Ethical and legal analysis of advertising for planned oocyte cryopreservation

This goal of this study is to conduct an ethical and legal analysis of advertising for planned oocyte cryopreservation (OC) targeted towards younger women.

This study involves a comparison of advertisements by commercial OC companies to ethical and legal standards for advertising.

Advertisements by 8 prominent egg freezing companies were reviewed, including materials from the companies’ websites, ads on social media, and comments made to the news media. Ethical standards for medical advertising were reviewed and applied, including historical codes of the American Medical Association, ACOG and ASRM policies on ethical advertising, as well as standards per the bioethics literature. Legal standards for truthful advertising were reviewed, including the Federal Trade Commission Act, the Food, Drug and Cosmetic Act and the Lanham Act. Drawing on recent studies on the safety, utility, and cost-effectiveness of planned OC for younger women, the companies’ advertisements were evaluated against the legal and ethical standards described.

According to the prevailing legal and ethical standards on truth in advertising, some advertisements by leading OC companies could be considered unethical, misleading, deceptive, and/or unfair. For example, presenting anti-Mullerian hormone (AMH) as a stand-alone test of future fertility is misleading given recent studies that question the utility of AMH as a marker of fertility, particularly by itself. Furthermore, advertising by commercial egg freezing companies generally omits information regarding the low usage rates of electively cryopreserved eggs, estimates of cost-effectiveness for cryopreservation at different ages, and the risks of delaying pregnancy to an advanced maternal age.

Leading commercial egg freezing companies specifically target younger women in their advertisements and convey the message that planned OC allows women to take control of their future fertility and free themselves of biological limitations. Some of the claims made and not made in advertisements by OC companies fail to adhere to ethical and legal standards for truth in advertising. Women, including young women in their twenties, should have the option to pursue OC if they so choose, but to truly respect their autonomous decision-making, they must be presented with truthful and non-deceptive information about their options. Although patients will discuss the procedure with a reproductive endocrinologist before ultimately choosing to proceed, marketing strategies that bring patients through the door have the power to shape patients’ impressions, goals and expectations. Misleading advertising places a heavy burden on reproductive endocrinologists to correct misconceptions, clarify current best evidence, and assist patients in making informed decisions. Further study is warranted to determine to what extent current advertising strategies impact young women’s decision to undergo OC, and what onus is placed on clinicians to ensure balanced, knowledge-based shared decision-making with their patients.