Between “Medical” and “Social” Egg Freezing

Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between “medical” and “social” egg freezing (MEF and SEF)—contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the “regulatory boundary-work” around the “medical”–”social” distinction in different egg freezing regulations. Based on systematic documents’ analysis we present a cross-national comparison of the way the “medical”–”social” differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness—highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between “medical” and “social” are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects.

‘At least I have done something’: A qualitative study of women's social egg freezing experiences

Social egg freezing has become an expanding clinical practice and there is a growing body of empirical literature on women's attitudes and the sociocultural implications of this phenomenon. Yet, its impact remains subject to ethical controversy. This article reports on a qualitative study, drawing on 18 interviews with women who had elected to initiate at least one egg freezing cycle in Belgium. Our findings, facilitated by a ‘symbiotic empirical ethics’ approach, shed light on the concerns and perceptions that accompany women's decisions while supporting a more context-sensitive reading of the ethical debate. We identified three key themes: feeling overwhelmed with uncertainty and a threatening future, bodily discomfort and distress during the medical process, and the endless pursuit of peace of mind. One of the issues that emerges from these findings is the risk ritual function of social egg freezing, referring to routine actions of risk anticipation that mitigate uncertainty and express a sense of individual responsibility. While more research is needed, this conceptualisation provides a starting point to flesh out the wider context of this moral practice and its symbolic meaning for women.

Kinderwunsch in der menopausalen Übergangszeit

Zusammenfassung. Die menopausale Übergangszeit ist gekennzeichnet durch den Verlust der Eizellreserve, das heisst der Zahl und Qualität der Oozyten. Diese Beeinträchtigung führt zu einer schnellen und massiven Abnahme der Fertilität. Die Eizellreserve lässt sich mit der Messung von FSH und AMH im Serum bestimmen sowie mit der Zählung der ultrasonografisch sichtbaren Follikel, dem sogenannten «antral follicle count» (AFC). Therapeutisch können zur Erfüllung des Kinderwunsches homologe Behandlungen wie monofollikuläre Hormonstimulationen und die In-Vitro-Fertilisation eingesetzt werden. Wesentlich aussichtsreicher ist jedoch meist die heterologe Eizellspendenbehandlung. Präventiv wird zunehmend die Methode des «Social Egg Freezing» angewendet.

‘I feel that injustice is being done to me’: a qualitative study of women’s viewpoints on the (lack of) reimbursement for social egg freezing

Background During the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium. Methods To understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis. Results We identify three themes: (1) From ongoing concern to non-issue; (2) Negotiating the reimbursement for social egg freezing; (3) From fully out-of-pocket to (partial) free good. In the first theme, we found that some women were concerned about the cost of social egg freezing and the lack of clear information about it. Furthermore, they reported moral sentiments of injustice which they attributed to their lack of acknowledgement for their struggles and needs. Other women perceived the reimbursement controversy of social egg freezing as something far removed from their lived experience. The second theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment unbefitting reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free. Conclusions This research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. Based on our results, it seems an oversimplification to portray social egg freezers as merely affluent women who are not concerned about the coverage of egg freezing costs. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them express a preference or a need for reimbursement.

Social Freezing: Pressing Pause on Fertility

Increasing numbers of women are undergoing oocyte or tissue cryopreservation for medical or social reasons to increase their chances of having genetic children. Social egg freezing (SEF) allows women to preserve their fertility in anticipation of age-related fertility decline and ineffective fertility treatments at older ages. The purpose of this study was to summarize recent findings focusing on the challenges of elective egg freezing. We performed a systematic literature review on social egg freezing published during the last ten years. From the systematically screened literature, we identified and analyzed five main topics of interest during the last decade: (a) different fertility preservation techniques, (b) safety of freezing, (c) usage rate of frozen oocytes, (d) ethical considerations, and (e) cost-effectiveness of SEF. Fertility can be preserved for non-medical reasons through oocyte, embryos, or ovarian tissue cryopreservation, with oocyte vitrification being a new and optimal approach. Elective oocyte cryopreservation is better accepted, supports social gender equality, and enhances women’s reproductive autonomy. Despite controversies, planned oocyte cryopreservation appears as a chosen strategy against age-related infertility and may allow women to feel that they are more socially, psychologically, and financially stable before motherhood.

P-352 Beyond individualisation: towards a more contextualised understanding of women’s social egg freezing experiences

