cancer, Helen has a young daughter (her one remaining embryo) and clearly feels it was all worth it. One can imagine many untold stories with a different ending.

Ultimately, it takes two to make a baby – Tessa Murray, director of communications at Tortoise Media who ran the webinar, challenged us to consider the role of men, their own dwindling sperm count over the last few decades and the continuing focus on women in the drive to 'correct' fertility problems. It would have been useful to explore that issue from first principles, as egg freezing seems to be uniquely the woman's domain, but this was beyond the scope of the webinar.

Claudia Williams, chairing, added her personal perspectives as a 27 year old woman. One hour is hardly enough to do justice to a contentious topic like egg freezing, but the evident expertise of the panel and the generosity of all participants in sharing perspectives from their own lives made this an absorbing experience. For further discussion, it would be useful to engage further with the issues surrounding women in the workplace and working towards swifter change in society.

The workplace should be supporting women with family-friendly policies. It should be eminently possible to return from maternity leave at the same level of seniority. Egg freezing should not be a 'graduation present' to young women, in the expectation they will devote their early working lives in an exclusive relationship with the workplace. The mere idea of 'Prosecco parties' is enough to send shivers down the spine, and not just because it is a ghastly drink designed for teeth-grinding headaches and rampant heartburn; rather, it reinforces a tiresome stereotype of women as prey to impulse and collective neurosis. Whereas the reality tends to be that deciding to freeze one's eggs is a more introspective, considered and intimate process.

I took from this webinar a strong feeling that this thoughtfulness on the part of the women concerned should be at least matched with transparency by the clinics providing this service, over the reality of expectations of success and the cold hard facts of the financial outlay required, which could leave even a relatively well-heeled professional seriously divested of hard-won financial security.

26 October 2020 - by Charlotte Spicer
Scientists have directly delivered proteins to mouse testes for the first time, in an attempt to treat male infertility.

The team of researchers from Seoul National University, South Korea, successfully delivered an important protein, necessary for sperm production, into the testes of infertile mice and restored normal reproductive function.

Infertility affects around 15 percent of couples worldwide, with male infertility thought to be linked to anywhere between 20-70 percent of these cases. Damage to the blood-testis barrier (BTB), which normally protects sperm cells from any harmful substances within the blood, is one cause of reduced sperm production.

Although gene therapy has the potential to correct defects underlying male infertility, there remains a number of safety and ethical concerns. The adverse long-term effects of genome editing of germ cells and risk to future generations remain unknown.

In the current study, published in ACS Nano, the scientists developed an alternative approach, using nanoparticles to directly deliver proteins to the testes. The delivery system, called Fibroplex, consisted of spherical nanoparticles made of silk fibroin, which were coated in lipids.

The Fibroplex was loaded with a protein required for normal function of the BTB, known as PIN1. The entire complex was then injected into the testes of young male mice which had been genetically engineered to lack the PIN1 protein, making them infertile.

The scientists found that Fibroplex safely delivered the PIN1 protein to the mouse testes and did not lead to any toxicity or testicular damage. The treatment increased sperm stem cell numbers and repaired the BTB. In addition, the treated mice had an increased number of mature sperm. Although the sperm count was still only around half of that of normal fertile mice, the treated mice were able to father a similar number of pups, whilst untreated PIN1-deficient mice were unable to reproduce.

The beneficial effects of the treatment lasted for approximately five months, after which the PIN1 protein degraded.

Further studies are now needed in order for scientists to understand whether this approach may be an effective strategy for treating infertility in humans.

26 October 2020 - by Annabel Slater
'Age and fertility – a topic that never gets old.' So said Sarah Norcross - director of the Progress Educational Trust (PET), the charity which publishes BioNews - excusing herself for the pun as she chaired the latest PET event 'Age-Old Question: Exploring Fertility and Ageing'.

The Office of National Statistics still shows the age of conception for men and women is rising. What are the consequences, and what is the understanding of experts and the general public?

