Elective Egg Freezing in the United Kingdom: The Importance of Financial Transparency
By: Natalie Richardson, PhD candidate, University of Kent; Visiting scholar, Research Group on Health Law and Innovation
July 24, 2023
Keywords: Fertility, Egg freezing, Assisted Reproduction, United Kingdom
Elective egg freezing (i.e. freezing one’s eggs for non-medical reasons) has significantly increased in popularity in recent years in the United Kingdom. Currently, elective egg freezing is only available through privately funded treatment in the UK, and there are no guarantees that frozen eggs will lead to a successful pregnancy. In this piece I draw on my PhD research which included interviews with service users (i.e. people who had undergone egg freezing) and service providers of elective egg freezing in the UK. I offer reflections on (1) the oversight of egg freezing in the UK and (2) the types of information that service users of egg freezing might need to know, with a focus on financial information. I then highlight some of the difficulties faced by the service users who I interviewed in relation to financial information. I argue that we need to improve financial transparency when it comes to egg freezing.
Oversight of Egg Freezing in the UK
Following the birth of the first baby conceived through IVF in 1978, the Human Fertilisation and Embryology Act was introduced in the UK in 1990 to regulate assisted reproductive technologies (ARTs). This Act established the independent regulator, the Human Fertilisation and Embryology Authority (HFEA), which licenses and inspects clinics, issues codes of practice, reports on ARTs, and standardises consent forms for treatment.
In recent years, a variety of concerns have surfaced about the increased commercialization of the for-profit ART sector. For many people, ARTs are not covered by public or private health insurance. In the UK, for instance, where the majority of healthcare is covered through the National Health Service (NHS) navigating fertility treatment through a private clinic is many people’s first experience with private medicine.
In response to these commercialization concerns, the HFEA has taken on a role as an independent information-provider in order to help service users make decisions about whether to engage in often pricey treatments. On their website the HFEA includes standardised information about clinic success rates. More recently they have added a traffic-light system for in vitro fertilization (IVF) add-ons. These add-ons can add hundreds of pounds to treatment costs and many of them have mixed evidence to support them. The HFEA, however, does not have powers to set pricing, or regulate advertising, which is dealt with instead by the Competition and Markets Authority (CMA) standards.
Importance of Accurate Information
In order to make an informed decision about whether to go ahead with elective egg freezing, those who are using this technology need access to accurate information. Professor Emily Jackson explains that this can be challenging as egg freezing is an ‘ambiguous technology’ due to uncertainties over the risks and benefits of treatment, as success rates are limited and data shows that few people are returning to use their eggs. Jackson argues that people must be equipped with as much information as possible to be able to navigate these complex decisions.
Dr Zeynep Gürtin highlights that in order to make an informed decision, people must be informed about four different types of information: (i) risks, (ii) side-effects, (iii) success rates, and (iv) costs. In their 2021 article, Gürtin and Emily Tiemann compared information on the websites of several UK-based clinics. They found that these clinics did not meet the HFEA standards for quality of information, including information about the true cost of a treatment cycle.
As part of my ongoing PhD project I interviewed 13 women who had completed at least one cycle of egg freezing at a UK clinic for ‘social’ reasons. While these service users were all financially well-off, to some degree, in order to be able to afford treatment, for many, cost was one of the most important factors affecting whether and when they could go ahead with the process, and how many cycles they could undergo. Financial considerations remain an important aspect of treatment for service users, before, during, and after the egg freezing process. Many of these service users found that it was difficult to navigate information from clinics about the realistic total costs of treatment. In particular, three different financial considerations came up recurringly in my interviews with these service users. These were: (i) the cost of treatment and medication, (ii) the cost of multiple egg freezing cycles and payment options, and (iii) the cost of storing and thawing eggs.
Treatment and Medication Costs
Firstly, service users need transparent pricing information at the outset, including clarity over exactly what aspects of treatment are included in any egg freezing ‘package.’ The specific services offered within a ‘headline price’ of an egg freezing package can vary between clinics, making it difficult for potential service users to compare prices. It is important for service users to be aware from the outset whether services such as counselling, tests and scans, first-year of storing eggs, and follow-up consultations are included, or they may face significant unexpected additional costs during the process.
