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Wang H. Single women's access to egg freezing in mainland China: an ethicolegal analysis. JOURNAL OF MEDICAL ETHICS 2023; 50:50-56. [PMID: 37147115 DOI: 10.1136/jme-2023-108915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
In the name of safeguarding public interests and ethical principles, China's National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women's reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women's reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women's well-being paternalistically and partly to implement the central government's policies to boost the birthrate and maintain traditional family structures. While the government's concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women's egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority's assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children 'at a proper age', and that egg freezing by single women offends China's public moralities have not been substantiated.
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Affiliation(s)
- Hao Wang
- Shen Junru Law School, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Cascante SD, Blakemore JK, DeVore S, Hodes-Wertz B, Fino ME, Berkeley AS, Parra CM, McCaffrey C, Grifo JA. Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center. Fertil Steril 2022; 118:158-166. [PMID: 35597614 DOI: 10.1016/j.fertnstert.2022.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review the outcomes of patients who underwent autologous oocyte thaw after planned oocyte cryopreservation. DESIGN Retrospective cohort study. SETTING Large urban university-affiliated fertility center. PATIENT(S) All patients who underwent ≥1 autologous oocyte thaw before December 31, 2020. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome was the final live birth rate (FLBR) per patient, and only patients who had a live birth (LB) or consumed all remaining inventory (cryopreserved oocytes and resultant euploid/untested/no result embryos) were included. The secondary outcomes were laboratory outcomes and LB rates per transfer. RESULT(S) A total of 543 patients underwent 800 oocyte cryopreservations, 605 thaws, and 436 transfers. The median age at the first cryopreservation was 38.3 years. The median time between the first cryopreservation and thaw was 4.2 years. The median numbers of oocytes and metaphase II oocytes (M2s) thawed per patient were 14 and 12, respectively. Overall survival of all thawed oocytes was 79%. Of all patients, 61% underwent ≥1 transfer. Among euploid (n = 262) and nonbiopsied (n = 158) transfers, the LB rates per transfer were 55% and 31%, respectively. The FLBR per patient was 39%. Age at cryopreservation and the number of M2s thawed were predictive of LB; the FLBR per patient was >50% for patients aged <38 years at cryopreservation or who thawed ≥20 M2s. A total of 173 patients (32%) have remaining inventory. CONCLUSION(S) Autologous oocyte thaw resulted in a 39% FLBR per patient, which is comparable with age-matched in vitro fertilization outcomes. Studies with larger cohorts are necessary.
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Affiliation(s)
| | | | - Shannon DeVore
- New York University Langone Prelude Fertility Center, New York, New York
| | - Brooke Hodes-Wertz
- New York University Langone Prelude Fertility Center, New York, New York
| | - M Elizabeth Fino
- New York University Langone Prelude Fertility Center, New York, New York
| | - Alan S Berkeley
- New York University Langone Prelude Fertility Center, New York, New York
| | - Carlos M Parra
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Caroline McCaffrey
- New York University Langone Prelude Fertility Center, New York, New York
| | - James A Grifo
- New York University Langone Prelude Fertility Center, New York, New York
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Cremonese J, Marcon M, Oppi L, Paletti G, Romolo V, Tozzo P, Caenazzo L. An Update on Planned Oocyte Cryopreservation (POC) in Italy: Medical, Epidemiological and Legal Consideration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2371. [PMID: 35206556 PMCID: PMC8872062 DOI: 10.3390/ijerph19042371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
Starting with a brief socioeconomic analysis of the phenomenon of female fertility, this narrative review aims to provide an analysis of the use and possibilities of medically assisted reproductive technology in combating fertility issues, adopting socioeconomic, legal and medical perspectives in Italy. The authors mainly employ data from the annual reports of the National Registry of Medically Assisted Reproduction (PMA Registry) and the Italian Statistical Institute (ISTAT) to understand the evolution of oocyte use in medically assisted reproductive technology in Italy from 2015 to 2018 and in particular to dissect the possibilities of oocyte cryopreservation as a measure to counteract age-related infertility, specifically through Planned Oocyte Cryopreservation (POC), also known as "social freezing". It seems that the best course of action in the context of medically assisted reproduction would be the use of young and healthy cryopreserved oocytes (autologous or donated), preferably before the age of 40, while encouraging donation of oocytes whenever possible. Italy's dependence on foreign biobanks for donated oocytes calls for the institution of a national biobank and further specific regulation of gamete donation. For this reason, it would be useful to encourage the acceptance of Planned Oocyte Cryopreservation to allow greater availability of healthy, younger oocytes.
