The revision of the French bioethics law and the questions it raises for the future of funding for egg freezing

Proost, Michiel De; Johnston, Molly

doi:10.1016/j.rbmo.2021.12.002

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Unlike egg freezing due to medical reasons, which is often subsidized (e.g., in 14 out of 27 countries in Europe, as well as in Australia and Israel [ 12 , 32 ];), EEF is privately funded [ 33 , 36 ]. As mentioned, the only exception is that of France, where EEF has only been ratified in 2021, but was then granted partial subsidy, thereby challenging the established distinction between medical and non-medical EF as a main funding criterion [ 22 ].…”

Section: Elective Egg Freezing – Policy Funding Equitymentioning

confidence: 99%

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Too much equity – is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel

Birenbaum‐Carmeli

2023

Int J Equity Health

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Background The preservation of human ova for future fertilization has been made available to healthy women in 2011–2012. This treatment, dubbed elective egg freezing (EEF), is undertaken primarily by highly educated unpartnered women without children, concerned of age-related fertility decline. In Israel, treatment is available to women aged 30–41. However, unlike many other fertility treatments, EEF is not state subsidized. The public discourse of EEF funding in Israel is the focus of the present study. Method The article analyzes three sources of data: press presentations of EEF; a Parliamentary Committee discussion dedicated to EEF funding; interviews with 36 Israeli women who have undertaken EEF. Results Numerous speakers raised the issue of equity, claiming that reproduction was a state interest and therefore, a state responsibility, including securing equitable treatment to Israeli women of all economic strata. Highlighting the generous funding of other fertility treatments, they claimed that EEF was inequitable, discriminating against poorer single women, who could not afford it. Few actors, however, rejected state funding as intervention in women’s reproductive lives and called for reconsideration of the local reproductive imperative. Conclusion The invocation of equity by Israeli users of EEF, clinicians and some policy makers as grounds for a call to fund a treatment that serves a well-established subpopulation seeking to relieve a social rather than a medical problem, illustrates the profound context-embeddedness of notions of health equity. More generally, it may suggest that using an inclusive language in a discourse of equity may potentially be invoked so as to promote the interests of a particular subpopulation.

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Section: Elective Egg Freezing – Policy Funding Equitymentioning

confidence: 99%

“…Levels of use are relatively low. According to various studies, 3 to 38% of the women return to clinics in order to have their ova thawed and fertilized [ 22 ].…”

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confidence: 99%

Too much equity – is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel

Birenbaum‐Carmeli

2023

Int J Equity Health

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“…Increased utilization of EEF coincides with greater availability and public awareness coupled with considerable media attention ( Ethics Committee of the American Society of Reproductive Medicine, 2018 ; Platts et al , 2021 ; Giannopapa et al , 2022 ). In addition, regulatory changes to gamete storage time limits in the UK, and the introduction of EEF in France and Singapore ( De Proost and Johnston, 2022 ; UK Government, 2022 ; Chin et al , 2023 ), means that more women are considering the option.…”

Section: Introductionmentioning

confidence: 99%

Eggsurance? A randomized controlled trial of a decision aid for elective egg freezing

