Egg freezing has been slower in the Muslim world due to cultural beliefs and religious regulations but the conversation is slowly starting to pick up, writes Maha El Akoum.
Science tells us that as women grow older, the quality of their eggs begins to decline, as “older eggs” tend to contain more chromosomal abnormalities. In addition to this, at menopause, ovulation ceases, and the ovary stops releasing eggs. Therefore, if a fertile woman desires a child but is unable or not ready to conceive, she can have the option to freeze her eggs for use at a later, more convenient, date.
Egg freezing is a well-established medical procedure that is based on decades of scientific and technological research. In fact, the first reported human birth from a frozen egg took place in 1986. It is a safe method of fertility preservation that doesn’t affect the health of babies born from those eggs and the chance of a successful pregnancy can be over 70% for women who opt to freeze their eggs before the age of 35.
Women choosing to go for egg freezing treatment will typically undergo a hormone treatment in order to stimulate the production of more eggs. After around 2 weeks of injections, and sometimes several ultrasounds to detect the ovulation process and to assess egg development, the doctor, guided by an ultrasound, then inserts a needle into the ovarian follicles in order to retrieve the eggs.
Once the eggs have been retrieved they are then frozen and stored for future use. When the woman is ready to use her eggs, she will undergo in vitro fertilisation (IVF) where the fertility specialist will fertilise her egg in a lab. If the procedure is a success and an embryo develops, the embryo is then transferred into a woman’s uterus a few days later.
Following the development of this technology, more and more women are opting to freeze their eggs in accordance with the trend of older motherhood.
Statistics from the Human Fertilisation and Embryology Authority (HFEA) have shown that egg freezing is the fastest growing form of fertility treatment in the UK with an uptake that is increasing at an average rate of 10% each year.
Most women who freeze their eggs for social reasons claim that their main motivation is to “buy time” to find the right partner, rather than rush into a relationship based on their biological clock.
The uptake has been slower in the Muslim world due to cultural beliefs and religious regulations. Here in Qatar, the World Innovation Summit for Health (WISH) in collaboration with the Research Center for Islamic Legislation and Ethics (CILE) published a research report titled ‘The Struggle to Conceive: an Islamic Approach’ that was launched and discussed during a panel session at the latest edition of the biennial summit that took place from November 15-19.
The report was launched during a panel discussion on November 18th that covered a variety of topics ranging from access to infertility treatment in underprivileged communities, to sex selection in IVF, to the Islamic ethical viewpoint on surrogacy and reproductive organ transplantation.
Oocyte cryopreservation (OC) commonly known as “egg freezing” was also discussed at length during the interactive session, and the majority of questions received from the live audience focused on the question of whether or not egg freezing was permissible in Islam.
Islamic Ethics and Infertility Treatment
It is important to stress that the collaboration between religious scholars and biomedical scientists is essential to the field of Islamic bioethics. This collective religio-moral reasoning (ijtihad) was institutionalised in the early 1980s through the establishment of Islamic Organisation for Medical Sciences (IOMS), the Islamic Fiqh Academy (IFA) and the International Islamic Fiqh Academy (IIFA).
The WISH report on Islamic Ethics and Infertility Treatment drew on the deliberations that stemmed from the meetings and discussions held by these institutions around the topic of assisted reproductive technologies (ARTs).
The main findings from the report were:
- When it comes to egg freezing, this was preferred to embryo freezing as disposal of surplus embryos is more problematic than the disposal of gametes (reproductive cells). Therefore, freezing of unfertilised eggs should be the first option, as long as freezing separate gametes is sufficient to treat infertility. This is because the moral status of a gamete is lower than that of an embryo seeing as neither an egg nor sperm can independently develop into a human being without mixing through the fertilisation process.
- In the case that freezing gametes is insufficient to treat infertility and freezing of embryos is necessary, the number of frozen embryos should be minimised in order to reduce the number of surplus embryos that won’t be used by the couple for procreation.
- Some individual contemporary Islamic bioethics voices found no difference between egg freezing for medical reasons and egg freezing for social reasons. When it comes to egg freezing for medical reasons, such as for women undergoing chemotherapy for cancer treatment, this was not only permissible, but encouraged.
- The report recommended that freezing gametes should also be possible for morally justified social reasons.
The WISH panel gathered global experts from the field of medicine, social sciences as well as religious scholars to discuss the important ethical and moral implications of infertility treatments and assisted reproductive technologies.
At the event, forum co-chair Dr. Mohammed Ghaly, Professor of Islam and Biomedical Ethics at Hamad Bin Khalifa University, said there is no strong opposition to egg freezing for women who are unmarried and want to conserve their fertility until they find their partner.
However, he advises that this is to be approached with caution for women who are married and should be assessed on a case by case basis.
Ghaly expressed concern around the possibility of modernising discrimination against women in the workplace, especially since tech giants such as Apple, Facebook and Google, over the past few years, have begun offering to cover the cost of egg freezing (one round of which costs approximately $10,000, plus extra for storage fees each year) to their female employees.
Facebook also offers surrogacy and adoption assistance. This was done in an attempt to attract and retain female staff in particular, giving them the chance to delay their childbirth so that they can focus on their careers. This is a growing global trend, and we see the average age for heterosexual marriage increasing worldwide.
In the UK, the average age of marriage for women has now reached 35, the age at which, science has proven fertility begins to rapidly decline.
This move has received criticism from skeptics who say that the policy may move in the wrong direction in that, instead of empowering women, egg-freezing reinforces and encourages the boxing of women in an uncomfortable set of expectations of what they “should” and “shouldn’t” be.
Dr. Ghaly labels this as disguised modernisation, adding that if the workforce doesn’t recognise or respect the biological nature of women, then we have a problem, not with women but with the workforce.
Therefore, employers should offer flexible schedules, so that women aren’t presented with a choice between family and work. Both are important, and work culture should adapt and change to be more accommodating of women, their nature, as well as their freedom of choice.
Prof. Sirour, a fellow panelist taking part in the discussion, added that freezing eggs for women who have yet to find the right partner is allowed and not problematic at all.
However, when eggs are used, these need to be fertilised by the sperm of the woman’s husband under a viable and lawful marriage contract. He also warned that eggs shouldn’t be used for donation and that they must be used by the same patient and advised that pregnancy shouldn’t be delayed past the age of 45 as this causes medically high-risk pregnancies in women.
Maha El Akoum is the Head of Content and a Research Fellow at the World Innovation Summit for Health (WISH), Qatar Foundation’s global health initiative.