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Affiliation(s)
- Jessica Cremonese
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Marianna Marcon
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Laura Oppi
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Giulia Paletti
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Vincenzo Romolo
- Galileian School of Higher Education, University of Padova, 35121 Padova, Italy; (J.C.); (M.M.); (L.O.); (G.P.); (V.R.)
| | - Pamela Tozzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
| | - Luciana Caenazzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
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Johnston M, Fuscaldo G, Richings NM, Gwini SM, Catt S. Employer-Sponsored Egg Freezing: Carrot or Stick? AJOB Empir Bioeth 2021; 13:33-47. [PMID: 34219623 DOI: 10.1080/23294515.2021.1941413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Since 2014, many companies have followed the lead of Apple and Facebook and now offer financial support to female employees to access egg freezing. Australian companies may soon make similar offers. Employer-sponsored egg freezing (ESEF) has raised concerns and there is academic debate about whether ESEF promotes reproductive autonomy or reinforces the 'career vs. family' dichotomy. Despite the growing availability of ESEF and significant academic debate, little is known about how ESEF is perceived by the public. The aim of this study was to explore women's attitudes toward ESEF. METHODS Women aged 18-60 years who resided in Victoria, Australia were invited to complete an online, cross-sectional survey investigating views toward egg freezing. Associations between participant demographics and their views about ESEF were assessed using multinominal logistic regression, adjusted for age and free text comments were analyzed using thematic analysis. RESULTS The survey was completed by 656 women, median age 28 years (range: 18-60 years). Opinions on the appropriateness of employers offering ESEF were divided (Appropriate: 278, 42%; Inappropriate: 177, 27%; Unsure: 201, 31%). There was significantly less support for ESEF among older participants and those employed part-time (p < 0.05). While some participants saw the potential for ESEF to increase women's reproductive and career options, others were concerned that ESEF could pressure women to delay childbearing and exacerbate existing inequities in access to ARTs. CONCLUSIONS Our analysis revealed that while some women identified risks with ESEF, for many women ESEF is not viewed as theoretically wrong, but rather it may be acceptable under certain conditions; such as with protections around reproductive freedoms and assurances that ESEF is offered alongside other benefits that promote career building and family. We suggest that there may be a role for the State in ensuring that these conditions are met.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.,Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Giuliana Fuscaldo
- Barwon Health, University Hospital Geelong, Geelong, Australia.,Eastern Health Clinical School, Monash University, Australia
| | | | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Chronopoulou E, Raperport C, Sfakianakis A, Srivastava G, Homburg R. Elective oocyte cryopreservation for age-related fertility decline. J Assist Reprod Genet 2021; 38:1177-1186. [PMID: 33608838 PMCID: PMC7894970 DOI: 10.1007/s10815-021-02072-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/11/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation. This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counselling. METHODS A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives. RESULTS Clinician-led counselling regarding reproductive aging and fertility preservation is often overlooked. Elective oocyte cryopreservation is not a guarantee of live birth, and the answer regarding cost-effectiveness needs to be individualized. The existing studies on obstetric and perinatal outcomes following the use of egg freezing are, until now, reassuring. Constant monitoring of short-term and long-term outcomes, uniform regulation and evidence-based, individualized counselling is of paramount importance. CONCLUSIONS Elective oocyte cryopreservation is one of the most controversial aspects of the world of assisted reproduction, and a lot of questions remain unanswered. However, women today do have this option which was not available in the past. Elective oocyte cryopreservation for age-related fertility decline should be incorporated in women's reproductive options to ensure informed decisions and reproductive autonomy.