The first speaker was Richard Anderson, professor of clinical reproductive science at the University of Edinburgh, who discussed female ageing and fertility at a clinical level. Women create all their eggs before they're born, in the form of immature egg follicles. Throughout their life, even before puberty, the numbers of these follicles decline.

Nonetheless, older women are having babies more than ever, with numbers of mothers in their late 30s having tripled since 1980. Yet the chance of miscarriage increases dramatically with age. According to data from the Human Fertilisation and Embryology Authority (HFEA), the occurrence of live birth following in vitro fertilisation (IVF) is over 30 percent for a woman under 35, and as low as 3-4 percent for a woman in her 40s.

What can be done? Science offers a few options, which Professor Anderson outlined: freeze your eggs, freeze part of your ovary, or use another younger woman's eggs. The first option, egg freezing, continues to increase in popularity and is an area of great research interest. Yet a Spanish study found that out of 5289 women who froze their eggs, only 12.1 percent went on to use them. Data also suggest that only one egg out of 20-25 collected will result in a baby.

Evidence suggests that the reasons women opt for elective egg freezing are due to partner choice, wish for financial stability, and their housing situation, instead of the 'glossy, slightly trite' adverts about egg freezing circulating in the US and probably soon in the UK. Professor Anderson said what is needed is an evidence-based, unbiased information source such as Michelle Peate's Decision Aid. It's essential that women, and men, should recognise the likelihood of success of egg freezing and the associated costs and risks.

Next to speak was Evelyn Telfer, professor of reproductive biology at the University of Edinburgh, and lead researcher at the lab which first created a mature human egg entirely outside the human body (see BioNews 937).

Professor Telfer spoke of a technique for storing pieces of ovary which contain primordial follicles. These immature follicles can be cultured to produce mature eggs, at about a 30 percent success rate – one possible approach to in vitro gametogenesis (IVG). This process is known as a 'multi-step culture system', and has been used to examine the effect of age, chemotherapy, and the role of signalling pathways.

But the big question is whether ovaries have the capacity to make new eggs. Are there germline stem cells in the adult human ovary? This question was answered in 2012 in a Nature Medicine publication showing that this cell type could indeed be isolated from the adult human ovary (see BioNews 646). Professor Telfer's lab has since reported that under the right conditions, such stem cells may be able to form new eggs (see BioNews 872).

Professor Telfer and her team are now investigating eggs produced by IVG, to find how similar they are to conventional eggs. Extensive further research will be needed before any clinical applications are developed.

Christopher Barratt, professor of reproductive medicine at the University of Dundee, delivered a talk focused on male fertility. Ageing somatic tissue can be disguised somewhat – consider those middle-aged celebrities who seem to have looked young for decades. Yet reproductive tissue changes with age, and the effects are visible in studies.

Is the age of first-time fathers increasing? Yes. In Australia in 1976, the average age of new fathers was 27.5 years old. Now, it is 33.5 years.

Is older reproductive age significant? Yes. Studies show that older men have lower odds of conception – a drop of 50 percent for men aged 35-39, compared to under 25-year-olds (see BioNews 974). Older men have increased semen abnormalities, incur a higher risk of premature birth and low birth weight, and other endocrine influences influencing their reproductive success, such as lower libido.

Furthermore, older fathers are also linked to higher rates of autism and schizophrenia in children. An observational study of four centuries of data in four different populations also indicates that children of older fathers have lower reproductive success and reduced longevity.

What can we do? Educate people, advised Professor Barratt, as knowledge about age and male fertility is very poor. According to Professor Barratt, even university science students don't tend to know how age impacts male fertility.

Dr Vasanti Jadva, principal research associate at the University of Cambridge's Centre for Family Research, addressed the psychological impact of older reproductive age on both parents and their children. Studies concerning older parent and child psychology are mixed, she reported. The findings are further confounded by different definitions for older parenthood, a lack of studies examining impact on later childhood, and how large cohort studies can't always identify mechanisms to explain the differences. Older women facing stressful fertility problems may also experience poorer mental health.

