nonmedical egg freezing, elective egg freezing, postpone motherhood, delayed motherhood, oocyte banking, age banking, banking for anticipated gamete exhaustion
Social egg freezing is storing of eggs from a healthy, fertile woman, who want to delay motherhood because of their career. Other reason for social freezing is waiting for the suitable partner. It is a fact that the best reproductive performance/ability of women is around their 25 years of age. Afterwards pregnancy rates decline relatively fast from 35 years and miscarriage rates rise exponentially. After the age of 43 years, chances of becoming pregnant are very low. It is also a fact that for women, combining career and motherhood, at the same time, is a very difficult. Social freezing has potential to harmonize these incompatibilities. However, it is a worldwide tendency that women decide to give birth in their elder ages, as compared to earlier/20–30 years ago. Nevertheless, it is important to freeze eggs from the best reproductive years to ensure maximum success rate of social freezing outcome.
The social egg freezing technique is made possible by the long-term cryopreservation of egg. Following hormone stimulation, eggs are retrieved from young women, frozen, and stored in liquid nitrogen. Additional protective substances, so-called cryoprotectants, are used to prevent freezing damage. The freezing methods currently in use, slow freezing and vitrification, differ in the speed at which the temperature is lowered and in the amounts and kind of cryoprotectants used. After thawing, fertilization can occur with the aid of IVF via the ICSI. Survival and implantation rates of the once frozen eggs after thawing and insemination show that these techniques are effective and successful freezing procedures. Egg cells can be frozen in a fertilized state (inseminated egg) or an unfertilized state (mature egg). Embryos can be cryopreserved as well.
In many countries, including Germany, there is not yet any legally binding age limit for the use of this technique. In Denmark, by contrast, there is a direct prohibition on technically assisted reproduction for women of 45 and older. The law stipulates a maximum storage period for frozen eggs of five years.
The reasons for and against a legally specified age limit for egg-cell transfer for the purpose of bringing about a pregnancy must therefore be carefully examined. Frequently cited arguments refer to the safety of the procedure for the woman and the child to be born. The benefits and risks of social egg freezing for the child to be born as well as for the woman, should she become pregnant at an advanced age, are discussed. Another point of discussion is the woman’s autonomy. Are women able to make an autonomous decision in favor of social egg freezing, or are they exposed to social pressures that undermine their freedom? Many critical authors adopt a gender perspective in this connection - that is, they also consider social egg freezing under the aspect of the social position of women in society and criticize implicit and explicit mechanisms of oppression. They arrive at the seemingly paradoxical conclusion that women’s emancipation is promoted by placing restrictions on the individual freedom to avail of social egg freezing.
Many of the ethical arguments in favor of egg freezing for nonmedical reasons focus on the liberating potential of egg freezing for women. If biological difference is the root of inequality between men and women, then egg freezing can help level the playing field by lengthening the time during which a woman can become pregnant, because women should also have the right to decide when to reproduce. Egg freezing for nonmedical reasons promotes sex equality. Among its many benefits, egg freezing promotes equal participation in employment, equal participation in educational endeavors, and a more equal amount of time to find a partner. Other benefits include more time to become emotionally and psychologically ready to be a parent, something appreciated by men and women alike. In this way, egg freezing serves as something akin to “reproductive affirmative action”.
An ethical question is whether it is necessary to expose healthy fertile women without inherent infertility factors and their future children to adverse physical outcomes and theoretical psychological problems of the children whose mothers could be taken for their grandmothers. Grandparents, who nowadays help a lot in looking after grandchildren, would be in the case of postponed motherhood (after social freezing) either in a state of health incompatible compared to the energy of the children, or deceased. It has also to be mentioned that later on, these old parents will for the same reasons not be able to look after their grandchildren. And it has also not to be forgotten that the resulting children could be very ashamed to have parents who could be perceived as their grand-parents, possibly leading to psychological problems.
Social egg freezing is possible prevention for age-related fertility decline or chromosomal abnormalities associated with advanced maternal age for those women who prefer to delay motherhood because of their career or want to wait for the suitable partner later in their lives.
Every woman who decided to undergo social freezing of their own eggs should be remembered the fact that success rates for egg freezing vary significantly based on the age of the woman at the time she freezes her eggs. It also raises the question of whether different ethical guidelines ought to be applied to different age-groups.
The ideal age for egg freezing is reportedly about 25 years, but these younger women tend not to consider egg freezing because they believe they have plenty of time and/or they underestimate their natural fertility decline after age 35 years.
Currently, the average reported age of women who freeze their eggs is 38 years, but that may be too late. By 38 years, the quality of a woman’s eggs is already in decline. Unfortunately, studies have shown that women do not consider egg freezing until precisely that age: late 30s or older.
Finally, egg freezing can play a role in enabling childbearing for gays, lesbians, and unmarried persons. For example, a gay male couple could procure a frozen donor egg and the services of a surrogate mother in order to complete IVF. A lesbian couple might freeze their eggs while searching for donor sperm. As society moves closer to accepting a universal human interest in reproducing that is not confined to a heterosexual norm, it becomes more difficult to justify the denial of access to assisted reproductive technologies on the basis of sexual orientation and/or marital status. In a 2013 statement by its ethics committee, the ASRM called for programs providing fertility services to “treat all requests for assisted reproduction equally without regard to marital/partner status or sexual orientation.” They supported their recommendation with research that suggests children are not harmed in their development by being raised by same-sex parents. They also noted that claims of physician autonomy or religious freedom are not legitimate bases for discrimination on the basis of sexual orientation.