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Affiliation(s)
- E Chronopoulou
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK.
| | - C Raperport
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
- Queen Mary University of London, Mile End Road, Bethnal Green, London, E1 4NS, UK
| | - A Sfakianakis
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - G Srivastava
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - R Homburg
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
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Bayefsky MJ. Legal and Ethical Analysis of Advertising for Elective Egg Freezing. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:748-764. [PMID: 33404329 DOI: 10.1177/1073110520979386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper reviews common advertising claims by egg freezing companies and evaluates the medical evidence behind those claims. It then surveys legal standards for truth in advertising, including FTC and FDA regulations and the First Amendment right to free speech. Professional standards for medical advertising, such as guidelines published by the American Society for Reproductive Medicine (ASRM), the American College of Obstetricians and Gynecologists (ACOG), and the American Medical Association (AMA), are also summarized. A number of claims, many of which relate to the targeting of younger women for eOC, are found to breach legal and ethical standards for truth in advertising. The ethical implications of misleading advertising claims are also discussed, and the central narrative woven by OC ads - that egg freezing is empowering to women - is examined. The paper concludes that a more balanced approach to the risks and benefits of OC is necessary to truly respect women's autonomy. Moreover, justice requires us to look beyond a medical procedure accessible only to a minority of women in order to address inequities in the workplace.
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Affiliation(s)
- Michelle J Bayefsky
- Michelle Bayefsky, B.A., is a fourth-year medical student at Harvard Medical School (Boston, Massachusetts). Previously she was a post-baccalaureate fellow in the Department of Bioethics of the National Institutes of Health, where her work focused on topics related to reproduction, genomics policy, and public health. Ms. Bayefsky graduated summa cum laude from Yale College (New Haven, Connecticut) with a Bachelor of Arts in ethics, politics and economics
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Yee S, Goodman CV, Fu V, Lipton NJ, Librach CL. Parenthood desire, childbearing plans and oocyte utilization among women who previously underwent planned oocyte cryopreservation. Reprod Biomed Online 2020; 42:442-450. [PMID: 33246804 DOI: 10.1016/j.rbmo.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION To examine the motivations, life circumstances and parenthood aspirations of a cohort of women who underwent planned oocyte cryopreservation (POC) at a Canadian academic IVF centre. DESIGN A single-site, cross-sectional, anonymous quantitative study using a study-specific questionnaire administrated via SurveyMonkey®. Of the 224 women who completed at least one POC cycle between 2012 and 2018, 198 were reached by email and invited to participate. RESULTS Of the 98 (49.5%) questionnaires returned, 86 were fully completed and were analysed. Mean age at first POC cycle was 35.7 ± 2.4 (range 27-43) and at survey was 37.7 ± 2.5 years. At POC, 77% were single and 97.7% childless. At survey, 96% had not attempted to use their cryopreserved oocytes, yet 26 (30%) had tried natural conception or fertility treatments. Of these, three conceived naturally and two by assisted reproduction. Eighty-five per cent expressed a strong motherhood desire and 67.1% indicated that usage of their cryopreserved oocytes was mostly contingent on relationship status. Many expressed a desire for shared genetic parenthood within a committed relationship. Forty-seven per cent did not want to carry a pregnancy beyond the age of 46. CONCLUSION The findings of this study confirm the central role of age and relationship status in influencing women's POC decisions and oocyte utilization plans. The late age at POC could be explained by women using it toward the end of their peak reproductive years to leverage their remaining chances of genetic motherhood. Surveying women at later points following POC would help to gain a more comprehensive picture of their oocyte utilization and disposition plans.
