Social Egg Freezing under Public Health Perspective: Just a Medical Reality or a Women's Right? An Ethical Case Analysis

Abstract

In recent years, a social trend toward delaying childbearing has been observed in women of reproductive age. A novel technomedical innovation was commercialized for non-medical reasons to healthy, ostensibly fertile women, who wished to postpone motherhood for various reasons such as educational or career demands, or because they had not yet found a partner. As a consequence, these women may be affected by age-related infertility when they decide to conceive, and fertility preservation techniques can be obtained through the so-called social egg freezing. This paper examines, from an ethical point of view, the impact of social egg freezing under some aspects that can involve policy making and resources allocation in public health. Due to the increasing demand for this procedure, some debated issues regard if it is reasonable to include social egg freezing in Public Healthcare System and consequently how to manage the storage of cryopreserved oocytes also from individual donors, how to support these egg banks and how to face, in the future, with the possibility that egg freezing will play a role in enabling childbearing for gays, lesbians, and unmarried persons. Social freezing may be advertised to harmonise gender differences, but we wonder if it is the proper solution to the problem or if it could also create further challenges. An ethical argumentation on these topics should address some questions that will be discussed.Significance for public healthOne of the purposes of medicine in health policies is the recognition of the different health needs of men and women because of their differences, that we can define gender equity, which should be guaranteed. Social egg freezing means to preserve and store a woman’s oocytes for non-medical purposes. This paper discusses how social freezing may be advertised to harmonise these incompatibilities and, if oocyte cryopreservation is an accepted procedure to counter infertility and if fertility treatment is covered by public healthcare, the consequence may be that it may also be covered by public national healthcare system or we have to admit that there is a distinction between assisted reproductive technologies for medical reasons and assisted reproductive technologies with oocytes previously stored for non-medical reasons.

Understanding social oocyte freezing in Italy: a scoping survey on university female students’ awareness and attitudes

“…If oocyte cryopreservation is an accepted procedure to counter infertility and if fertility treatment is covered by public healthcare, should the logical consequence be that social freezing should also be covered by public national healthcare systems - or mandated insurance coverage - or that it should be admitted that there is a relevant distinction between ART with medical indications and ART with oocytes previously stored for non-medical reasons? (Borovecky et al, 2018). This aspect has also been debated in the literature and an objection to full coverage is that this could be a suboptimal allocation of scarce funds: healthcare budgets are strained and several countries are already struggling to accommodate the requests for ART for medical reasons and the added costs might be overwhelming (Mertes and Pennings 2012).…”

“…This medical innovation is now being widely promoted and offered also to healthy, fertile women who wish to postpone motherhood. While the option of freezing oocytes of cancer patients or other patients with decreased fertility is generally positively considered both from a medical and an ethical point of view, offering the same option to healthy women, for the reasons previously indicated, is met with new ethical challenges that have recently been debated in the literature (Borovecky et al, 2018; Bracewell-Milnes et al 2018; Jones et al 2018).…”

CRISPR-Cas and Its Wide-Ranging Applications: From Human Genome Editing to Environmental Implications, Technical Limitations, Hazards and Bioethical Issues

“…Fears that scientists may one day start “playing God” are not new after all: decades ago, in vitro fertilization (IVF) has been harshly criticized by many as “unnatural” or taking on prerogatives that do not belong to men [ 139 , 140 , 141 ]. IVF techniques are still morally and ethically controversial and often restricted, as are fertility preservation procedures capable of prolonging the time frame in which parenthood is achievable [ 142 , 143 , 144 , 145 ].…”

Use ofin vitrofertilization—ethical issues

“…Since the success rate of IVF declines rapidly in ages above 35 years when the woman uses her own eggs, social egg freezing (oocyte cryopreservation) has been introduced as a means to preserve and store oocytes retrieved at an earlier age. Stored oocytes are used in IVF at a time when the social circumstances for having a child would be preferable ( 23 ).…”