Growing numbers of women are choosing to freeze their eggs in order to delay childbearing until later in life. Some ethicists, however, worry that the existence of oocyte cryopreservation technology places responsibility for juggling career, education, and family-making on women alone.
“I think it is all too easy for this technology to become the ‘solution’ to the ‘problem’ of women’s fertility declining with age,” says Josephine Johnston, director of research and research scholar at The Hastings Center in Garrison, NY.
Another way of viewing the problem, she says, is that that there is a lack of economic, cultural, and structural support for women having babies during their peak fertility.
Cryopreservation does very little to change “the work/life system” that most women find themselves in, says Erin Heidt-Forsythe, PhD, assistant professor in women’s, gender, and sexuality studies and political science at The Pennsylvania State University in University Park.
“There is an economic system that enforces a ‘fertility penalty’ on women who have children,” she notes. This system doesn’t ensure paid family leave, convenient and high-quality child care, or flexible work schedules for parents.
Karey A. Harwood, PhD, associate professor in the Department of Philosophy and Religious Studies at North Carolina State University, says it is worth considering whether egg freezing is a “technological fix” for a social problem that ultimately sells women short.
“Some ethicists raise the concern that oocyte cryopreservation works at cross purposes with efforts to reform the workplace to make it more equitable and family-friendly,” says Harwood.
Inmaculada de Melo-Martín, PhD, MS, professor of medical ethics in medicine at New York City-based Weill Cornell Medical College, says it is ethically problematic to talk about women “wishing” to defer childbearing. “This presents the problem as one that results primarily from women’s free choices,” she says.
Arguably, she says, such “choice” results from social conditions that make it difficult for many women to both have jobs or pursue an education and have children at a younger age.
“Oocyte cryopreservation for healthy women thus medicalizes what is essentially a social problem, reinforces norms about women’s responsibility for their reproductive health, and extends concerns about infertility to healthy women,” says de Melo-Martín. Some other ethical concerns include the following:
• Oocyte cryopreservation is costly, and thus unavailable to many individuals.
While there are higher rates of infertility and impaired fecundity for women and men of lower socioeconomic status, says Heidt-Forsythe, cryopreservation is beyond their financial reach. She argues that this reinforces, rather than alleviates, equal access to medical care around infertility. “Reproductive autonomy thus comes at a price — for those that are willing and able to pay huge sums to freeze their eggs,” says Heidt-Forsythe.
• The benefits of cryopreservation may be exaggerated, and the risks minimized.
Oocyte cryopreservation protocols are quite new, and large safety and efficacy studies are lacking, notes de Melo-Martín. Therefore, the long-term safety and efficacy evidence is non-existent.
“Given this state of affairs, offering this new technology to young healthy women under the guise of ensuring their future fertility is certainly ethically problematic,” de Melo-Martín says.
Many women believe that oocyte cryopreservation ensures a reproductive future by which women can carry pregnancies to term even if they are infertile. “However, in reality, this future is far from secure,” says Heidt-Forsythe. Studies have shown that the use of frozen eggs lowers the success rate for pregnancies brought to term with live births.
“There are currently few guidelines — beyond the American Society for Reproductive Medicine’s professional guidelines — that mandate truthfulness or accuracy in reporting the likelihood of pregnancy for those women that cryopreserve their eggs,” says Heidt-Forsythe.
Johnston fears that prospective users of elective cryopreservation might not be adequately informed about risks. “I have these concerns based on some of the advertising and marketing strategies I have seen,” she says.
Women pay a considerable amount of money to have their oocytes extracted, cryopreserved, and then stored for what might be years, even when they will never come to use the cryopreserved eggs. “Conflicts of interest can thus play a role in recommendations for these procedures,” says de Melo-Martín.
Success rates with egg freezing decline significantly with a woman’s age. “If women are provided with good information, the weighing of risks and benefits ought to be left to them, out of respect for patient autonomy,” says Harwood, adding that potential users of this technology have to be savvy and discerning consumers.
“The caveat emptor approach, with the burden on the buyer to become better informed, seems to be the model governing expectations about oocyte cryopreservation,” Harwood says.
SOURCES
- Inmaculada de Melo-Martín, PhD, MS, Professor of Medical Ethics in Medicine, Weill Cornell Medicine, New York City. Phone: (646) 962-8031. Fax: (646) 962-0281. Email: [email protected].
- Karey A. Harwood, PhD, Associate Professor, Department of Philosophy and Religious Studies, North Carolina State University. Phone: (919) 515-6383. Fax: (919) 513-4351. Email: [email protected].
- Erin Heidt-Forsythe, PhD, Assistant Professor in Women’s, Gender, and Sexuality Studies and Political Science, The Pennsylvania State University, University Park. Phone: (814) 865-1209. Email: [email protected].
- Josephine Johnston, Director of Research/Research Scholar, The Hastings Center, Garrison, NY. Phone: (845) 424-4040 ext. 208. Email: [email protected].
