Egg freezing and egg banking: empowerment and alienation in assisted?reproduction

摘要

Getting eggs, unlike sperm, has always posed special problem because of their relative scarcity and location in the body. Although a woman is born with the maximum number of eggs that she will ever have, they are lost as she ages. The ability to hyperstimulate ovaries and then surgically retrieve multiple mature oocytes has been a driving force in the take-off of IVF and assisted reproduction. It has also made egg donation to infertile women and gestational surrogacy viable, as well as donation to researchers, and eventually for clinical use in regenerative medicine.5Despite the ASRM's pronouncement that oocyte cryopreservation is no longer ‘experimental' for several uses, programs vary in their skill and success rate in the art of freezing. The larger and more experienced programs will have success rates comparable to the use of fresh or frozen embryos, said to be 30–50% per frozen-thawed egg, but few programs without considerable experience score that high. Indeed, of the 50% of the U.S. ART programs that report offering oocyte cryopreservation, over 50% of them have never thawed and inseminated frozen eggs and had live births thereafter.9Egg freezing is a clear advantage for those couples undergoing IVF who have qualms about freezing embryos but few about freezing eggs. The ‘qualms' might be specifically moral, or they may reflect a more general concern about not having too many embryos left in the freezer.11 For either group egg freezing is empowering. They will be able to avoid the risk of reduced efficiency from an IVF cycle due to their reluctance to discard embryos or to have too many leftover. Instead of limiting the number of eggs inseminated to those that they would transfer to the uterus (discarding the extra eggs or not retrieving them at all), now they may retrieve all eggs, inseminate only the number that can be safely transferred, and freeze surplus eggs for later thawing and use.12 If the stored eggs were no longer needed, they could be discarded without the ethical frisson of discarding frozen embryos.13Egg freezing also enhances freedom for women undergoing cancer treatment who want to preserve their fertility. If they had a spouse or partner, they could undergo a stimulation and retrieval cycle, create embryos, and freeze them for later use. They could do the same without an available partner, if they were willing to use donor sperm to create embryos. This would ensure them genetic offspring, but with an absent sperm donor father. If they lack a partner and willingness to use a sperm donor, egg freezing would be empowering because it both protects their fertility and gives them choice over the genetic father of their post-treatment children.22 A similar need might arise with women with genetic diseases or other conditions, such as premature ovarian failure, who had not yet found a partner but wanted to ensure they had healthy eggs at a later point in their life for reproduction. Egg freezing has also been touted as a way to provide women who are still fertile with insurance against their biological clock. Women in their twenties or early thirties will be able to devote themselves to career without losing reproductive potency. By freezing eggs they will still have healthy eggs available for when they are ready to start a family. Rescheduling motherhood in this way does sound empowering, but again nothing is as simple as it sounds. Here egg freezing empowers women to assert ownership and control over the eggs they have produced. This follows from the structure of property or ownership rights in one's gametes. Women banking eggs are the owners of them, and will have ultimate dispositional control over them until they choose to transfer that control to another.44 How they will or should exercise that control is the question. As women come to view storing eggs as a banking transaction, with the possibility of accruing interest (in the form of rising prices) or independent sale, a sense of alienation or commodification might accompany egg freezing. Although their goal at time of freezing is to reserve their own fertility, they will also have to think of their eggs as possible future commodities that are transferred to others, either on grounds of altruism or profit. The forms they will be asked to sign for future disposition of stored eggs will remind them of this contingency as well as the infectious disease and other FDA screening that will then have to be done to prepare for or done at a later time for those contingencies. At some point women freezing their eggs may come to see them as another commodity on the reproductive market/that arose from their non-market efforts to preserve their fertility. Only later are do they become marketeers, either as entrepreneurs or sellers in their own right, but that possibility hovers from the inception. Empowerment occurs but at the price of (later) alienation. Of course, free