Australasian Science: Australia's authority on science since 1938

Fertility on Ice

By Michael Cook

Cryopreservation and eventual transplantation of ovarian tissue may delay menopause, but what are the consequences?

One seldom-mentioned element in the bioethicist’s skill set is a wild imagination. Perhaps that’s why I’m a journalist and not a bioethicist.

Take the novel technique of fertility insurance through ovarian tissue cryopreservation (OCT). So far, nearly 30 babies in the US and Europe have been born to mothers who had a slice of their own frozen tissue grafted onto an ovary to restore their fertility. In all these cases the surgery was needed because the woman was about to have chemotherapy, which would destroy ovarian function.

Whenever this development has emerged in the media, a fertility specialist has described OCT as the best friend of an ambitious woman in her twenties because it stops her biological clock. After freezing ovarian tissue at an IVF clinic, she can shatter glass ceilings, make a motza, and marry Mr Right whenever she wants.

So what a surprise it was to read recently in the American Journal of Bioethics about OCT for a 2-year-old. Not in my wildest dreams had I thought of that!

The child had a rare form of sickle cell disease that required a bone marrow transplant. Her mother (no mention of a father) was worried that her daughter would be infertile, so she asked doctors for OCT. Ethicists were consulted and they gave the procedure the thumbs-up.

This extends the range of the market for OCT from 2 years to at least 70. A number of women around the globe have already used IVF with donor embryos to bear children into their sixties and even their seventies. OCT makes it possible for today’s 30-year-old to give birth to her own biological child in 2052.

Another possible benefit of OCT is deferring menopause. Sherman Silber, an American surgeon from Missouri who is a world leader in the technique says: “A woman born today has a 50% chance of living to 100. That means they are going to be spending half of their lives post-menopause. But you could have grafts removed as a young woman and then have the first replaced as you approach menopausal age. You could then put a slice back every decade.”

It could also be a solution to declining birth rates, Silber says. He told a fertility conference in 2009: “We are in the middle of a massive global infertility epidemic caused by the new structure of our society, where women choose not to have children until they are older. As a result, many of them become infertile because of the ageing of their eggs and ovaries. This procedure is a solution to that social dilemma, allowing women to have children when they are older by preserving their ovaries when they are younger and transplanting them back at a later date.”

So are there any ethical issues? At first blush the idea of preserving fertility seems unequivocally positive. OCT is another way of enhancing women’s reproductive autonomy.

But closer scrutiny reveals a few problems. Take the 2-year-old, for instance. Even if the operation does not jeopardise her health, she will grow up with the expectation of childbearing always before her. Feminist bioethicists point out that OCT for a 22-year-old reinforces the burden of gender stereotypes about the obligations of motherhood – how much heavier will this weigh on a 2-year-old?

OCT as a solution to social infertility creates even more dilemmas. If the 22-year-old has her child at 42 – or 52 or 62 – how will it affect her child? Women (and men) are best able to cope with the demands of raising babies in their twenties and thirties. Some of the sexagenarian and septuagenarian mothers have died within a couple of years of giving birth. Is a fertility treatment that produces orphans really good public policy?

Some bioethicists argue that OCT and egg freezing, another technique, allow women to remain fertile as long as men. It’s a case of reproductive technology overcoming inequality. But that makes sense only if we ignore children’s preferences. Could most teenagers cope with a mother suffering from dementia or Parkinson’s disease?

All in all, I suspect that if ovarian tissue cryopreservation ever takes off, the only unequivocal beneficiaries will be IVF clinics selling the dream of miracle babies.

Michael Cook is editor of the online bioethics newsletter BioEdge.