April 18, 2024
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April 18, 2024
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Egg Freezing: Where Science and Halakha Intersect

Englewood—The Yeshiva University Student Medical Ethics Society recently sponsored a discussion on the social, ethical and halakhic impact of egg freezing, or oocyte cryopreservation at Congregation Ahavath Torah in Englewood. Dr. Kenneth Prager, Chairman of the Medical Ethics Committee of Columbia University moderated the panel with Rabbi Dr. Zalman Levine, specialist in Reproductive Endocrinology and Infertility, and Rabbi Kenneth Brander, Dean, Center for the Jewish Future—also an expert on infertility counseling and treatment according to Halakha–and former Chief Rabbi in Israel Rabbi Mordechai Eliyahu, an expert on medical ethics.

The quest to freeze eggs stems from the fact that they are a diminishing resource. Egg production, oogenesis, takes place in the first five months of life and then stops. At five months, a developing female has 6-7 million eggs in both ovaries. Then they begin a long, slow process of dying off. When a baby girl is born, the number of her eggs is already down to 1-2 million. At puberty, she has about 400,000. That number continues to decline until menopause when she has no more eggs in her ovaries.

As a woman ages, and her store of eggs gets smaller, so do her chances of having a baby. At age 20, there is only a 5% chance a woman will not be able to have a child. At age 30, there is a 15% chance. The percentage doubles at age 35-40. From 40-45, there is a 65% chance the woman will not bear a child.

In the metabolic process, all cells die. But if you can drop the temperature of a cell to close to 0, the molecular process stops. Thaw the cell and the process continues. In the 1940s, cattle farmers drove the research to freeze sperm from bulls to enhance breeding procedures for milk and meat production. The biggest obstacle in freezing was overcoming the sharp, jagged feature of ice crystals which would tear the membrane and kill the cell. In 1949, a process was developed that dehydrated the sperm cell, replaced water with cryo-protectants—chemicals that do not freeze in the same way—and allowed the cells to be frozen to 450 degrees below Fahrenheit and then thawed at a later time. The ingredients we use now to freeze cells are similar to the anti-freeze we put in our cars. The first successful pregnancy from frozen sperm resulted in 1953. Researchers advanced the process, learning how to both freeze and thaw cells much more slowly. After 1978, the process was used with embryos. The first pregnancy from a frozen, thawed embryo was in 1984.

Freezing eggs is more difficult than freezing sperm. Eggs are composed of 90% water. Replacing it with chemicals can be toxic. Sperm undergoes meiosis, division, and forms new cells in 72 days. Eggs undergo meiosis in two phases. They undergo meiosis1 and stop when a baby girl is 5 months old and undergo meiosis 2 when ovulation begins. That’s when eggs are frozen. The chromosomes live at opposite poles in the cell, connected with spindle protein fibers. If the spindle is damaged, it will not combine with sperm DNA.

Once the process of slow freezing was perfected, egg freezing became viable. The first pregnancy resulted in 1986. The past 10 years have seen the process become more reliable and predictable by using a flash freezing method. The cell is immersed in liquid nitrogen for less than a second. There are no ice crystals and less chance of disrupting the spindles.

Egg freezing is coming of age. Six months ago, the American Society for Reproductive Medicine removed the experimental designation for the procedure. Now we know how to freeze eggs. But why do we want to? And should we?

Couples going through In Vitro Ferlization (IVF) can make good use of egg freezing. If a woman’s eggs are ready at a time when her husband’s sperm count is low, the eggs can be frozen and thawed when the sperm count is higher.

When a young woman has a cancer diagnosis, it can be a sentence for infertility as well, since chemotherapy is toxic and wipes out all the eggs. Now it is possible to delay chemotherapy long enough to remove the eggs and freeze them.

Some young women discover they are a carrier for Fragile X syndrome, the condition that causes premature ovarian failure. If you have that information at age 20, you can freeze eggs while you are healthy to ensure you will have them later.

Then there are the elective reasons to freeze eggs. Women may delay childbearing while they complete their education or build careers. In the past, a woman’s biological clock began ticking loudly. Now she can freeze her eggs if she wishes. An infertile woman can also elect to have a baby with a donated egg.

But egg freezing is a complicated process. Dr. Prager pointed out that the process is not as simple as collecting eggs to put in a basket. A woman has to take high doses of hormones and then be monitored for one to three days. The egg retrieval is done under anesthesia by inserting an ultrasound guided needle through the vaginal wall. The eggs are then removed, cleaned and frozen. It is very expensive and not covered by insurance—about $10,000-$15,000 for the procedure and another $6,000-$12,000 annually for storage.

Thirty-five years have passed since Louise Brown made history as the first baby born from the process of in vitro fertilization. Dr. Levine noted we have less data about babies born from frozen eggs, but so far the data we have reveals no problems with births from the process. Dr. Levine says the biggest risk is creating false hope. The success rate for live births is still low.

At each stage in the process, the odds of reaching a successful conclusion get smaller. There is a 97% chance the frozen eggs will survive. By the time they go through fertilization, are implanted in the uterus, form an embryo and result in a live birth, the odds are down to 3 – 4%. Usually three to four embryos are implanted to increase the chance of success. With the multiple embryos, the odds of having a live baby are 20 – 30%.

Rabbi Brander noted that as Jews, our job is to be a junior partner with Hashem; to finish the job that he began. Halakha tells us to try to have children, but we are not halakhicly mandated to use fertility treatments to make that happen. The science has to be used with responsibility. A number of dilemmas are raised by freezing eggs. Rabbi Eliyahu was against it because of the possibility of encouraging single family homes and ordering sperm to have children, until he saw that Israeli couples were doing IVF with gentile donor sperm. Rav Moshe Tendler permits it when there is no alternative.

Is elective egg freezing by women a process to be encouraged? Some think it may relieve the stress of dating; a woman can freeze eggs now and not rush into an unsuitable marriage. Men may consider dating older women who have eggs stored and waiting. Rabbi Menachem Borshtein, director of Machon Puah, suggested in 2011 that single women over the age of 32 should freeze their eggs. At Machon Puah, trained supervisors are present for the entire process of egg retrieval to ensure halakha is not compromised. On the other hand, Rabbi Brander sees young people very quickly end a relationship, or not consider beginning one, if everything is not perfect. Egg freezing might exacerbate the problem, taking away the incentive to be more willing to overlook personality and background characteristics in a person that doesn’t match up to a checklist.

The most critical dilemma for halakhic authorities is defining motherhood when a woman bears a child using a donor egg. The decisions have swung back and forth, with most poseks now saying the gestational mother is the halakhic mother but many recommend conversion of the baby to avoid any future problems.

The Yeshiva University Student Medical Ethics Society, sponsor of the program, was founded in 2005 with help from the school’s Center for the Jewish Future. Through its annual conference and lectures, the group has become an educational resource for laymen, rabbis, patients, doctors and other health professionals.

By Bracha Schwartz

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