Against the self-determined decision of women in favor of social egg freezing, it is argued that women are pressed into making the decision by social conditions and hence are not in a position to decide autonomously. Other concerns could be the possibility of creating high (and potentially false) hopes and introducing medical processes to primary fertile women.
Nowadays, hormonal stimulation with ensuing egg collection prior to the freezing process can be conducted with a very low risk of less than 1% for complications such as bleeding or ovarian hyperstimulation syndrome (OHSS). The risks directly associated with egg retrieval are very slight. According to the current state of science, there is only a slight risk of damage to the woman’s body through egg retrieval and the associated preparation (bleeding, infection, injury to other organs or complications due to anaesthesia).
Further sources of concern regarding the safety of the process are freezing damage and the toxicity of cryoprotective agents (CPA). Potentially affected by freezing damage are, in particular, the spindle apparatus and the associated arrangement of chromosomes. However, the spindle apparatus recovers after thawing and seems to do so without alterations in >80% of the cases. The older the woman is at the time the cells are frozen, however, the greater the damage to the spindle apparatus after thawing. As egg freezing is followed by ICSI, there could be risks associated with the treatment.
Eggs would undergo further aging due to the freezing process and that, as a consequence, one cannot predict what birth rates will be achieved with the technique, especially when eggs are collected from women over the age of 35. While egg freezing for women aged over 38 years need not be banned outright, there should be candid disclaimers about the low probability of successful thawing, fertilization, implantation, and live birth. Without this transparency and truthful disclosure, egg freezing for women aged over 40 years becomes the ultimate snake oil: an expensive procedure that is not much more than an empty promise.
Medically speaking, pregnancies of women of 35 and older are considered to be high-risk pregnancies. The debate over social egg freezing also addresses the ability of late mothers to cope with physical and psychological stress. Nevertheless, older mothers have many resources, such as partnership and economic security that constitute a favorable living situation for late motherhood. Age also has positive effects on parenthood. Children of older mothers (older than 35 years) are more likely to be born into a stable family environment.
So, are there sufficient reasons for a legally stipulated limit on the age of the woman at the time of the implantation of the embryo in order to prevent women from using this technique at an advanced age? Late pregnancy is in fact associated with increased risks for the woman. However, these vary between individuals and are not generally higher than in the case of other medical interventions in which people are considered to be capable of making an informed decision, such as a sterilization operation. Another reason to limit the age of women would be the risk for the child to be orphaned at a young age.
Finally, there couldn’t be any guarantee of becoming pregnant after social egg freezing, although a woman has lots of stored eggs. The risk of reaching 45 or 50 years of age without becoming pregnant, despite of a lot of physical and psychological stress (not to mention the financial issues) is not negligible.
The fact that the average age of women opting for social egg freezing is currently 38 is not evidence that poor success rates are achieved with the procedure in principle, but is instead an argument for improved social information and education concerning the procedure. The success of the technique cannot be promised with certainty since even IVF without social egg freezing leads to conception and the birth of a child only in a maximum of 30% of cases.
The reproductive success depends on the age of the egg, not on the age of the uterus. Even if studies of age effects on the uterine function show a decreasing uterine capacity to adopt to and manage the gestational changes that are mostly explained by an impaired myometrial function and impaired decidual and placental development at later age, it remains unclear how severe these decreases are. Thus, it is important to freeze eggs from the best reproductive years (about 25 years) to ensure maximum success rate of social freezing outcome.
Arguments that oppose egg freezing, or at least find it sufficiently problematic to justify restricting in some way, often identify harms believed to be significant enough to warrant limiting individual autonomy. First among these would be harms to women themselves, including raising false hopes and commercial exploitation. Given the very low success rates of egg freezing for women in their 40s, the potential for commercial exploitation undeniably exists. Second would be harms to children. Available data suggest that children born from egg freezing and IVF do not experience any statistically significant physical or developmental harm, although long-term studies are not yet available. Both the low success rates of egg freezing for older women and concerns about setting up a situation where the early death of a parent is more likely could warrant imposing age limits for egg freezing and/or IVF. Finally, there are social harms to consider, including exacerbating a class divide based on who can afford to access the technology and reinforcing a “bioessentialist” understanding of family that requires genetic connection between parent and child.
The positive aspects of late motherhood like equal participation by women in employment, more time to choose a partner, better financial opportunities for the child and a reduction of genetic risks have to be taken into account. Existing data indicate that the process does not entail any significant increase in the risk of a malformation in the child. Even though the risk of morbidity and mortality in a later pregnancy is increased for the woman, the level of interindividual differences is large.
Finally, the assertion that social egg freezing is a technical pseudo-solution to a social problem rests on two questionable premises. First, it presupposes that the availability of social egg freezing will entail that other measures to promote the compatibility of career and family will be restricted or fail to be taken altogether. It is hard to render such a linkage plausible. Even when women have children later in life, they will still need structural support to combine their job and childcare. Besides, as gender roles change, men will claim a better compatibility of job and family as well. Those who assert that social egg freezing is a technical pseudo-solution to a social problem presuppose that, in a society in which genuine equality had been realized, all women would want to have their children at a young age. However, this is not plausible either, since presumably even under such optimal conditions some women - as now already many men - would want to postpone having children to a time when they have already made important career moves or their life situation seems compatible with starting a family.