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Affiliation(s)
| | | | - Vivian Fu
- CReATe Fertility Centre, Toronto, Canada
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, Canada
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Miner SA, Miller WK, Grady C, Berkman BE. "It's Just Another Added Benefit": Women's Experiences with Employment-Based Egg Freezing Programs. AJOB Empir Bioeth 2020; 12:41-52. [PMID: 32990510 DOI: 10.1080/23294515.2020.1823908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In 2014, companies began covering the costs of egg freezing for their employees. The adoption of this benefit was highly contentious. Some argued that it offered women more reproductive autonomy, buying time to succeed in their careers and postpone childbearing. Others suggested this benefit might place inappropriate pressure on women, unduly influencing them to freeze their eggs to prioritize their career over reproduction. Although ethical problems with this benefit have been explored, there has not been research analyzing the perspectives of women working for companies that offer employer-based egg freezing. Furthermore, existing empirical studies often focus on the experiences of egg freezers rather than the young women thinking about, but not yet using, this technology. Methods: Through in-depth semi-structured interviews, we explore the perceptions and attitudes of 25 women employees of companies with employer-based egg freezing. Results: These women describe delaying childbearing for a multitude of reasons, including not having a partner, and the desire to achieve social and career goals. Many women did not know that their employers covered egg freezing before the interview (44%; 11/24), suggesting this benefit is not essential to their career and family-building decisions. While women did not describe pressure to use this technology, they did describe how this benefit would not solve the difficulties of becoming a mother while excelling in their careers. Conclusion: Although women may not feel pressure to freeze their eggs and delay childbearing, they still feel constricted in their reproductive options. While employer programs may offer women the ability to delay childbearing, many saw this delay as postponing problems with work-life balance rather than solving them. We suggest that sociocultural shifts, such as workplace daycare, flexible workplace hours, and acceptability of non-biological parenthood, might allow women to feel more empowered about their reproduction choices.
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Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - W K Miller
- Doximity, San Francisco, California, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Mahesan AM, Sadek S, Ramadan H, Bocca S, Paul ABM, Stadtmauer L. Knowledge and attitudes regarding elective oocyte cryopreservation in undergraduate and medical students. FERTILITY RESEARCH AND PRACTICE 2019; 5:5. [PMID: 31007938 PMCID: PMC6458751 DOI: 10.1186/s40738-019-0057-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/01/2019] [Indexed: 11/16/2022]
Abstract
Background To assess knowledge and attitudes regarding elective oocyte cryopreservation among female undergraduate students (UG) and medical students (MS) in Eastern Virginia. Methods An anonymous cross-sectional study surveying female UG at a local university and MS at our academic medical center in May of 2017. The survey contained questions on demographic information, interest in fertility preservation, and knowledge about age related changes in fertility. Results There were 74 of 102 female UG and 95 of 117 female MS who responded, for a response rate of 73 and 81% respectively. UG were significantly younger than MS (21.4 vs 26.8, p < 0.001). Further, UG generally planned on conceiving at a younger age than MS (age 26–30 vs 31–35), and favored younger ages to consider oocyte cryopreservation (age 26–30 vs 31–35). Only a minority of both UG and MS were willing to undergo egg freezing at the current price of approximately $10,000 (15% vs 26% respectively, p = 0.044). Moreover, 73% of students overall responded that they would be more likely to freeze oocytes if their employer paid. Notably, both UG and MS underestimated age of fertility decline. Conclusion Both UG and MS revealed a need for education on age-related changes in fertility. Most UG and MS would not undergo elective oocyte cryopreservation at the present cost but would consider it at a lower cost. Electronic supplementary material The online version of this article (10.1186/s40738-019-0057-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnold M Mahesan
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Seifeldin Sadek
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Hadi Ramadan
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Silvina Bocca
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | | | - Laurel Stadtmauer
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
