Durch Fortschritte in der modernen Reproduktionsmedizin ist es Frauen heute möglich, auch nach der Menopause mit eigenen Eizellen schwanger zu werden. Damit wird die Fortpflanzung im homologen System auch im Alter zu einer realistischen Option. Gegen derartige späte Schwangerschaften gibt es vielfältige Argumente, die vor allem auf mögliche Schädigungen aufgrund des hohen Alters der Mutter verweisen. Maßnahmen der Anti-Aging-Medizin zum Erhalt bzw. zur Verbesserung der kognitiven und physischen Leistungsfähigkeit im fortgeschrittenen Alter könnten diese Einwände gegen den Einsatz von Reproduktionstechniken nach (...) der Menopause entkräften. Der Beitrag geht der Frage nach, wie erstrebenswert postmenopausale Schwangerschaften unter diesen Voraussetzungen eigentlich sind. Es wird die These vertreten, dass eine Schadensargumentation für eine ethische Bewertung allein nicht ausreichend ist, sondern auch Überlegungen zu Status und Authentizität des Kinderwunsches, zum Selbstverständnis der Medizin, zur Autonomie der Betroffenen sowie zur Natürlichkeit der Lebensführung berücksichtigt werden müssen. Darüber hinaus zeigt sich, wie Entwicklungen in zwei spezifischen Anwendungsbereichen (Anti-Aging- und Reproduktionsmedizin) in einer gemeinsamen Betrachtung zusammengeführt und mit Gewinn für allgemeinere medizinethische Überlegungen bewertet werden können. (shrink)

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.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. (shrink)

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg‐freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women (...) of various ages. We argue that although reproductive technology, and egg freezing in particular, promise to improve women's care by offering more choices to achieve pregnancy and childbearing, they actually have the potential to be disempowering. First, commercial motives in the fertility industry distort women's medical deliberations, thereby restricting their autonomy; second, having the option to freeze their eggs can change the meaning of women's reproductive choices in a way that is limiting rather than liberating. (shrink)

The aim of this article is to provide a systematic reconstruction and critique of what is taken to be a central ethical concern against the use of non-medical egg freezing. The concern can be captured in what we can call the individualisation argument. The argument states, very roughly, that women should not use NMEF as it is an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market. Instead of allowing or expecting (...) women to deal with them on an individual level, we should address them by challenging the patriarchal structures of the labour market—for example, by securing equal pay, or paid maternal leave, or ‘paid paternal [partner] leave and sick leave and affordable child care’. It will be made clear that there are several versions of this argument. The author will try to elaborate this claim, and it will be explained that the differences depend on the way in which bioethicists believe that individuals use of NMEF is morally problematic, compared with the alternative of securing social change for women in, say, the labour market. Finally, a critical discussion of three versions of the individualisation argument will follow, and it will be shown why all versions are on rather thin ice, or in other words, that they are implausible. (shrink)

Non-medical egg freezing is egg freezing for the sake of delaying parenthood. The label ‘non-medical’ can be confusing, since the extraction and freezing of eggs is undeniably a medical procedure. The point is that whereas ‘medical egg freezing’ is done in order to retain capacity to procreate despite a potentially threatening medical condition, ‘non-medical egg freezing’ is done for the sake of getting more time to find a suitable partner and/or to establish a career before embarking on parenthood. One type (...) of argument against NMEF is the individualisation argument, according to which NMEF is problematic in virtue of being an individual solution to a social problem. The underlying problem that ought to be targeted, it is argued, is the patriarchal structures in the labour market, which disprivilege women and make it excessively difficult to combine a work and parenthood. In “Arguments on thin ice”, Thomas Søbirk Petersen helpfully distinguishes between three variants of the individualisation argument: the non-address view, the distraction view and the further oppression view.1 Petersen argues, moreover, that none of these is convincing, and therefore that the rejection of NMEF is unwarranted. According to the non-address view, the reason NMEF ought to be rejected is that “it cannot address the social causes that make it so difficult to balance career and family”2 or that it “does not substantially alter the social structures that have constructed inequalities”3 between women and men. Petersen …. (shrink)

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...