Judging by the studies that do exist, children do not appear to be adversely affected by having older parents. If anything, it is the parents themselves who may be adversely affected - some studies of older mothers reported lower social support, worse relationships with their partners, and more parental stress.

Another study indicated that older mothers are more likely to use donor eggs. They may also report regret in not having more children. Dr Jadva concluded that more studies are needed to investigate aspects of older parenthood.

It was time for questions. Professor Barratt was asked if men should be freezing their gametes to avoid age-related issues, as women do. Not likely on a global scale, he said, since sperm freezing is quite costly.

Asked about the production of eggs from ovarian stem cells, Professor Telfer recalled her initial reluctance to believe that she and her colleagues had achieved this. Their achievement continues to rock the scientific community, and is still controversial (see BioNews 1038). The adult stem cells that do exist in the ovarian tissue are not there to make new eggs normally. Professor Telfer stressed that while research using animal models is ongoing, research using human cells is still at an early stage.

What current steps and systems exist to raise awareness about age and fertility? Professor Barrett said it was 'blatantly obvious' that society overall does not understand its reproductive capacity. An unfair burden is placed on women, and that better education needs to implemented, beginning with young people. Dr Jadva agreed that many people don't understand that fertility declines with age, and that fertility studies tend to focus on people who have already started facing difficulties.

An audience member commented that the challenges discussed during the event were not just issues for science and medicine, but for policymakers and society more broadly, and were challenges that faced women and men alike.

mproving choices for fertility patients during a pandemic
27 April 2020 - by Sarah Norcross
So many fertility patients are experiencing the heartbreak of IVF cycles being cancelled, or treatment being halted partway through a cycle, during the global coronavirus/COVID-19 pandemic. For some older patients who may not get another chance, the enforced cessation of treatment is particularly devastating.
Everyone working in the fertility sector recognises that time is of the essence for patients experiencing infertility. It is good to see the UK fertility community working together, through bodies such as the British Fertility Society and the Association of Reproductive and Clinical Scientists, to ensure that processes are in place for a safe and smooth reopening of fertility clinics as soon as this is deemed possible.
As clinics begin to operate once more in countries including Denmark, the Netherlands and Spain, the UK can learn from the experiences in these countries. The European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine are doing valuable work considering whether, when and how treatment might be resumed.
But resuming treatment is only part of the challenge. For people who fall afoul of age-related access criteria imposed by England's Clinical Commissioning Groups (CGCs), there has been no assurance that the clock has stopped ticking. Given the circumstances, the Progress Educational Trust (PET) – the charity that publishes BioNews – has been urging CCGs to effectively 'stop the clock' in relation to accessing NHS-funded fertility treatment, so that patients are not disadvantaged through no fault of their own.
PET understands that this is what will happen in Scotland, where fertility treatment is commissioned centrally. We hope CCGs will follow suit, and thereby help patients who already had to contend with an IVF postcode lottery before the current pandemic added to their difficulties.
We are delighted that our work has prompted the UK Government to stop the clock in one crucial respect – namely, by granting a two-year extension to the ten-year legal limit on storage of eggs, sperm and embryos, as reported elsewhere on BioNews this week. This extension is a pragmatic solution to the current situation, and will come as a huge relief to patients who have yet to use their frozen eggs, sperm or embryos to try for a baby.
However, there remains a broader problem to be resolved. The Government's announcement of an extension was influenced by – and underlines the importance of – PET's ongoing #ExtendTheLimit campaign, which calls for a substantial and permanent extension to the ten-year limit on the storage of eggs for non-medical (social) reasons.
This outdated and unscientific limit means that increasing numbers of women face a stark choice between seeing their frozen eggs destroyed, or becoming a mother before they are ready to do so. Please help PET change this situation by signing and sharing our #ExtendTheLimit petition at www.change.org/extendthelimit (if you can post a comment when you sign, then this is even better!).
PET also encourages everyone to respond online to the UK Government's current public consultation on this issue, before the consultation closes next week (on Tuesday 5 May).
The legal, social and medical issues surrounding egg, sperm and embryo freezing were explored at a PET event earlier this year, and PET has made this discussion more widely accessible in a series of online films. Another development reported on BioNews this week concerns special legal requirements for confidentiality and secrecy that apply to fertility treatment, and this too was explored at a recent PET event that is now available to watch online as a series of films.
Unfortunately holding face-to-face public events is not practical at the moment, which is why some of the PET events that were due to take place in coming weeks have had to be postponed or cancelled. But rest assured that we have plans to start holding some of our events online, and will have some exciting announcements to make about this in the near future.
In the meantime, we could not do any of the work discussed above without your support. We appreciate that times are tough and uncertain for many of you at the moment, but please donate what you can to our appeal.
If you are doing your shopping online, please try visiting Easyfundraising first. More than 4000 shops and websites will donate to us for free when you shop online with them using this service. Sign up to support us at www.easyfundraising.org.uk/causes/pet/
Meanwhile, if you are shopping on Amazon UK and you already have an account with them, the best way to support us is via Amazon Smile. In order to do this, go to https://smile.amazon.co.uk and log in using your usual Amazon account (if you are not logged in automatically). Alternatively, use this link to access the Amazon website before you start shopping, and donate a percentage of what you spend to us (at no extra cost to you).

