Push for Social Egg Freezing: By whom? For whom?

By now it’s a familiar marketing tactic in the IVF industry:  Pursue a dubious line of research and then manufacture a constituency that “demands” widespread access to the new technology.  The latest campaign is being staged with the aim of normalizing egg freezing, thereby creating a new profit center for the industry in the form of otherwise fertile young women.

In the last several years, the message that egg freezing can help women defeat the biological clock has reached the mainstream press and blogosphere. This year, high- profile outlets published pieces in which women trumpeted their faith in the technology.  Pieces by Sarah Elizabeth Richards in the Wall St. Journal and Amy Klein at Slate, provoked heated debate among both readers and the international community of scholars and activists concerned about the implications of the technique.

There has been pushback. Miriam Zoll, for example, challenged claims that egg freezing is implicitly safe and efficient in a response, also at Slate, to the Klein piece. And at The Feminist Wire, Lynn M. Morgan and Janelle S. Taylor tallied the negatives, calling the procedure “invasive, dangerous, unregulated, and insanely expensive.”

But a quick scan of the internet shows that the marketing of egg freezing to beat the biological clock is already well underway.  See, for example, the Fertility Center of Illinois, the Extend Fertility website, and InVia Fertility. Once again, the industry is marketing a technology without first carrying out extensive studies to determine its safety.   

What came first, the technology or the demand?

Originally, egg freezing was put forward as a response to the “complex ethical, social, legal, moral, and religious issues” surrounding the fate of excess embryos in the IVF clinic.  In 1986, Christopher Chen made a preliminary communication to The Lancet reporting “the first successful attempt at deep freezing and thawing of the human oocyte.” [by subscription].  Chen reasoned that “oocyte banking, like sperm banking, should be more acceptable to the community than embryo storage, since it involves only the gamete.”

Within a decade, IVF researchers were expanding the circumstances in which they thought egg freezing should be carried out, advocating the technique as a means of maintaining the fertility of women undergoing radiation or chemotherapy for cancer (see, for example, Saunders et al. 1996) [by subscription]

By 2006, at the 54th Annual Meeting of the Pacific Coast Reproductive Society—the must-attend conference for top IVF researchers—a team led by Richard Paulson of University of Southern California was proposing egg freezing as “a promising strategy for circumventing the age-related decline in human fertility.”

Bioethicists and philosophers, including the likes of Julian Savulescu and Imogen Gould, soon weighed in, arguing the social benefits of freezing eggs and embryos for “social,” “non-medical” reasons.

Safety questions and social concerns

Back in 1986, when Chen’s “human oocyte study” at Flinders yielded twins, he based his claim that the method was safe not on direct evidence, but on absence of evidence of harm.  As Chen wrote, “there have been no reports of detrimental effects on human or mouse embryos.  Animal studies have shown no harmful effects of oocyte freezing on the offspring.”  

In the intervening years, the IVF community has, as is typical, lagged in carrying out comprehensive, well designed studies on the short- and long-term health effects of egg retrieval and cryopreservation on either women or “freeze-thaw” offspring.  

Not surprisingly, there has been correspondingly minimal focus in the press on these gaps in medical knowledge.  Although cautionary notes have been sounded in popular media about social egg freezing (see for example this 2011 OpenSalon post or this 2012 post in Salon) the message that there are risks does not seem to have gotten through to a broad public.   On Google Trends, the list of the top ten search terms related to “freezing eggs” does not include “risk,”  although “freezing eggs cost” figures prominently.  In fact, between 2004 and 2015, Trends records no searches for “freezing eggs risk” or “egg freezing risks.”

Equally disquieting is the way in which egg freezing is being cast in feminist terms as enhancing “reproductive choice,” and as a way of finally leveling the playing field between men and women in the corporate arena.

Egg Freezing and the Workplace

The flimsiness of such arguments is laid bare in a recent GW Law School Public Law and Legal Theory Paper.  In “The Gender/Class Divide: Reproduction, Privilege and the Workplace,” June Carbone, the Robina Chair in Law, Science and Technology at the University of Minnesota, and Naomi Cahn, Harold H. Greene Professor of Law at George Washington University examine claims made in favor of social egg freezing and find them wanting.  

