Abstract
As oocyte and ovarian tissue cryopreservation techniques continue to improve [2, 3], there is a growing need to address the moral permissibility of what has been called ‘social’ egg freezing.1 Often used to preserve the fertility of cancer patients, egg freezing has recently gained popularity among women wishing to guard themselves against age-related infertility. Higher education, career advancement, an increased cost of living and difficulties finding a long-term partner are just some of the reasons why a number of women are having children at an older age [4, 5].
Of course some women, for various reasons, choose to embrace motherhood later than their own mothers. But many, like me, become older mothers because there was no other choice. It’s just how my life unfolded… . To suggest that most women are choosing to delay child-bearing is to suggest that women have an incredible level of control over their lives. In the real world this is just not true.
– Sushi Das [1]
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Notes
- 1.
In this chapter I shall use the term ‘egg freezing’ to refer to the initial and subsequent phases of fertility preservation methods for women. These include the initial removal and cryopreservation of oocytes, ovaries and ovarian tissue as well as the subsequent in vitro maturation of immature oocytes, in vitro fertilization and ovarian transposition.
- 2.
Although, the phrase ‘delayed attempts at childbearing’ can describe a women’s attempt to conceive and have children at an older reproductive age, it should be noted the phrase is problematic because it can imply that women who have (or attempt to have) children when they are older do so ‘voluntarily’. As I will argue in this chapter, the ‘choice’ to delay childbearing may not be fully voluntary.
- 3.
For example, bone marrow or stem cell transplantations, oophorectomy for cancer prophylaxis or benign conditions can threaten women’s fertility. Certain autoimmune and rheumatological conditions can also lead to infertility.
- 4.
Karey Harwood describes social egg freezing as ‘insurance against age-related infertility’. My use of ‘age-related’ infertility thus picks up on Harwood’s description, but avoid the assumption that egg freezing is ‘insurance’ that guarantees successful pregnancies when frozen eggs are thawed and used in the future.
- 5.
The ASRM defines experiments as ‘a procedure for the treatment of infertility is considered experimental until there is adequate scientific evidence of safety and efficacy from appropriately designed, peer-reviewed, published studies by different investigator groups’. Until there is ‘adequate peer-reviewed scientific evidence’, egg freezing will be considered an ‘experimental’ procedure regardless of improved rates of success in clinical trials and fertility clinics.
- 6.
The success of egg freezing technology varies with respect to the specific procedure being offered (including the processes by which eggs are frozen and thawed, the method/site of re-implantation) and also the relevant features of the patient (such as age and health). Many people worry that because using egg freezing technology to reproduce is less certain than using ‘natural’ conception within the optimal reproductive age (20–35), women (and couples) risk being exploited by fertility clinics and risk developing ‘false hope’ concerning the procedure’s success.
- 7.
Although the ASRM warns women that there is a risk to future offspring due to the effects of cryopreservation on meiotic spindle of the oocyte, there remain concerns regarding the potential for chromosomal aneuploidy or other karyotypic abnormalities in offspring; some studies have suggested that oocyte cryopreservation produces risks to offspring that are actually comparable to ‘natural’ conception. However, given the experimental nature of female fertility preservation techniques, the risks are largely unknown.
- 8.
The use of the term menopause might be slightly misleading since female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35.
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Acknowledgments
Thanks to the Joseph L. Rotman Institute of Science and Values for research assistance and a special thanks to Professor Carolyn McLeod for her helpful suggestions and ongoing support. This research was supported by the oncofertility consortium NIH 8UL1DE019587, 5RL1HD058296.
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Petropanagos, A. (2010). Reproductive ‘Choice’ and Egg Freezing. In: Woodruff, T., Zoloth, L., Campo-Engelstein, L., Rodriguez, S. (eds) Oncofertility. Cancer Treatment and Research, vol 156. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-6518-9_17
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