The Human Fertilisation and Embryology Authority (HFEA), the independent body responsible for the regulation and licensing of fertility clinics, reported that in the UK as at December 2012 only 20 babies had been born after treatment using the patient’s own frozen eggs.
That may be about to change, with ramifications for insurers. In October 2014, Facebook and Apple announced that each would offer a contribution of up to $20,000 to female employees, covered by their health insurance policies in the US, who want to have their eggs frozen, in case they are needed for future fertility treatment.
Although cost is perhaps the main barrier for women who want to have their eggs frozen as a precautionary measure, egg freezing is a relatively novel technique and there is no guarantee that the procedure will result in a live birth. Insurers should be mindful of the Pandora’s box of legal and ethical dilemmas that could open up in Silicon Valley and spread to the UK if this becomes popular.
Notwithstanding the cost and lack of certainty as to the success of the procedure, there are a number of risks associated with the procedure itself, all of which could trigger claims. These include:
- adverse reaction to fertility drugs
- multiple births, which carry risk for both the mother and the unborn baby (including premature birth and below normal birth weight). To minimise this risk, the HFEA imposed a limit on the number of embryos that can be transferred
- Ovarian hyper-stimulation syndrome, which can be life threatening
- ectopic pregnancy; and
- birth defects
Given the above and, as with any medical procedure, obtaining proper informed consent is paramount to safeguard doctors and their insurers. In addition, careful consideration needs to be given to:
- Obtaining consent for the storage of the eggs and for the eggs to be used in the patient’s fertility treatment
- How long the eggs are to be stored for. The statutory storage period under the Human Fertilisation and Embryology Act 2008 is 10 years; however, this can be extended under certain circumstances
- What will happen to the eggs if the patient dies or becomes unable to make decisions for herself
- Whether the eggs that are harvested for egg freezing are to be used only for the patient’s treatment, or whether they are to be donated for someone else’s treatment (for example, some clinics offer an ‘egg-sharing’ programme whereby the patient receives free IVF treatment when they donate a proportion of their eggs to an anonymous woman who is unable to produce her own eggs for IVF treatment), or for research or training purposes; and
- Whether there are any other conditions that the patient wants to impose on the use of her eggs
These considerations with regard to patient consent are particularly salient in situations where the offer of a contribution towards the cost of the procedure has been made by employers, and could be interpreted by the employee as pressure on her to delay having children in order to enhance her career prospects.
Insurers will therefore want to make sure that clinicians support patient autonomy by ensuring that a proper informed consent process is followed. Clinicians should explain the egg freezing process, the benefits and risks of the procedure, as well as discussing other options available. The HFEA also suggests that clinics should offer the patient an opportunity to discuss her feelings or concerns with a specialist counsellor.
The insurance industry will be watching developments with interest as the procedure gains popularity. The Silicon Valley giants may have made a move that will have widespread implications for women, employers and insurers.