We (HFEA) understand that some patients are concerned about the current situation with coronavirus (COVID-19) and the impact it has on their fertility treatment. This page provides information about coronavirus and fertility treatment, as well as links to support services.
We understand that patients are concerned about the current situation with coronavirus (COVID-19) and its impact of fertility treatment provision across the country.
Our role as the regulator
As the regulator, we are responsible for setting standards and monitoring the performance of fertility clinics and making sure they comply with the law. It is not our role to provide patients or clinics with medical advice, however as the COVID-19 outbreak has dramatically impacted on the health service across the country and the way fertility clinics can offer treatment, we’ve taken steps to keep patients and clinic staff safe.
What we've told clinics
In line with guidance from the British Fertility Society (BFS) and Association of Reproductive and Clinical Scientists (ARCS), we’ve issued General Directions which now require all clinics to have a COVID-19 strategy in place and to wind down their treatment services over the next three weeks.
General Directions are issued when we need to change clinic practice in line with new policy or guidance. General Directions are mandatory, meaning that all clinics must follow them. If a clinic fails to do so, it would be a breach of a statutory licence condition, which may have serious implications on their license, including suspending or revoking a clinic’s license.
Our Direction addressing the coronavirus (COVID-19) situation was implemented in line with the professional guidelines from the BFS and ARCS, as well as advice from the NHS that all non-urgent, elective surgery should stop by 15 April 2020 the latest.

Mar 20 2020

What fertility patients need to know about Covid-19 plans
British Fertility Society Chair, Dr Jane Stewart, explains how the fertility sector is responding to the current coronavirus pandemic. Dr Stewart has advice to patients and acknowledges that there will be significant disappointment as centres decide not to start new cycles of treatment


Coronavirus (COVID-19) infection and pregnancy
Version 4: Published Saturday 21 March 2020 - guidance for healthcare professionals on coronavirus (COVID-19) infection in pregnancy, published by the RCOG, Royal College of Midwives, Royal College of Paediatrics and Child Health, Public Health England and Health Protection Scotland.
The document above is for healthcare professionals. We have also prepared information for pregnant women and their families, drawn from this guidance:
Information for pregnant women and their families

Q&As relating to this guidance - updated 21 March 2020
Sign up here to receive the latest updates by email when the guidance is updated.
This guidance will be updated on a regular basis as new data becomes available.
If you would like to suggest additional areas for this guidance to cover, any clarifications required or to submit new evidence for consideration, please email COVID-19@rcog.org.uk.