Carbone and Cahn situate egg freezing in terms of shifts in childbearing patterns from the 1960s on, which have yielded pronounced differences among women who are college graduates and those who are not.  Generally, the latter bear children earlier, often without marrying, and receive little support from employers (the U.S. Census Bureau reports that only about one-fifth of women without a high school degree get paid maternity leave).  For these women, the “child penalty” is high, and they cycle in and out of the workforce to accommodate childcare and family demands.  They often have minimal access to medical care.

College-educated women bear children later—the age at first birth has steadily gone up over the last several decades—and some two-thirds receive health and maternity benefits from employers.  Too, they often can also count on the financial support of partners (only about two per cent of white college graduates bear children while unmarried).

Write Carbone and Cahn, “For those who marry ‘well,’ the payoffs are greater than ever in terms of family income security in a stagnant economy, marital satisfaction, and the ability to produce ‘high quality’ children (with superlative opportunities at a time when class-based differences in expenditures on children have increased substantially).”  In other words, the economic divide in the country as a whole is replicated among women—and their children.

Given such different life trajectories, the authors argue, it is likely that, even if price were not a factor, the principle benefits conveyed by social egg freezing would fall almost entirely to middle or upper middle class women, who could further their careers, wait for Mr. or Ms. Right, and gain “the maturity and stability necessary to continuing two-parent relationships.”  Among these women, the authors envision, “Once egg freezing takes hold as a valuable—and viable—option, pressures are likely to build to make it a routine one,” even “a rite of passage into adulthood.”  

But such an eventuality would likely “exacerbate existing inequalities”:

IVF clinics, eager to expand their clientele, might target young women, with college students a prime target. They might offer enticing discounts: bank your eggs with us today, promise to donate any unused eggs in the future and we will write off fifty percent or more of the egg freezing cost. The clinics would attract what is likely to become a captive audience: The young women who bank their eggs would then have to return to the same clinics to use them. Even if the women could transfer the eggs elsewhere, the clinics could easily build in incentives for the women to use their IVF services. Moreover, healthy eggs from young women with the “right” racial, physical and academic attributes are often hard to come by; the clinics could invest in producing a new source of eggs for transfer to those women who didn’t plan ahead by banking their own.

As I concluded in my 1997 article on delayed childbearing in The Atlantic, women in the workforce

would do well to continue to press for a reconfiguration of society, so that they might, if they chose to, have babies in their twenties and develop their careers in their thirties.

Carbone and Cahn, as have many others, point to structural shifts that would support such a reconfiguration, including equal access to health care, some form of federally funded parental leave, better child care options, family friendly workplaces, European style “flexicurity,” which would help women at all economic levels regain jobs after childbearing.

Some women seem to think it is politically inappropriate to discuss such social shifts; some have even blamed fertility researchers and the press for blowing the age-related fertility statistics out of proportion. But why is availing oneself of medical technology inherently superior to taking social action?  Although freezing one’s eggs looks on the face of it like the epitome of “individual choice,” it—like choosing to delay having children or to have children at all—is made in the context of larger social forces.  In the “promise of autonomy” offered by egg freezing proponents, Carbone and Cahn see a trap:

[T]he option to create a family at the time of your choosing[…]may become just another form of coercive motherhood—freeze your eggs or infertility will be your fault, freeze your eggs so you can be a good employee on someone else’s (gendered) terms.  Its promise of permitting women to delay fertility reinforces culturally masculine work norms and lifestyle priorities.

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Gina Maranto is Director of Ecosystem Science and Policy and coordinator of the Environmental Science and Policy program at the University of Miami's Leonard and Jayne Abess Center. She is the author of Quest for Perfection: The Drive to Breed Better Human Beings (1996).

Previously on Biopolitical Times:

• The Big Freeze
• Egg Freezing: Risks to Women and Children Unknown
• Sofia Vergara Freezing Her [Perfect, Perfect, Perfect] Eggs