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Simopoulou M, Sfakianoudis K, Bakas P, Giannelou P, Papapetrou C, Kalampokas T, Rapani A, Chatzaki E, Lambropoulou M, Lourida C, Deligeoroglou E, Pantos K, Koutsilieris M. Postponing Pregnancy Through Oocyte Cryopreservation for Social Reasons: Considerations Regarding Clinical Practice and the Socio-Psychological and Bioethical Issues Involved. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E76. [PMID: 30366459 PMCID: PMC6262467 DOI: 10.3390/medicina54050076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 11/21/2022]
Abstract
Oocyte freezing for 'social reasons' refers to women of reproductive age who are aiming to prolong, protect and secure their fertility. The term emerged to describe application of the highly promising technique, namely vitrification on oocytes retrieved through controlled ovarian stimulation (COS) from women intending to preserve their fertility for social reasons. These women opt to cryopreserve their oocytes at a point in their life when they need to postpone childbearing on the grounds of so called 'social' reasons. These reasons may include a highly driven career, absence of an adequate partner, financial instability, or personal reasons that make them feel unprepared for motherhood. This is a sensitive and multifaceted issue that entails medical, bioethical and socio-psychological components. The latest trend and the apparent increase noted on oocyte freezing for 'social reasons' has prompted our team of fertility specialists, embryologists, obstetricians, gynecologists and psychologists to proceed with a thorough, critical and all-inclusive comprehensive analysis. The wide range of findings of this analysis involve concerns of embryology and epigenetics that shape decisions made in the IVF laboratory, issues regarding obstetric and perinatal concerns on the pregnancy concluding from these oocytes and the respective delivery management and neonatal data, to the social and bioethical impact of this trend's application. This literature review refers to matters rising from the moment the 'idea' of this option is 'birthed' in a woman's thoughts, to proceeding and executing it clinically, up until the point of the pediatric follow up of the children born. We aim to shed light to the controversial issue of oocyte freezing, while objectively exhibit all aspects regarding this complex matter, as well as to respectfully approach how could the prospect of our future expectations be shaped from the impact of its application.
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Affiliation(s)
- Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | | | - Panagiotis Bakas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Polina Giannelou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
- Centre for Human Reproduction, Genesis Athens Clinic, 14⁻16, Papanikoli, 15232 Athens, Greece.
| | - Christina Papapetrou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Theodoros Kalampokas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Ekaterini Chatzaki
- Laboratory of Histology-Embryology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Chrysoula Lourida
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Efthymios Deligeoroglou
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528 Athens, Greece.
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, 14⁻16, Papanikoli, 15232 Athens, Greece.
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
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Weber-Guskar E. Debating social egg freezing: arguments from phases of life. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:325-333. [PMID: 29022171 DOI: 10.1007/s11019-017-9806-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
So-called "social egg freezing" allows a woman to retain the possibility of trying to have a child with her own oocytes later in life, even after having become infertile in the strict sense of the word (that is, infertile without assistance in reproduction).There is a debate about whether it is morally permissible at all, the extent to which it should be permitted legally or even supported, and whether it is ethically desirable. This paper contributes some thoughts to the issue of ethical desirability. More precisely it deals with the question of whether there is any valuable argument to be made on the basis of the idea of life phases and normative expectations related to them. So the question is: Is there a right time in life to have a child, and does this speak against or in favor of social freezing? This question is answered in three steps. First, I will give an overview of ethical arguments that are mostly put forward in favor or against the use of social egg freezing and show that and why the question of life phases should be taken into account. Second, I will sketch what I understand by phases of life, more precisely, what I understand by normatively conceptualized life stages, that are to be distinguished from other kinds of life phases, and how they relate to a good life. Third, I will present two arguments that rely on the idea of life stages and speak against social egg freezing. However, I will criticize them and instead show that from the perspective of life stages nothing speaks against using the technique within certain limits.
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Affiliation(s)
- Eva Weber-Guskar
- Philosophisches Seminar, Georg-August-Universität Göttingen, Humboldtallee 19, 37073, Göttingen, Germany.