24 February 2020 - by Professor Geeta Nargund
As the Medical Director of CREATE Fertility and long-term campaigner for gender equality and women's reproductive choices, I listened with earnest when Caroline Dinenage, former Health Minister, made the long overdue announcement last week that the Government will be reconsidering the current ten-year storage limit on eggs, sperm and embryos frozen for non-medical purposes. I am delighted the Government has acknowledged the hard work of the Progress Educational Trust (PET)'s #ExtendTheLimit campaign and has launched a public consultation.
Modern egg freezing is conducted with the use of vitrification (flash-freezing), which is a significant development that I have long felt to be the second wave of female equality, following the advent of the pill in the 1960s. Whilst egg freezing does not guarantee a baby in the future, it provides women with realistic options to manage the decline in female fertility after the age of 35, which has forced many to make tough decisions around when to start a family.
Egg freezing was originally used for women looking to preserve their fertility prior to cancer treatment, which would leave their fertility at risk. However, it is now also used by those who may need to delay having children for a range of other reasons, including not having met the right partner, pursuing a career, not being financially ready, or needing to focus on caring for a relative.
The term I prefer to use is 'AGE (Anticipated Gamete Exhaustion) banking' rather than 'social freezing', which I believe diminishes the process from a medical need to a mere wish. Egg freezing is a proactive and preventative action that women can take to preserve younger and healthier eggs until the time is right for them to become parents.
However, the full potential of this 'game-changing' medical innovation has been held back by the arbitrary ten-year storage limit for eggs frozen for 'non-medical' reasons. It was set before the introduction of vitrification, when the effects of long-term storage of frozen eggs and embryos were unknown. But with current knowledge about the safety and efficacy of vitrification, this limit is now outdated, and it is vital that it is extended if the full benefits of egg freezing are to be realised. The unintended consequence of the current limit is an unnecessary time pressure discouraging women from freezing in their late twenties to early thirties, when eggs are of highest quality.
Personally, I am not keen on an unrestricted extension, but suggest a further extension of ten years, with a possibility of further extension to be considered on a case by case basis. Extending the limit by ten years would provide women with flexibility when it comes to deciding when to freeze their eggs, enabling them to do so earlier, if they are able, when eggs are of highest quality. However, these extensions should be decided on an individual basis, taking age, fertility health and clinician's recommendations into account. This would avoid the unintended consequences of women having children in their sixties or seventies, when it may have a negative impact on both their health and the long-term welfare of the child.
Some, who are against egg freezing and the extension of this limit, have quoted the Human Fertilisation and Embryology Authority (HFEA) data that questions the success of frozen eggs. However, the HFEA does not include information on the method used to freeze eggs and therefore the national data may include eggs frozen using the old slow-cooling method, which is far less successful than the modern vitrification method. In addition, the data doesn't specify the age of the woman at egg freezing, which significantly impacts the chance of a successful pregnancy later.
Large data published in scientific journals since 2010 suggests that with the use of the modern vitrification technique, live birth rates using fresh or frozen-thawed eggs are comparable in women of similar age per oocyte and per cycle of treatment. Until reliable and large data are available in the UK, we need to look beyond our shores as we have a duty to provide women with clear, up-to-date and accurate data so that they can make fully informed decisions about the age at which they should freeze their eggs.
This Government consultation will have positive effects for women, men and couples in planning for their future families. Following the cabinet reshuffle last week, I hope that Matt Hancock will pursue this matter without delay.
Egg freezing has been transformed over recent years and is a truly life-changing medical development that empowers women with the ability to choose when the time is right for them to have children, without sacrificing a career or rushing a relationship. By discouraging women from freezing their eggs at a younger age when they are at their most healthy and fertile, the full emancipatory potential of egg freezing is limited by the ten-year storage limit. It is time for the law to change to realise this potential, and to catch up with today's technology and societal needs.

