Suppsosed suuport for infertility tratements featured by Apple and Facebook  is really an interest in employers “care for loved ones and raise their families”?

Introduction.

Last 15th October, NBC News featured a news story that was then picked up by a national newspaper[1], which discussed an initiative promoted by Apple and Facebook to “continue to expand our benefits for women, with a new extended maternity leave policy, along with cryopreservation and egg storage as part of our extensive support for infertility treatments”, as the report literally stated. It continued: “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families”.

The initiative however, is not free from controversy, as the article itself states. And not without reason.

After the unquestionable goodness contained in measures such as paid maternity leave, medical cover in the facilities themselves, 4,000 dollars in “baby-cash” to Facebook employees when they become parents (and if they adopt), maternity leave extended to four months (also for fathers and flexible) and subsidies for childcare in the offices, the company is now offering another – funding the cryopreservation of oocytes, for which Facebook covers up to 20,000 dollars, the normal cost of two rounds of egg freezing, enough to obtain around twenty eggs. Apple has committed to seconding the initiative from January next year.

Ovarian hyperstimulation

Obtaining oocytes (up to 20 in two stimulation cycles) requires stimulating multiple ovulation in the woman by administering drugs such as clomiphene, and is not free of risks. It has potentially serious side effects, such as thromboembolic disorders, some types of cancers and even death[2],[3].

Egg cryopreservation.

A study published in 2010[4] compared the clinical pregnancy rate following transfer of embryos obtained by in-vitro fertilisation (IVF), starting from oocytes cryopreserved by two different techniques (vitrification and slow-freezing), achieving success rates of 38% and 13%, respectively. Spontaneous abortion rates were similar.  These figures are similar to those obtained in IVF with fresh or cryopreserved embryos, and have a high rate of embryo loss, which continues to pose an ethical problem.

Postponing motherhood: is it recommended?

It appears from reading the article concerned that the measure proposed intends somewhat more than offering assistance in cases of infertility, as stated in the aforementioned article. What has been offered to all women in the companies concerned and aired on the media through a major North American television channel, makes one suspect that hidden behind the measure is an attempt to make women employed in these companies decide (through the option of freezing their eggs to be used in the future) to postpone possible child-bearing. Perhaps they are more useful to the company within a certain age range (their youth) in which a pregnancy could mean an interruption to their work activity, strategically problematic for the interests of the aforementioned multinationals.

But indiscriminately encouraging young women to postpone motherhood until they are older does not seem to be the most sensible thing to do, biologically speaking. Over the age of 35, a woman’s likelihood of pregnancy is reduced, the risk of her children having genetic abnormalities increases, the probability of miscarriage is also higher (more than double in a 40-year-old women compared to a 30-year-old), and health problems during the pregnancy, such as diabetes, high blood pressure and preeclampsia, are also more common. Giving birth may also have more complications in women over 35. Finally, although it is not our case, the possibility of multiple pregnancies increases in late pregnancies, even without infertility treatments[5].

Using cryopreserved eggs that were extracted when the woman was younger hopes to minimize the risks of miscarriage and genetic abnormalities. Nevertheless, it must be remembered that the process of cryopreservation itself, together with the subsequent IVF procedures required, introduces new risks that could be higher than those of a pregnancy resulting from natural fertilisation, even at an older age.

It should also be added that the objections that may arise do not end with the pregnancy itself, but may extend to the subsequent motherhood, for which being young is an objective advantage.

Natural fertilisation or IVF?

Opting for egg cryopreservation also entails pregnancy via IVF. Renouncing natural fertilisation when it is possible in order to avoid a pregnancy, to seek it in the future using a cryopreserved egg, advocates IVF in the woman, which undoubtedly has more risks and less likelihood of pregnancy than natural fertilisation in normal conditions. We do not known whether the companies in question will also pay for the IVF process in the future, which, in addition to being more unsafe and ineffective, is much more expensive and, probably, will be at the employee’s expense.

And one further problem: the “surplus” embryos from all IVF procedures, a real unresolved ethical problem.

Conclusion.

In our opinion, this issue is posing a conflict of interest for women on aspects that are not comparable as regards their scale of values. The right to a promotion in work should not be compared to the right to become a mother, or, as seems to happen in this case, have it imposed. Inducing a woman to renounce her legitimate choice to live her maternity at the best age for it, in the interests of greater professional performance, does not exactly seem to defend her rights and dignity. Efforts to reconcile work and family life, prioritising the latter over the former, seems anthropologically more correct, more satisfactory for the woman and her husband, and much more beneficial for a society that is aging by leaps and bounds due to lack of a sufficient generational replacement.

Julio Tudela Cuenca Bioetics Observatorory UCV

                                                                                          Bioethics Observatory

Catholic University of Valencia

[1] ABC · Sociedad · 16 Oct. 2014

[2] Jóźwik M, The mechanism of thromboembolism in the course of ovarian hyperstimulation syndrome. Dev. Period Med. 2012;16(4):269-71

[3] Cluroe AD, Synek BJ. A fatal case of ovarian hyperstimulation syndrome with cerebral infarction. Pathology 1995;27(4):344-646. doi:10.1080/00313029500169273

[4] Smith, GD. et al. Prospective randomized comparison of human oocyte cryopreservation with slow-rate freezing or vitrification. Fertility and Sterility 2010;94(6):2088-95

[5]http://umm.edu/health/medical/spanishpreg/embarazos-de-cuidados-especiales/embarazo-en-edad-avanzada