Falling birth rates and social freezing: from a medical choice to a legal, economic and political dilemma
From international cases to regional resolutions: the cryopreservation of oocytes for family planning is intertwined with the constraints of Law 40, the limits on healthcare spending and the issue of the falling birth rate
Key points
The renewed and growing interest in social freezing hinges entirely on the tension between individual choice and the public interest. The preventive cryopreservation of oocytes to plan one’s reproductive future originated for medical reasons — such as the protection of patients with cancer or endometriosis — is commonly referred to as ‘medical freezing’ and is already recognised in the Essential Levels of Care as a service covered by the National Health Service.
Between science and society: the new fertility map
However, in recent months, the cases of US Congresswoman Alexandria Ocasio-Cortez and the Spanish Football Federation’s shift towards protecting female athletes have brought this possibility back to the forefront of public debate – even for women who have no medical issues and who choose cryopreservation to plan a pregnancy later in life. Italy’s severe decline in the birth rate, initiatives by some regions in support of social freezing, the proposals tabled in Parliament, and the strict framework set out by Law 40 of 2004 on medically assisted reproduction are, at last, turning this into a matter of political debate as well.
“We were one of the first centres in Italia to successfully carry out this procedure, as early as 2007, but it is only in recent years that the number of women asking us to perform it for non-medical reasons has increased, and they currently account for around 30 per cent of requests,” explains Professor Alessandra Andrisani, director of the Medically Assisted Reproduction Unit at the Padua University Hospital Trust.
How does it work? An expert explains
“Clinically, the procedure is based on vitrification, an ultra-rapid freezing process at -196 °C in liquid nitrogen that preserves the quality of the gametes,” explains the professor. The process for the woman initially involves 10 to 15 days of hormonal stimulation, followed by a transvaginal egg retrieval carried out as an outpatient procedure under sedation. At that point, the oocytes can be stored for years without ageing or deteriorating. ‘We have stored some for 15 years and they were in perfect condition.’
The issue of age is precisely one of the key points of concern regarding this technique. ‘I may have the oocytes of a 25-year-old, but if the woman is over 40, the body that undergoes and sustains pregnancy – which is a tremendous test of strength – is that very body, with all its limitations. In my view, a healthy woman can safely go as far as 42–43 years of age. It is therefore very important to consult and rely on specialists both at the time of cryopreservation and when choosing to try for a pregnancy,” concludes the specialist, who is currently in Prato della Valle, Padua, taking part in the ‘Dì Salute Weekend’ festival, specifically to offer free advice and check-ups to women interested in this option.