The government consultation on egg, sperm and embryo storage limits will be discussed at the Progress Educational Trust's free-to-attend event 'Freezing Eggs: What Are Your Choices? What Are Your Chances?' in London on the evening of Wednesday 29 April 2020.

by Dr Kirsty Horsey
The final session of the Progress Educational Trust (PET)'s annual conference 'Reality Check: A Realistic Look at Assisted Reproduction' asked: 'Should Fertility Patients Be Given What They Want, or What They Need?'
Sally Cheshire, Chair of the Human Fertilisation and Embryology Authority (HFEA), said that what fertility patients want most of all is a baby, or at least the chance to have a baby. She explained that many patients will do anything to achieve their aim, and that the regulator's job is to help them achieve this in the best way possible, as part of good care. She went on to explain that many patients won't (at least initially) get what they want, raising the point that 60 percent of patients self-fund their treatment, so the HFEA must help ensure that all patients get what they need.
As part of what patients need, Cheshire spoke about the information available to patients and the fact that honest, unbiased opinion about what might work needs to be published and transparent. She explained that it is difficult to regulate new and emerging treatments (not least the 'add-ons' discussed in earlier conference sessions), and that many of these treatments are not, in fact, currently regulated by the HFEA. However, the HFEA can offer information allowing patients to make informed choices about potential treatments, especially when it is sometimes hard for patients to find uncontradictory and unbiased information for themselves.
Overall, Cheshire's message was that the HFEA does not support patients spending money on (often unnecessary) 'add-on' treatments, citing an HFEA survey from last year, showing that three-quarters of patients had at least one add-on with their treatment. The HFEA rates 11 add-ons using a traffic light system. The green rating is reserved for procedures or techniques that have been shown to be effective and safe by at least one good-quality, randomised clinical trial. It was reported in the survey that none of the most common add-ons used were rated green.
Cheshire argued that clinicians selling add-ons without evidence do the fertility sector, and patients, a disservice. The HFEA will continue, as part of the inspections process, to look at information available on clinics' websites and at claims made by these clinics, as well as keeping an eye on some advice coming from the non-regulated sector.
In the next presentation, Dr Jane Stewart, chair of the British Fertility Society (BFS), asked what was difficult about taking medical advice. She said that the role of 'Dr Google' and events like the Fertility Show has both good and bad aspects. It is good that there is much up-to-date information available that can usefully stimulate debate, but this is mixed with out-of-date and commercially influenced information. How might patients tell the difference?
Dr Stewart went on to explain how the doctor-patient relationship has evolved over time, towards a spirit of mutual co-operation and patient-centred care, describing the doctor as a 'bridge between the world of medicine and the expectations and needs of patients'. She pondered whether reproductive medicine had redefined patients as consumers (she insisted on using the word 'patient') and asked what the harm is in giving all patients what they want. The harm, she said, can come from the fact that many patients are vulnerable, some are ill-informed, and most will do anything (including pay) to have the chance of having a child. Thus, the doctor has a duty to help the patient come to the right decisions for them, even if that means challenging their expectations and assumptions. 'It's OK to say no', she argued.
Professor Bobbie Farsides then told us about the power of words, explaining that 'wants' are something that we feel we would like to have, do or be. Simply, a preference. By contrast, 'needs' are things we require, because they are essential or important, not just desirable. She explained that it is easier to claim support for needs as they have more societal endorsement, whereas some wants are not seen as acceptable (though some individual assertions of needs are also deemed unacceptable). 'What starts as a dream becomes a project that's all-consuming', she said, adding 'for example the desire to become a mother turns into a need'.
Structural issues shape expectations in this domain, including the way society thinks and talks about parenthood and about what women are expected to do. Professor Farsides said that given these significant pressures, we (including the fertility sector) must ask whether there is a particular form of vulnerability in patients wanting what others want them to want. She argued that professionals must present a 'fair offer', for patients to consider and maybe accept, that is not against the patients' interests.
PET's head of communications Dr Catherine Hill then gave a personal response to the wants-versus-needs question, telling her story of infertility and the phone call, when she was 21, that changed the course of her life. What she wanted was a large family, though what she needed after that call was help and support, but she was offered none. She described this time as traumatic, leaving her needing to try to forge a new identity as a potential fertility patient.
On starting fertility treatment at 37 years of age, she was shocked to find that she was not eligible for IVF on the NHS, but pleased to be told she 'had the eggs of a 30-year old'. This turned out not to be true – the test she was given only measured quantity, not quality. A new clinic told her to use an egg donor, and, when she used her own eggs, the clinic suggested preimplantation genetic screening (PGS) (itself a contentious 'add-on'). This resulted in two embryos, and led to her having a daughter.
Dr Hill said she wished she had been better informed throughout this process. She argued that fertility patients' needs include emotional support, fair access to NHS-funded IVF, fertility education (which becomes more pressing as more and more procedures are offered), and better fertility preservation options. She added that funding of NHS fertility services, as well as monitoring of the funding situation, is incredibly important.
In the discussion chaired by Fiona Fox, chief executive of the Science Media Centre, there was generally much agreement with the speakers. Cheshire, responding to a point from the audience, said that fertility education was not a key responsibility of the HFEA but that they try to do it anyway. She added that the BFS has an ongoing education project, and suggested that perhaps the HFEA could be a conduit for information in new ways in future. Dr Hill added that it was hard to fathom why fertility education and the Fertility Fairness campaign lacks funding, when the fertility industry is worth so much.
Professor Farsides said that the old-fashioned view that the regulator was something to push against no longer holds true. She argued that clinics, and the fertility industry more widely, should work with the regulator to ensure that patients get both what they want and what they need.