Sandhu,

Hickey,

Koye

et al. 2024

Human Reproduction

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STUDY QUESTION Does a purpose-designed Decision Aid for women considering elective egg freezing (EEF) impact decisional conflict and other decision-related outcomes? SUMMARY ANSWER The Decision Aid reduces decisional conflict, prepares women for decision-making, and does not cause distress. WHAT IS ALREADY KNOWN Elective egg-freezing decisions are complex, with 78% of women reporting high decisional conflict. Decision Aids are used to support complex health decisions. We developed an online Decision Aid for women considering EEF and demonstrated that it was acceptable and useful in Phase 1 testing. STUDY DESIGN, SIZE, DURATION A single-blind, two-arm parallel group randomized controlled trial was carried out. Target sample size was 286 participants. Randomization was 1:1 to the control (existing website information) or intervention (Decision Aid plus existing website information) group and stratified by Australian state/territory and prior IVF specialist consultation. Participants were recruited between September 2020 and March 2021 with outcomes recorded over 12 months. Data were collected using online surveys and data collection was completed in March 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Females aged ≥18 years, living in Australia, considering EEF, proficient in English, and with internet access were recruited using multiple methods including social media posts, Google advertising, newsletter/noticeboard posts, and fertility clinic promotion. After completing the baseline survey, participants were emailed their allocated website link(s). Follow-up surveys were sent at 6 and 12 months. Primary outcome was decisional conflict (Decisional Conflict Scale). Other outcomes included distress (Depression Anxiety and Stress Scale), knowledge about egg freezing and female age-related infertility (study-specific measure), whether a decision was made, preparedness to decide about egg freezing (Preparation for Decision-Making Scale), informed choice (Multi-Dimensional Measure of Informed Choice), and decision regret (Decision Regret Scale). MAIN RESULTS AND THE ROLE OF CHANCE Overall, 306 participants (mean age 30 years; SD: 5.2) were randomized (intervention n = 150, control n = 156). Decisional Conflict Scale scores were significantly lower at 12 months (mean score difference: −6.99 [95% CI: −12.96, −1.02], P = 0.022) for the intervention versus control group after adjusting for baseline decisional conflict. At 6 months, the intervention group felt significantly more prepared to decide about EEF than the control (mean score difference: 9.22 [95% CI: 2.35, 16.08], P = 0.009). At 12 months, no group differences were observed in distress (mean score difference: 0.61 [95% CI: −3.72, 4.93], P = 0.783), knowledge (mean score difference: 0.23 [95% CI: −0.21, 0.66], P = 0.309), or whether a decision was made (relative risk: 1.21 [95% CI: 0.90, 1.64], P = 0.212). No group differences were found in informed choice (relative risk: 1.00 [95% CI: 0.81, 1.25], P = 0.983) or decision regret (median score difference: −5.00 [95% CI: −15.30, 5.30], P = 0.337) amongst participants who had decided about EEF by 12 months (intervention n = 48, control n = 45). LIMITATIONS, REASONS FOR CAUTION Unknown participant uptake and potential sampling bias due to the recruitment methods used and restrictions caused by the coronavirus disease 2019 pandemic. Some outcomes had small sample sizes limiting the inferences made. The use of study-specific or adapted validated measures may impact the reliability of some results. WIDER IMPLICATIONS OF THE FINDINGS This is the first randomized controlled trial to evaluate a Decision Aid for EEF. The Decision Aid reduced decisional conflict and improved women’s preparation for decision making. The tool will be made publicly available and can be tailored for international use. STUDY FUNDING/COMPETING INTEREST(S) The Decision Aid was developed with funding from the Royal Women’s Hospital Foundation and McBain Family Trust. The study was funded by a National Health and Medical Research Council (NHMRC) Project Grant APP1163202, awarded to M. Hickey, M. Peate, R.J. Norman, and R. Hart (2019–2021). S.S., M.P., D.K., and S.B. were supported by the NHMRC Project Grant APP1163202 to perform this work. R.H. is Medical Director of Fertility Specialists of Western Australia and National Medical Director of City Fertility. He has received grants from MSD, Merck-Serono, and Ferring Pharmaceuticals unrelated to this study and is a shareholder of CHA-SMG. R.L. is Director of Women’s Health Melbourne (Medical Practice), ANZSREI Executive Secretary (Honorary), RANZCOG CREI Subspecialty Committee Member (Honorary), and a Fertility Specialist at Life Fertility Clinic Melbourne and Royal Women’s Hospital Public Fertility Service. R.A.A. has received grants from Ferring Pharmaceuticals unrelated to this study. M.H., K.H., and R.J.N. have no conflicts to declare. TRIAL REGISTRATION NUMBER ACTRN12620001032943 TRIAL REGISTRATION DATE 11 August 2020 DATE OF FIRST PATIENT’S ENROLMENT 29 September 2020

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“…This hypothesis was recently echoed in the report of ESHRE on fertility preservation and the Nuffield Council on Bioethics [ 7 , 13 ]. However, the recent revision of the French bioethics law has defied all predictions and decided to offer partial reimbursement of the clinical procedure costs of ‘non-medical’ egg freezing [ 14 ]. Johnston et al argued that the growing demand for SEF triggers the need for reviewing public funding [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

‘I feel that injustice is being done to me’: a qualitative study of women’s viewpoints on the (lack of) reimbursement for social egg freezing

Proost

Coene

Nekkebroeck³

et al. 2022

BMC Med Ethics

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Background During the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium. Methods To understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis. Results We identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free. Conclusions This research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance.

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The revision of the French bioethics law and the questions it raises for the future of funding for egg freezing

Cited by 9 publications

References 9 publications

Too much equity – is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel

Too much equity – is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel

Eggsurance? A randomized controlled trial of a decision aid for elective egg freezing

‘I feel that injustice is being done to me’: a qualitative study of women’s viewpoints on the (lack of) reimbursement for social egg freezing

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