More and more women are turning to egg freezing as a strategy for managing conflicting timelines related to professional goals and family formation aspirations. Drawing on critical realism, this article argues that vicious aspects of the reproductive marketplace and the workplace along with cultural ideals of motherhood and the nuclear family incentivize agents to freeze their eggs. While individual egg freezers help contribute to the maintenance of structures and cultures that perpetuate inequalities related to class, race, and gender and hinder (...) the flourishing of all women, ethical analysis should critique the structural and cultural forces that make egg freezing an attractive option for women balancing procreation and professional pursuits. (shrink)

This article discusses the new reproductive technology of egg freezing in the context of existing literature on gender, medicalization, and infertility. What is unique about this technology is its use by women who are not currently infertile but who may anticipate a future diagnosis. This circumstance gives rise to a new ontological category of “anticipated infertility.” The author draws on participant observation and a qualitative analysis of scientific, mainstream, and marketing literature to identify and compare the representation of two different (...) candidates for egg freezing: women with cancer and healthy young women. Although both populations experience anticipated infertility, their dichotomous portrayals as appropriate candidates are demonstrative of gender norms linking women to motherhood. Egg freezing is a concise illustration of how the medicalization of women’s bodies and bodily processes masks a host of cultural anxieties about aging, illness, reproduction, and risk. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and (...) third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

Most discussions of population control focus on how many children people should have, but ignore issues to do with the timing, so there is little discussion of the value of delaying childbearing. Once we recognize that delaying childbearing can have a significant impact on the size of the population, and, therefore, on CO2e emissions, our perspective on egg freezing changes significantly. In this article, I argue that, if we focus on future generations in general, rather than focusing only on the (...) children who would be conceived using frozen eggs, policies permitting or encouraging the freezing of eggs may reduce potential harms to future generations. This, I argue, may block the objections to egg freezing for non-medical reasons which focus on the potential risks to the child. (shrink)

BackgroundEgg freezing has emerged as a technology of assisted reproductive medicine that allows women to plan for the anticipated loss of fertility and hence to preserve the option to conceive with their own eggs. The technology is surrounded by value-conflicts and is subject to ongoing discussions. This study aims at contributing to the empirical-ethical debate by exploring women’s viewpoints on egg freezing in Austria, where egg freezing for social reasons is currently not allowed.MethodsQ-methodology was used to identify prevailing viewpoints on (...) egg freezing. 46 female participants ranked a set of 40 statements onto a 9-column forced choice ranking grid according to the level of agreement. Participants were asked to explain their ranking in a follow-up survey. By-person factor analysis was used to identify distinct viewpoints which were interpreted using both the quantitative and the qualitative data.ResultsThree distinct viewpoints were identified:(1) “women should decide for themselves”,(2) “we should accept nature but change policy”, and (3) “we need an informed societal debate”. These viewpoints provide insights into how biomedical innovations such as egg freezing are perceived by women in Austria and illustrate the normative tensions regarding such innovations.ConclusionsAcknowledging the different prioritizations of values regarding assisted reproductive technologies is important to better understand the underlying normative tensions in a country where egg freezing for social reasons is currently not allowed. The study adds new empirical insights to the ongoing debate by outlining and discussing viewpoints of those directly affected: women. Following up on the lay persons perspective is particularly important in the context of future biomedical innovations that may challenge established norms and create new tensions. It therefore also adds to the societal debate and supports evidence-informed policy making in that regard. (shrink)

This article explores egg freezing experiences of women in Turkey. Since 2014, it has been legal in Turkey to use egg freezing technology for ageing women, while it was previously allowed only for disease-related purposes. In cooperation with a private fertility clinic in Istanbul, the authors conducted 21 interviews with older, single women who held either professional or managerial positions and who were undergoing or had undergone the procedure. Drawing on a qualitative analysis of these interviews, the authors explore the (...) social context in which women postpone motherhood and decide to freeze their eggs. The study also looks at the women’s emotional responses to ageing that were triggered by the experience of egg freezing and their narratives of empowerment as a result of the procedure. (shrink)