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Hammarberg K, Kirkman M, Pritchard N, Hickey M, Peate M, McBain J, Agresta F, Bayly C, Fisher J. Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Hum Reprod 2018; 32:575-581. [PMID: 28077428 DOI: 10.1093/humrep/dew342] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/09/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the reproductive experiences of women who cryopreserve oocytes for non-medical reasons? SUMMARY ANSWER One in three women had been pregnant at some stage in their lives and while most still wanted to have a child or another child, very few had used their stored oocytes, predominantly because they did not want to be single parents. WHAT IS KNOWN ALREADY The number of healthy women who freeze oocytes to avoid age-related infertility is increasing. Evidence about reproductive outcomes after oocyte cryopreservation for non-medical reasons is needed to help women make informed decisions. STUDY DESIGN SIZE, DURATION A cross-sectional survey was carried out. Study packs which included a self-administered questionnaire were mailed by clinic staff to 193 eligible women. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had stored oocytes for non-medical reasons at Melbourne IVF, a private ART clinic, between 1999 and 2014 were identified from medical records and invited to complete an anonymous questionnaire about their reproductive histories and experience of oocyte cryopreservation. MAIN RESULTS AND THE ROLE OF CHANCE A total of 10 survey packs were returned to the clinic marked 'address unknown'. Of the 183 potential respondents, 96 (53%) returned the questionnaire. One respondent provided only free-text comments, thus data from 95 respondents were compiled. The mean age at the time of freezing oocytes was 37.1 years (SD ± 2.6, range: 27-42) and the average number of oocytes stored was 14.2 (SD ± 7.9, range: 0-42); 2% had attempted to store oocytes but had none suitable for freezing, 24% had stored <8 oocytes, 35% had 8-15, 25% had 16-23 and 14% had stored >23 oocytes. About one-third of respondents (34%) had been pregnant at some point in their lives. Six women (6%) had used their stored oocytes and three of them had given birth as a result. The main reason for not using stored oocytes was not wanting to be a single parent. Of the 87 (91%) women who still had oocytes stored, 21% intended to use them while 69% indicated that their circumstances would determine usage. The mean number of children respondents would ideally have liked to have was significantly higher than the number of children they expected to have (2.11 versus 1.38, P < 0.001). LIMITATIONS, REASONS FOR CAUTION The limitations are inherent to any anonymously completed questionnaire: participation bias, missing data and the possibility that some questions or response alternatives may have been ambiguous. WIDER IMPLICATIONS OF THE FINDINGS The findings add to the very limited evidence about the reproductive outcomes experienced by women who freeze oocytes for non-medical reasons and can be used to help women make informed decisions about whether to store oocytes. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by Melbourne IVF. K.H. has received honoraria from Merck-Serono, J.M. is a clinician at Melbourne IVF, F.A. is a Melbourne IVF employee, J.F. is supported by a Monash Professorial Fellowship and the Jean Hailes Professorial Fellowship which receives funding from the L and H Hecht Trust, managed by Perpetual Trustees Pty Ltd. M.K., N.P., M.H., M.P. and C.B. have no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia.,Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne, Victoria 3000, Australia
| | - Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Rd, Melbourne, Victoria3004, Australia
| | - Natasha Pritchard
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Rd, Melbourne, Victoria3004, Australia
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - John McBain
- Melbourne IVF, 320 Victoria Pde, East Melbourne, Victoria 3002, Australia
| | - Franca Agresta
- Melbourne IVF, 320 Victoria Pde, East Melbourne, Victoria 3002, Australia
| | - Chris Bayly
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Rd, Melbourne, Victoria3004, Australia
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Bachmann G, MacArthur TA, Khanuja K. Need for Comprehensive Counseling in Women Requesting Oocyte Cryopreservation. J Womens Health (Larchmt) 2017; 27:227-230. [PMID: 29072973 DOI: 10.1089/jwh.2017.6423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this study is to assess current counseling recommendations for women undergoing elective oocyte cryopreservation. DATA SOURCES PubMed and Clinical Key. MATERIALS AND METHODS A search of PubMed and Clinical Key was conducted to assess current counseling practices for elective oocyte cryopreservation. RESULTS It is substantiated that uniform counseling guidelines are lacking for this group of assisted reproductive technology (ART) patients presenting only for cryopreserving their oocytes. However, although a woman may be a suitable candidate for pregnancy at the point that she undergoes oocyte cryopreservation, possibly many years later, at the time of oocyte thawing, this same woman may have multiple risk factors, which will increase her risk for pregnancy-related maternal and fetal morbidity and mortality. CONCLUSIONS Given the increasing use of oocyte cryopreservation, data support that women be extensively counseled at the time they are requesting elective oocyte cryopreservation for future use in the same manner that they are counseled when requesting ART for pursuing an immediate pregnancy.
