The Ethics of Egg Freezing
What's wrong with women resetting their biological clocks?
"My parents want me to have this as a gift," say many of the patients of fertility specialist Dr. Daniel Shapiro, the medical director of Reproductive Biology Associates in Atlanta. The gift is financial support for retrieving and freezing their daughters' eggs.
More and more American women are waiting until they are older to have children. Why? Because they are building their careers and waiting for Mr. Right. But what if Mr. Right fails to come along before age 35? As the biological clock ticks along the chances of having biologically related children steeply diminish. Some women are now taking advantage of "fertility insurance" by having fertility clinics retrieve and freeze their eggs. The new trend for would-be grandparents to pay for this new fertility preserving procedure was reported in mostly approving terms last week on the front page of The New York Times.
While many women put off childbearing as their careers develop, others are stuck waiting for their relationships to reach the next level, thanks to the fecklessness of modern men. Many women in their late 20s and early 30s are in long-term relationships with men whom they think will eventually father their children. The relationship doesn't work out and the women find themselves without a partner in their mid-30s or later.
Demographic trends over the past 50 years also must also be taken into account. Before the advent of the contraceptive pill in 1960, the median age for marriage for women and men was 20.3 and 22.8 years respectively. In 2010, the median age for marriage had risen to 26.1 and 28.2 years. In addition, the average age of mothers at first birth has increased [PDF] from 21.4 in 1970 to 25.2 in 2009. The most recent vital statistics report by the Centers for Disease Control and Prevention noted [PDF] that in 2009 the "rate of 39.1 births per 1,000 women aged 15'"19 was the lowest ever reported in the nearly seven decades for which a consistent series of rates is available." On the other hand, the birthrate for women aged 35-39 was 46.5 births per 1,000 women. In fact, more children were born to women over age 35 than to women under age 20.
Every advance in assisted reproduction comes with ethical questions, and this one is no different. First, should it be done at all? In her 2009 article, "Egg Freezing: A Breakthrough for Reproductive Autonomy," North Carolina State University philosopher Karey Harwood notes that infertility occurs when a normal biological process is impeded by disease or defect. Thus assisted reproduction techniques are used to treat the illness of infertility.
However, women who decide to have their eggs frozen are not infertile. They are making an "elective" or "social" choice to take advantage of egg freezing. Does this make any ethical difference? No, argues Harwood. She points out that contraception and non-therapeutic abortion are both "elective" and do not treat an illness. "The analogy to a contraceptive pill is apt because both egg freezing and the pill can effectuate delayed reproduction," writes Harwood. "Because egg freezing may be reasonably interpreted as another form of family planning, it can be considered a legitimate exercise in reproductive autonomy."
In addition, freezing eggs gets around the moral assertion that frozen embryos are persons since uninseminated eggs do not have two sets of genes derived from parents. Of course, using frozen eggs later to create embryos via in vitro fertilization (IVF) techniques for implantation into a woman's womb is likely to run into that objection eventually. Standard IVF techniques often involve producing extra embryos that are frozen as backups to be used if those initially introduced into a woman's womb fail to implant or if patients later desire additional children. Consequently, there are often frozen embryos leftover once IVF treatments have been completed. Using frozen gametes, both eggs and sperm, means that people using this assisted reproduction technique might not have to make decisions about what should be done with any leftover embryos.
In addition, to the above ethical arguments, some ethicists deploy three other objections to this new way to extend women's fertility; (1) false hope, (2) harm to children, and (3) inappropriate commercialization.
The biological clock ticks relentlessly away so that typically a woman's fertility (defined as probability of getting pregnant during a year) falls from 86 percent at age 20 to 52 percent at age 35. Thereafter it drops ever more steeply to 36 percent by age 40 and 5 percent by age 45.
The claim that egg freezing as a kind of "fertility insurance" engenders false hope in women who aim to preserve and extend their fertility rests chiefly on two concerns. The first is women may overestimate the real chances of having a baby using this technique. If the relevant standard is the success rate to other IVF techniques, then recent data from several clinics indicates that the rate of live births using frozen eggs is comparable, about 1 in 3 cycles results in a live birth.
The other issue is that women who hear of the technique will wait too long before taking advantage of it. Clinical evidence strongly suggests that the chances of having a baby is greater for women who choose to freeze their eggs before age 35. This is because eggs frozen after that age do not grow and implant as readily. Older eggs are far more likely to have flaws that prevent them from developing into babies than younger eggs do.
Another ethical concern is that children born from frozen eggs are disproportionately at risk for various physical and mental harms. Already some 2,000 children may have been born using frozen eggs. Preliminary indications are that rate of birth defects among such children is comparable to that of children born by means of conventional IVF techniques. For example, a 2009 study looked at 936 live births from frozen eggs and reported, "Compared with congenital anomalies occurring in naturally conceived infants, no difference was noted." Of course, since the technique is so new, researchers need to keep an eye on children born using this technique to see if any deleterious consequences arise in the longer term.
The final set of ethical objections centers on claims that this technique furthers the medicalization and commercialization of women's bodies. Of course, it is women who are choosing voluntarily to take advantage of this technology. They must believe that it can benefit them and further the development of their life plans. Providers of this service do get paid (the whole process can cost as much as $20,000 out of pocket), but so too do lawyers, teachers, car mechanics, plumbers, and everybody else. There is no compelling ethical reason to believe that fertility specialists should not be fairly compensated at market rates for their services.
Some ethicists argue that egg freezing amounts to an illegitimate technological fix to some of the persistent problems of sexual inequality. In this case, the ethical thing to do is to change workplaces so that there is less conflict between bearing children and women's careers. In addition, public policy should be steered in directions that would encourage women to avoid the problem of age-related infertility simply by having children at younger ages. However, the case of France suggests that contemporary attempts to shift public policy in directions friendly to childbearing and rearing may have limits. In pronatalist France, the average age for first childbirth is 29.9 years, and despite all sorts of social programs aimed at easing the burdens of child rearing, French women have a lower labor force participation rate than do American women.
On the other hand, egg freezing actually promotes equality between the sexes. Oxford University philosophers Imogen Goold and Julian Savulsecu correctly point out, [PDF], "Men already enjoy the choice of when they have children. Women should have the opportunity to enjoy the same choices as men, if we can provide them, unless there are good reasons not to."
Instead of dismissing egg freezing as a mere biomedical work-around, it should be celebrated as another way in which technological progress is reducing and ameliorating inequalities between women and men, reproductive and otherwise.
Ronald Bailey is Reason magazine's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.
