Between “Medical” and “Social” Egg Freezing

Abstract

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.

Too much equity – is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel

“…Though scholars debate the clarity of the division between medical and non-medical reasons for egg freezing and the related funding gaps [ 37 – 41 ], lay persons largely support the selective funding, viewing the funding of medical egg freezing more favorably than EEF subsidy [ 33 , 37 , 41 – 44 ]. As a result of this policy, some women cannot access EEF due to its high cost [ 42 , 43 , 45 ], rendering EEF part of stratified reproduction, available mostly to wealthier women in wealthier countries.…”

The emergence of temporality in attitudes towards cryo-fertility: a case study comparing German and Israeli social egg freezing users

“…The procedure needs to be paid out of one’s own pocket. In Germany, by contrast, there is no formal legal or regulatory framework of SEF—which is allowed and performed (Rimon-Zarfaty et al, 2021 ). The German EPA, which prohibits egg donation, permits the freezing of fertilized eggs only at the pronuclear state (while limiting the cryopreservation of embryos), and therefore does not restrict the freezing of unfertilized eggs (Robertson, 2014 ).…”

“…While the second type demonstrates the extent to which the phenomenology of singlehood produces a certain temporal identity that exceeds cultural boundaries, the other two represent a cultural contrast. Relevant cultural scripts to explain these differences include the high social expectations anticipated by German mothers (Fagnani, 2002 ; Mckay, 2011 ), and the Israeli pro-natalism which generally speaking frames the favorable Israeli approach to fertility medicine (Gooldin, 2008 ; Kahn, 2000 ), and preservation (Birenbaum-Carmeli, 2016b ; Inhorn et al, 2020 ; Shkedi-Rafid & Hashiloni-Dolev, 2011 ; Rimon-Zarfaty et al, 2021 ). Further possible explanations may include the general promotion of individualism in Germany (Raz & Schicktanz, 2016 ), where familism and individualism are perceived as contradictory and the increasing value of individual self-realization was identified as leading to a decline in birth rates (Hashiloni-Dolev & Shkedi, 2007 ; Keller et al, 2005 ).…”

Social egg freezing and reproductive rights justification: A perspective from China

“…European countries, for example, have diverged on permitting SEF. 11 In countries where SEF has been permitted but the public resources only cover MEF, such as the United Kingdom, 12 Germany, and the Netherlands, 13 while bioethicists are concerned about the unequal access to SEF, 14 other argues that storage limits for SEF interfere with a woman's right to respect for her family life. 15 Some favor SEF by emphasizing that it improves the social benefits of some females based on equal concern and respect for women.…”

“…18 Where there are substantial disparities in access to ARTs, particularly due to economic barriers, as in the United States, 19 scholars worry about the medical risks of SEF, its false hopes, and inequalities in access. 20 Without valid informed consent, especially under business strategies, SEF barely promotes reproductive autonomy, 21 even when it is offered by female workers' 3 Rimon-Zarfaty, N., Kostenzer, J., Sismuth, L. K., & de Bont, A. (2021).…”