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Affiliation(s)
- Gloria Bachmann
- Department of Obstetrics Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Taleen A MacArthur
- Department of Obstetrics Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Kavisha Khanuja
- Department of Obstetrics Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey
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Abstract
Genetic relatedness poses significant challenges to traditional practices of medical ethics as concerns the biobanking of human biological samples. In this paper, we first outline the ethical challenges to informed consent and confidentiality as these apply to human biobanks, irrespective of the type of tissue being stored. We argue that the shared nature of genetic information has clear implications for informed consent, and the identifying nature of biological samples and information has clear implications for promises of confidentiality. Next, with regard to the special case of biobanking human embryos and eggs, we consider issues arising from: first, the type of tissues being stored; second, the use to which these tissues are put; and third, how this plays out given the shared and identifying nature of these tissues. Specifically, we examine the differences between human bodily tissues and human reproductive tissues focusing on the assumed potential of the reproductive tissues and on the possible greater emotional attachment to these tissues because of their real and imagined kinship. For some donors there may be a sense of family connection with embryos and eggs they once thought of as 'children-in-waiting'. Finally, we conclude by considering the implications for ethical practice.
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Affiliation(s)
- Françoise Baylis
- Novel Tech Ethics, Faculty of Medicine, Dalhousie University, P.O. Box 15000, 1379 Seymour Street, Halifax, NS, B3H 4R2, Canada.
| | - Heather Widdows
- Centre for the Study of Global Ethics, Department of Philosophy, University of Birmingham, Birmingham, B15 2TT, UK
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Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum Reprod Update 2016; 22:440-9. [DOI: 10.1093/humupd/dmw007] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 11/15/2022] Open
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Liang T, Motan T. Mature Oocyte Cryopreservation for Fertility Preservation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 951:155-161. [DOI: 10.1007/978-3-319-45457-3_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Petropanagos A, Cattapan A, Baylis F, Leader A. Social egg freezing: risk, benefits and other considerations. CMAJ 2015; 187:666-669. [PMID: 25869870 PMCID: PMC4467930 DOI: 10.1503/cmaj.141605] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Angel Petropanagos
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont.
| | - Alana Cattapan
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
| | - Françoise Baylis
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
| | - Arthur Leader
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
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Mertes H. Does company-sponsored egg freezing promote or confine women's reproductive autonomy? J Assist Reprod Genet 2015; 32:1205-9. [PMID: 26003658 DOI: 10.1007/s10815-015-0500-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE A critical ethical analysis of the initiative of several companies to cover the costs of oocyte cryopreservation for their healthy employees. The main research question is whether such policies promote or confine women's reproductive autonomy. RESULTS A distinction needs to be made between the ethics of AGE banking in itself and the ethics of employers offering it to their employees. Although the utility of the former is expected to be low, there are few persuasive arguments to deny access to oocyte cryopreservation to women who are well informed about the procedure and the success rates. However, it does not automatically follow that it would be ethically unproblematic for employers to offer egg banking to their employees. CONCLUSIONS For these policies to be truly 'liberating', a substantial number of conditions need to be fulfilled, which can be reduced to three categories: (1) women should understand the benefits, risks and limitations, (2) women should feel no pressure to take up the offer; (3) the offer should have no negative effect on other family-friendly policies and should in fact be accompanied by such policies. Fulfilling these conditions may turn out to be impossible. Thus, regardless of companies' possible good intentions, women's reproductive autonomy is not well served by offering them company-sponsored AGE banking.
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Affiliation(s)
- Heidi Mertes
- Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000, Gent, Belgium,
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