However men are still very much involved
20 January 2020 - by Professor Marcia C. Inhorn
Women are electing to collect and freeze their eggs in the hope of preserving fertility for the future. A common assumption is that this is to allow time to become established in a career but, in fact, only around two percent of the women we interviewed did so for that reason.
For most women it was the lack of a partner they wish to parent with that drove them to freeze their eggs. But that doesn't mean that men are excluded from the process.
We found that male partners, ex-partners, friends, fathers, brothers and even judges played a role in about two thirds of cases.
In a binational study, published in Human Fertility and presented in Edinburgh last week at Fertility 2020, 150 women in the USA and Israel were asked about their experiences with egg freezing. Most of these women were already established in a career and were high-fliers in business, the health sciences and other chosen professions.
In our late 30s, which is the age at which many of these women chose fertility preservation, women's fertility begins to drop rapidly. So, this was very much a case of either freezing eggs now or accepting that having a baby in the future might be especially difficult.
About a third of the cohort were going through fertility preservation alone or with support from female relatives and friends, but for the rest, men were providing more than a dozen types of support, which were grouped into four categories: instrumental; financial; physical; psychological.
Support from men: Some male support happens during the decision-making process. Men helped to research fertility preservation and found useful information on egg freezing for their female partner, family member or friend.
There could be financial support from a father or father figure, something that was found to be very common in the Israeli group. 
Brothers sometimes provided emotional support to their sisters undergoing elective egg freezing, bringing a curated music playlist, or making jokes and providing distraction to make egg collection more comfortable. 
There was also male support that was important after egg collection, which includes a general anaesthetic. The majority of clinics require that a patient is accompanied home after the procedure.
In a handful of cases a male judge might mandate a man to pay for egg freezing as part of a divorce settlement.
Why are women remaining single? It is heartening to hear these stories of partnership and support outside of a romantic relationship. But it does also raise the question of why these women struggle to find a partner to parent with. In fact, even in cases where women were in a relationship (either new or long standing) only a small number went on to marry their partner with most, ultimately, splitting up.
Some women related their partnership problems to the prevalence of so-called 'Peter Pan syndrome' among men. Women find a lot of men their own age too immature or unready to parent. It may also be down to demographic changes.
In the USA there are now four women for every three men in higher education. And once this education is completed women tend not to want to 'marry down' and partner with a man who has a lower level of educational achievement.
When the cohort was asked about relationships, some also said that they felt that men their age or older were looking for younger female partners. They thought that by the time a man is mature enough and ready to be a father they do not want to form relationships with women who are of the same age and perhaps less fertile.
Will egg freezing become as ubiquitous as oral contraception? Carl Djerassi, the chemist, playwright and novelist whose work was instrumental in development of the first contraceptive pill, said that he thought one day everyone would be freezing their eggs. While technically we can now do this and the techniques for freezing and thawing are improving all the time, only about one in five cycles will enable a woman to have a baby.
Still, it does seem that for highly educated single women, elective egg freezing is becoming normalised. And although these women are struggling to find partners, we should not assume that men have no interest in being involved. 
At present there are a few companies that will fund egg freezing as an employment benefit but most of the women we spoke to were self-funding. That does exclude women who do not have the financial means, or a parent, friend or sibling who can give or loan money for elective egg freezing.
So, it seems unlikely that everyone will be undergoing elective egg freezing any time soon. But in the future, who knows. What we do know is that men are stepping up to support the women in their lives as they go through egg freezing, and that is something to be acknowledged positively.