Definition of the problemThe article addresses the relationship between reproduction, time and the good life. Services offered by reproductive medicine and conceptions of the good life in time influence each other reciprocally. This interaction is characterised by implicit and explicit normative settings and expectations of appropriate temporality.ArgumentsWe first discuss the significance of time for the life course and for parenthood from a sociological and social psychological perspective. Reproductive medicine can increase the options for becoming a parent and thus for life-time (...) autonomy. However, in the context of societal imperatives for optimisation and efficiency, it can also have opposite effects and increase heteronomy. Overall, this leads to changed forms of adaptation and self-determination, new dilemmas and ambivalences in the temporal optimisation of parenthood.ConclusionsAgainst this background, we explain how the ethics of reproductive medicine could benefit from interdisciplinary research that focuses on life in its temporal course. (shrink)

Durch Fortschritte in der modernen Reproduktionsmedizin ist es Frauen heute möglich, auch nach der Menopause mit eigenen Eizellen schwanger zu werden. Damit wird die Fortpflanzung im homologen System auch im Alter zu einer realistischen Option. Gegen derartige späte Schwangerschaften gibt es vielfältige Argumente, die vor allem auf mögliche Schädigungen aufgrund des hohen Alters der Mutter verweisen. Maßnahmen der Anti-Aging-Medizin zum Erhalt bzw. zur Verbesserung der kognitiven und physischen Leistungsfähigkeit im fortgeschrittenen Alter könnten diese Einwände gegen den Einsatz von Reproduktionstechniken nach (...) der Menopause entkräften. Der Beitrag geht der Frage nach, wie erstrebenswert postmenopausale Schwangerschaften unter diesen Voraussetzungen eigentlich sind. Es wird die These vertreten, dass eine Schadensargumentation für eine ethische Bewertung allein nicht ausreichend ist, sondern auch Überlegungen zu Status und Authentizität des Kinderwunsches, zum Selbstverständnis der Medizin, zur Autonomie der Betroffenen sowie zur Natürlichkeit der Lebensführung berücksichtigt werden müssen. Darüber hinaus zeigt sich, wie Entwicklungen in zwei spezifischen Anwendungsbereichen (Anti-Aging- und Reproduktionsmedizin) in einer gemeinsamen Betrachtung zusammengeführt und mit Gewinn für allgemeinere medizinethische Überlegungen bewertet werden können. (shrink)

Recently, Petersen provided in this journal a critical discussion of individualisation arguments in the context of social egg freezing. This argument underlines the idea that it is morally problematic to use individual technological solutions to solve societal challenges that women face. So far, however, there is a lack of empirical data to contextualise his central normative claim that individualisation arguments are implausible. This article discusses an empirical study that supports a contextualised reading of the normative work of Petersen. Based on (...) a qualitative interview study, we found that most women could make sense of this argument but addressed other concerns that are overlooked in the premises of moral individualisation arguments, for instance, the influence of relationship formation on the demand of egg freezing. Furthermore, women did not experience social egg freezing as morally problematic. Nonetheless, the interviewees pointed to a need of more societal solutions and even actively advocated for efforts to increase accessibility such as a partial reimbursement and better quality of information. The implications of these findings for empirical bioethics are discussed. While more research is needed, we argue that, in order to better address individualisation arguments and related ethical concerns, we need to contextualise normative evaluations within women’s moral reasoning. (shrink)

While proponents of social egg freezing argue that it is liberating for women, opponents contest that the technology provides an individualist solution to a social problem. This article comprises personal and academic reflections on the debate on social egg freezing from four young women studying reproductive technologies. We challenge the promotion of social egg freezing as an empowering option for women and question cultural assumptions about childbearing, the disclosure of risk, failures to consider sexual diversity and socioeconomic status, and the (...) expansion of the market in reproductive tissues. (shrink)

According to Petersen, ‘the individualization argument against NMEF [nonmedical egg freezing]’ states: ‘it is morally wrong to let individuals use technology X [NMEF] – in order to try to handle a problem that is social in nature – if the use of X [NMEF] will somehow work against a social solution to a social problem P [gender inequality in the labor market]’. While there may be individuals making individualisation argument against NMEF, I do not read the scholars he discusses—Karey Harwood,1 (...) 2 Lynn Morgan, Janelle Taylor3 and Angel Petrapanagos4—as making this argument. These scholars agree with the premise of the individualisation argument that NMEF ‘is an individualistic and morally problematic solution to the social problems that women face’, but this does not mean that they agree with the conclusion ‘women should not use NMEF’. In fact, several admit that NMEF can be a good choice for some women; Petropanagos, for example, states ‘individual women may benefit from egg freezing to satisfy their reproductive desires’.4 In this commentary, I argue that Petersen incorrectly reduces these scholars’ positions to the individualisation argument by neglecting three pertinent factors: their feminist orientation, their multifaceted critiques of NMEF and how the rapidly advancing field of reproductive medicine informs their ethical analysis. While Petersen …. (shrink)

