According to the Human Fertilisation and Embryology Authority (HFEA, 2021), ‘egg freezing is one way of preserving a woman's fertility so she can try to have a family in the future. It involves collecting a woman's eggs, freezing them, and then thawing them later so they can be used in fertility treatment’. Such oocyte preservation for non-medical indications has also been called ‘elective egg freezing’, ‘social egg freezing’, or ‘oocyte banking for anticipated gamete exhaustion (AGE)’, states Polyakov and Rozen (2021), who also note that in the UK, there is a 10% annual growth in the number of women who participate in AGE banking.
Given that we appear to be at the dawn of a new oocyte-related ice age, there are ethical aspects of the procedure that perhaps deserve consideration. The Royal College of Obstetricians and Gynaecologists (RCOG, 2018) has urged caution, observing that ‘the procedure does not guarantee success and there are high private treatment costs, as well as the side effects associated with egg freezing and IVF treatment’. The high cost is confirmed by the HFEA (2021), who state that ‘the whole process for egg freezing and thawing costs an average of £7 000–£8 000’.
However, as the RCOG (2018) indicates, the debate over social egg freezing is a nuanced one. For example, while acknowledging that egg freezing indirectly encourages women to have children at an advanced maternal age, with a significantly increased risk of medical complications in pregnancy, Bracewell-Milnes et al (2018) nevertheless argue that social egg freezing should continue to be undertaken ‘for those single women in their late 30s for whom the high costs and low success are acceptable.’
They maintain, however, that by educating women from an early age, ‘this would allow women to plan their reproductive behaviour more realistically, present to fertility clinics at a younger age, thus reducing the chance of involuntary childlessness’ (Bracewell-Milnes et al, 2018). But Jones et al (2018) are clear that ‘women should no longer be punished with childlessness for not finding a partner, nor should they feel pressured into a relationship because of their declining ovarian reserve’. Further, Jones et al (2018) contend that social egg freezing ‘extends the window of opportunity for single women to find a partner and offers them hope where their “biological clock” would otherwise run out of time’.
Expanding the scope of the debate, Petersen (2021) considers the argument that women ought not to use social egg freezing ‘as it is an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market’, yet concludes that if the procedure confers some benefits on women by making ‘it easier for them to balance career and family life, this will, all else being equal, bring greater equality between as least some women and some men when it comes to having children, reproductive freedom and career opportunities'. Petersen (2021) further suggests that there is little or no evidence that women's use of social egg freezing will distract from attempts to reach social solutions to social problems, such as those posed by a labour market that favours men at the expense of the career prospects of women, asserting that ethical discussion of social egg freezing ‘usually attracts attention to the huge social moral problems that women often face in the current labour market’.
Responding to Petersen (2021), Wall (2021) invokes the character Olaf from the Disney film Frozen 2 (2019) who says of advancing technologies that they are both our ‘saviour and our doom’. Noting that feminist scholars will agree with the premise that social egg freezing is an ‘individualistic and morally problematic solution to the social problems that women face’, Wall (2021) cites those who argue that this does not mean that they agree with the conclusion that women should not use social egg freezing: ‘We can maintain that [social egg freezing] is both our saviour and our doom, without having to rely on the dichotomy between the individual and the social’. Perhaps it is the case, as Wall (2021) reflects, that social egg freezing ‘is closing the gap between men and some women (our saviour), while leaving social solutions to gender inequality frozen (our doom)’.
With the reproductive landscape continually evolving, it seems likely that the ethics of social egg freezing might be a topic that will engage the midwifery profession in the not-too-distant future.