12 August 2019 - by Sarah Gregory
A couple in Ohio is suing a fertility clinic and associated organisations after a genetic test given as a Christmas present revealed a sperm mix-up in their IVF treatment.
Using a DNA kit, Joseph Cartellone discovered that he was not biologically related to his daughter, who had been conceived following IVF treatment at the Christ Hospital and the Greater Cincinnati Institute for Reproductive Health in 1994. The family is now suing for unspecified damages.
'It's hard to explain the shock and agony when you find out that someone you love and care for - your own daughter - is not genetically related to you,' Joseph Cartellone said at a Washington DC news conference. 'There's a mix of anger, pain and confusion that comes along with having to accept this and having to break the news to our family.'
Joseph and Jennifer Cartellone started IVF treatment at the Christ Hospital in 1993. The following February, Jennifer had three embryos transferred to her uterus, which she and her husband believed were made from her eggs and his sperm. She subsequently became pregnant with their daughter Rebecca.
However, last Christmas, Rebecca bought the family DNA kits from Ancestry.com to explore their heritage and the results, later confirmed by a paternity test, showed that father and daughter were not biologically related. The Cartellones still do not know the identity of Rebecca's biological father, but a private investigation by the family has traced him back to a handful of men, including a doctor working at the hospital at the time.
Joseph Cartellone said that his wife now 'has to deal with the fact that this clinic… fertilised her eggs with a complete stranger's sperm and placed them in her body' and in an interview with Good Morning America said that his daughter is 'experiencing significant emotional stress and confusion concerning her own identity'.
A lawsuit has been brought against the Cincinnati Institute for Reproductive Health, the associated The Christ Hospital, and Ovation Fertility, and includes counts of breach of contract, battery and negligence. The Cartellones are also seeking damages for facilities to reveal who fathered Rebecca and how the alleged mishap occurred; they also want to know if Joseph Cartellone's sperm was used by another of the clinic's clients.
'These clinics need to be held accountable and they need to suffer real consequences for their actions,' said Joseph Cartellone. 'We're willing to do whatever it takes to make sure that this doesn't happen again to anyone else.'
The current case highlights the insufficient regulation of fertility clinics in the USA, whereby  'error reporting is essentially voluntary, and tragic cases of lost, destroyed or otherwise improperly handled embryos appear to be on the rise' according to a recent report by law firm Peiffer Wolf Carr and Kane. The firm, which is representing the Cartellones, said that 'nail salons are subject to far tighter state and federal controls than US fertility clinics'.