Study question What are the moral perceptions and views of women considering social egg freezing? Summary answer Participants did not perceive egg freezing as a morally problematic solution to societal problems but addressed concerns about relationship formation and wanted more social efforts. What is known already Central to the social egg freezing debate is the individualisation argument which underlines the idea that it is morally problematic to use individual medical-technological solutions, such as egg freezing, to solve the societal challenges women face, for instance in the current labour market. It has been said that, instead of quick medical-technical solutions that target individual women’s bodies, we should focus on substantive changes that target the androcentric work culture. This theme relates to feminist concerns about unnecessary medicalisation geared towards women. Furthermore, there is a call for more empirical studies to back up this central normative claim. Study design, size, duration Seventeen participants were recruited by psychologists working in two Belgian centres for reproductive medicine which offer egg freezing for social reasons. In addition, four participants were recruited through via social networks. Interviews took place between February 2019 and November 2020 at a location of the participants’ preference or through online video connections. Participants/materials, setting, methods At the beginning of the interview, open questions were asked to invite the participants to speak about social egg freezing in their own words. In the second part of the interview, we used four cards with controversial statements based on a study of the bioethics literature, to encourage the participants to reflect about ethical concerns. In this part, we engaged in Socratic dialogue. For the analysis, thematic analysis was used combined with interdisciplinary collaborative auditing. Main results and the role of chance This is the first study providing empirical evidence about (potential) egg freezers’ moral reasoning about individualisation arguments. Most participants in our study could make sense of the individualisation argument but emphasised another societal challenge rather than the current labour market. They highlighted ‘the lack of a partner relationship’ as driving their motivation for this procedure. The shortage of eligible partners has been well defined in social science scholarship about social egg freezing but this element has rarely been articulated in the premises of individualisation arguments. This topic of relationships is challenging to analyse from a normative perspective because it was experienced as much more personal and intimate by the women in our study than for instance measures to realise more fair labour conditions, such as improved access to childcare. Some participants believed egg freezing resulted from individual problems and found the individualisation argument not applicable to their own situation. Furthermore, no participant found the individualisation argument legitimate to depict social freezing as morally problematic. Nonetheless, the participants showed a sense of sympathy with women who lack access to egg freezing and were in favour of societal solutions in several public domains. Limitations, reasons for caution Given that we report on a small-scale qualitative study of possible social egg freezers at two Belgian fertility clinics, and that our study foregrounds the voices of mostly white higher educated women who were able to afford this technology, our results cannot be generalised to all social egg freezers. Wider implications of the findings Our findings can contribute to a better understanding of previously identified normative arguments (e.g., individualisation and unnecessary medicalisation). There is a definite need to further analyse the complex interplay between respecting autonomous choices and evaluating contextual factors in this debate and other practices where similar individualisation arguments are used. Trial registration number Not applicable

P–352 Beyond individualisation: towards a more contextualised understanding of women’s social egg freezing experiences

Study question What are the moral perceptions and views of women considering social egg freezing? Summary answer Participants did not perceive egg freezing as a morally problematic solution to societal problems but addressed concerns about relationship formation and wanted more social efforts. What is known already Central to the social egg freezing debate is the individualisation argument which underlines the idea that it is morally problematic to use individual medical-technological solutions, such as egg freezing, to solve the societal challenges women face, for instance in the current labour market. It has been said that, instead of quick medical-technical solutions that target individual women’s bodies, we should focus on substantive changes that target the androcentric work culture. This theme relates to feminist concerns about unnecessary medicalisation geared towards women. Furthermore, there is a call for more empirical studies to back up this central normative claim. Study design, size, duration Seventeen participants were recruited by psychologists working in two Belgian centres for reproductive medicine which offer egg freezing for social reasons. In addition, four participants were recruited through via social networks. Interviews took place between February 2019 and November 2020 at a location of the participants’ preference or through online video connections. Participants/materials, setting, methods At the beginning of the interview, open questions were asked to invite the participants to speak about social egg freezing in their own words. In the second part of the interview, we used four cards with controversial statements based on a study of the bioethics literature, to encourage the participants to reflect about ethical concerns. In this part, we engaged in Socratic dialogue. For the analysis, thematic analysis was used combined with interdisciplinary collaborative auditing. Main results and the role of chance This is the first study providing empirical evidence about (potential) egg freezers’ moral reasoning about individualisation arguments. Most participants in our study could make sense of the individualisation argument but emphasised another societal challenge rather than the current labour market. They highlighted ‘the lack of a partner relationship’ as driving their motivation for this procedure. The shortage of eligible partners has been well defined in social science scholarship about social egg freezing but this element has rarely been articulated in the premises of individualisation arguments. This topic of relationships is challenging to analyse from a normative perspective because it was experienced as much more personal and intimate by the women in our study than for instance measures to realise more fair labour conditions, such as improved access to childcare. Some participants believed egg freezing resulted from individual problems and found the individualisation argument not applicable to their own situation. Furthermore, no participant found the individualisation argument legitimate to depict social freezing as morally problematic. Nonetheless, the participants showed a sense of sympathy with women who lack access to egg freezing and were in favour of societal solutions in several public domains. Limitations, reasons for caution Given that we report on a small-scale qualitative study of possible social egg freezers at two Belgian fertility clinics, and that our study foregrounds the voices of mostly white higher educated women who were able to afford this technology, our results cannot be generalised to all social egg freezers. Wider implications of the findings: Our findings can contribute to a better understanding of previously identified normative arguments (e.g., individualisation and unnecessary medicalisation). There is a definite need to further analyse the complex interplay between respecting autonomous choices and evaluating contextual factors in this debate and other practices where similar individualisation arguments are used. Trial registration number Not applicable