Two service users I spoke to were in the unfortunate position of having prices change during their treatment due to changes in clinic management. In the UK, fertility clinics are increasingly being acquired by private equity firms which can lead to cost-cutting measures. This often includes clinics changing their pricing structure, keeping the ‘headline’ price for a cycle of egg freezing the same but changing the content of this package so that aspects of treatment, including counselling, follow-up consultations, and the first-year of storage, are no longer included. Two service users I spoke to faced additional charges of £500-2000 more than what they were initially quoted at the beginning of their treatment. In both of these situations, these charges were to cover aspects of treatment that were originally included in the egg freezing package, but stopped being included when the content of the package changed part way through the process.
Furthermore, medication is excluded from package costs, including multiple-cycle packages. The cost of medication varies hugely (between £500-£1500 per cycle) depending on the service user and specifics of the service user’s treatment protocol. Mutiple service users I spoke to reported trying to cut costs by shopping around for cheaper medication and traveling further afield to specific pharmacies rather than getting their medication through the clinic directly at a premium price tag. Some service users also reported being surprised to find that the medication costs were also subject to change during the course of a treatment cycle. For example when the collection of eggs was delayed by a day or two to give follicles more time to develop, this cost the service user hundreds of pounds because additional stimulation medication was needed.
Multiple Cycles and Payment Options
A second financial consideration for service users was the number of egg freezing cycles and payment options for those cycles. In order to collect a large number of eggs for potential future use, service users may be advised to undergo multiple collection cycles. This will depend on many factors including the service user’s age and fertility test results. This is also an important financial decision, as service users will have to decide how many eggs they are looking to collect to achieve their own perception of ‘success’ and weigh this against how much they are willing, or able, to spend on the process.
Service users I spoke to had mixed experiences of discussing multiple cycles with their clinics. Some, particularly those with low fertility results during initial testing, were advised by clinicians from the beginning that they would likely need multiple cycles and were therefore able to plan for this financially. For others, however, these discussions came as a surprise following their first cycle, and one service user made the decision not to go ahead with further cycles, despite a relatively low number of eggs retrieved, because they were only financially and emotionally prepared to do one cycle.
Similarly, depending on fertility testing results and the number of cycles anticipated, service users may be able to sign up for a treatment package at a clinic. One of the most commonly available packages is a three-cycle package where service users effectively get three cycles for the price of two, excluding medication. One service user was told by her doctor that she could go ahead with a multi-cycle package that would cover four-cycles, or 20 eggs, and budgeted for this discounted multi-cycle package. However, later in the process of arranging payment she was told by an administrative staff that her fertility results were too low for her to be eligible for that particular program.
Other options include freeze and share schemes. In these schemes, service users can get heavily discounted treatment for donating half of the eggs collected. This latter offer is only available to service users who are under age 35 and who meet certain health requirements. Since the average age of people freezing their eggs electively is over 35, many will not qualify for this scheme.
Storage and Thawing Costs
Finally, service users’ financial considerations continue even after eggs have been retrieved. Therefore, a third important financial consideration for service users is the cost of storing eggs and the cost of subsequent treatment to use those eggs. Storing eggs costs approximately £125-£350 per year in the UK.
There will also likely be additional costs if people return to thaw their frozen eggs. In the UK, the NHS strives to offer three funded cycles of IVF for women under 40, and one funded cycle to women aged 40-42. In order to qualify, a woman must have been trying to conceive naturally for two years with a partner, have undergone 12 unsuccessful cycles of artificial insemination, or have a diagnosed reason for infertility. Since the average age of people freezing their eggs for elective reasons is 38 many will not qualify for NHS funded IVF with their frozen eggs when they would want to thaw them, due to these age and eligibility requirements. In addition, women seeking to pursue solo motherhood using their frozen eggs will only qualify if they first try artificial insemination or are diagnosed as infertile.
In practice, funding for fertility services is managed by regional clinical commissioning groups (CCGs).The vast majority of CCGs do not offer the recommended number of funded cycles, and many have even stricter eligibility requirements.
People interested in freezing their eggs in the UK have to navigate a for-profit commercial industry. As I have explained, despite being financially well-off individuals, to some degree, financial considerations were important to service users in deciding whether to go ahead with treatment, and how many cycles to undergo. The CMA regulations were recently brought in to address concerns over clinic marketing, as this falls outside the remit of the HFEA, however issues remain regarding clinic transparency over the complete costs of egg freezing treatment.
This piece has highlighted some aspects that service users found difficult to navigate and areas where more attention is needed regarding information about costs. Ultimately this issue will become more pressing as this technology continues to grow in popularity, and it is important to ensure that people have all the information that they need when making decisions about whether to freeze their eggs.