On the ethics of social egg freezing and fertility preservation for nonmedical reasons

摘要

Abstract: The practice of egg freezing reached a new milestone in 2012, when the American Society for Reproductive Medicine removed its designation as “experimental”. Studies of the safety and efficacy of egg freezing led the ASRM to recommend egg freezing for patients facing infertility due to gonadotoxic therapies, but prompted continued caution against egg freezing when undertaken for nonmedical reasons. The European Society of Human Reproduction and Embryology has more explicitly supported nonmedical egg freezing. Ethical debate about nonmedical egg freezing raises many familiar issues, including the limits of individual autonomy when a medical technology is used for an elective reason. Concerns include commercial exploitation, pressure on women to use egg freezing, and the overall impact of egg freezing on sex inequality and professional norms. The ethical debate also calls for a more careful consideration of whether age-related fertility decline should count as a medical justification for fertility preservation. In lieu of broad consensus on these matters, this paper recommends honoring the principle of autonomy while insisting on better information about utilization and outcomes. Given the significant drop-off in success rates for women who attempt egg freezing when they are older than 38 years, full disclosure in the informed consent process must involve information about success rates by age-group. Much greater consistency and thoroughness in reporting would yield better and more generalizable data.