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, the American College of Obstetricians and Gynecologists, and the American Medical Association, 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. (shrink)

In this paper, we recommend expanding infertility insurance mandates to people who may become infertile because of cancer treatments. Such an expansion would ensure cancer patients can receive fertility preservation technology (FPT) prior to commencing treatment. We base our proposal for extending coverage to cancer patients on the infertility mandate in Massachusetts because it is one of the most inclusive. While we use Massachusetts as a model, our arguments and analysis of possible routes to coverage can be applied to all (...) states' seeking inclusive coverage for infertility treatment. Furthermore, our proposal can also be applied to people with other diseases who may be rendered infertile by treatment. (shrink)

Melanie was 29-years-old, married, and hoping to start a family when she discovered a lump in her pelvis. She was diagnosed with non-Hodgkin lymphoma. But one of her biggest fears upon learning of her diagnosis was the possibility of loosing her ability to have children. When Melanie asked her oncologist and radiation oncologist about the risk cancer treatment posed to her fertility, they told her it was small, as only one ovary would be destroyed during the radiation. Deciding to ask (...) for another opinion, she sought out a reproductive endocrinologist, who told her, contrary to what her oncologists had said, that women like her typically did have problems conceiving after radiation treatment on their pelvis. One of the hardest parts of dealing with her dual diagnosis, Melanie later recalled, was the unknown: “I didn't know if my treatment would definitely render me infertile.”. (shrink)

Oocyte cryopreservation, or ‘egg freezing,’ is the practice of preserving unfertilised oocytes for later fertilisation. This practice allows women to extend their reproductive years. In 2014, Facebook and Apple announced that they would subsidise their female employees’ elective — or ‘social’ — use of egg freezing so that these women can more easily reconcile the demands of career and family life. This announcement engendered controversy and moral debate. Given that social egg freezing is becoming more popular, ethical and empirical analyses (...) are warranted. Here, I utilise content analysis to examine media messages in advertising for SEF. I conclude that many fertility clinics engage in biased advertising — i.e. they advertise the service persuasively, not informatively, emphasising indirect benefits while minimising risks and the low chance of successfully bringing a child to term. As advertising for medical services has been shown to influence the use of those services, advertising for SEF should emphasise clear and easily interpretable statistics about success rate, usage rate, cost, and risk. (shrink)

In this dissertation I examine ethical issues that concern fertility preservation (FP) technologies for women from a feminist perspective. FP technologies involve the removal, cryopreservation and subsequent storage of reproductive materials for future use. The aim of these technologies is to preserve the option of future genetic reproduction. FP technologies have been developed in the cancer context because infertility is one of the long-term side-effects of many cancers or cancer therapies. Many FP technologies are still experimental, but some technologies are (...) becoming available to healthy women who wish to guard against age-related infertility. Although FP technologies are expanding women’s reproductive options and benefitting some women by satisfying their desires for genetically-related children, these technologies pose numerous physical, emotional and financial risks to women. I maintain that a feminist examination of choice is necessary for the ethical provision of FP technologies within patriarchal contexts. My analysis begins by demarcating two oppressive social biases from one another: namely pronatalism and biologism. I argue that each of these biases can unduly influence women’s reproductive choices about FP technologies. I then consider how these biases might be identified and challenged in the FP decision-making context. I outline an ethical process of informed choice that is equipped to protect patient autonomy when such autonomy is threatened by these biases. I then consider whether the choice to use FP should be available to both women within and without the cancer contexts. I argue that both disease-related FP and age-related FP can be morally permissible. Finally, I consider whether there should be an upper age limit on women’s access to their stored reproductive materials. I argue that age can be morally relevant to reproduction and thus age limits on access to assisted reproduction are morally permissible. I conclude by suggesting how feminist insights might inform policies on FP technologies and related assisted reproductive technologies. In sum, my dissertation shows that a feminist analysis of choices about FP is essential for ensuring the ethical provision of FP technologies. (shrink)