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Let her freeze her eggs
Publication Date : 31-05-2012
Should Singapore's ban on "social egg freezing" stay?
Gynaecological oncologist Tay Eng Hseon of the Thomson Women Cancer Centre raised this issue in an interview with The Straits Times last week. He objects to this practice where women have their oocytes (eggs) frozen while they are still young, so that they can postpone child-bearing, focus on their careers and bide their time, waiting for Mr Right.
Until recently, the freezing technology available saw ice crystals forming inside eggs, raising the risk of chromosomal abnormalities. But current technology called vitrification has removed this problem.
The UK's Royal College of Obstetricians and Gynaecologists, an ertswhile opponent of social egg freezing, recently reviewed the new technology to find it "can conserve egg competence for fertilisation and development at a level similar to that of freshly collected eggs".
Every female is born with about two million eggs, 88 per cent of which are lost by the age of 30 and 97 per cent by 40. Egg quality also diminishes with age.
Whereas sperm has long been successfully cryo-preserved, it is only now that women have equality in fertility preservation. Such social egg freezing is being performed in Australia, Britain, Canada, Europe, Malaysia and the United States - countries where no ban has ever been imposed.
Given that reproductive liberty is widely cherished, the fertility industry is self-regulated in most countries, save for bans on human cloning and rules on experimentation with human embryos.
In these countries, the debate (once it became clear that vitrification works) has simply been whether healthy younger women should take the health risks involved in egg harvesting.
Drugs used to prepare the eggs for harvesting may cause strokes, kidney damage and perhaps breast and uterine cancers. Surgery is also involved to actually harvest the eggs.
But the Health Ministry continues to ban the freezing of eggs except for women who might lose their fertility, say, as a result of cancer treatment. In 2004, KK Hospital offered it to younger cancer patients.
The rationale then was that freezing technology was still experimental. Eight years on, the ban has stayed. Healthy younger women are not permitted to have their eggs frozen for social reasons.
But given that more authorities are giving the thumbs-up to vitrification, what are objections to social egg freezing - like those espoused by Tay - based on?
First, there is the fear that women with frozen eggs may decide on ever later marriages and pregnancies, which entail higher risks.
But however desirable earlier marriage and child-bearing are, it is unjust to deny fertility preservation equality to women. Why not do both - promote earlier marriages and younger pregnancies among the willing while also helping women who want to preserve their fertility for later?
Using their own younger oocytes will not only give them genetic children but also obviate the need to get young women as egg donors, which is not widespread as egg donation carries serious medical risks.
Second, Tay fears that in-vitro fertilisation using these frozen eggs might become the social norm, which will raise health-care costs.
But this is unlikely, since many women will marry and want to have children early and through natural means. Letting them freeze their eggs simply allows them to have more children later if they wish to, even after their fertility declines.
Another group who would benefit from freezing eggs are those who marry late, say, in their 40s, when fertility is low. This group, who might otherwise be childless, can now have their own genetic offspring with lower risks of chromosomal abnormalities.
Leftover oocytes can also be donated to infertile women of whatever age. There might be leftovers because Mr Right came along early enough for natural reproduction; or he never appeared so the eggs were never used; or because the woman had the number of offspring she wanted using her young eggs and still had some to spare afterwards.
Third, Tay says Nature is inherently ageist as "fertility wanes with age... A woman loses the opportunity to bear a child easily if she does not do it in a timely manner".
Yet here precisely is a way to overcome the trap of time.
Tay's appeal to "natural" limits portrays child-bearing and rearing as solely biological concerns. But social context matters as well. In fact, what he expresses is a traditional stereotype where women stay at home, bear children early in life and have as many babies as possible. That might be the norm in older agrarian societies with no effective contraception to space out child-bearing. It did insure against high infant mortality rates and produced labour needed in the fields.
But this no longer applies in today's economy where women work outside the home and infant mortality rates are low.
As this is a cultural presupposition not all may share, Tay's paternalism must be rejected. Instead, reproductive justice demands equality and choice. Equal respect for the autonomy of all competent persons means that every woman - not her doctor - has the right to choose if she will bear children, with whom, how many, how often and when.
If a well-informed woman willingly and knowingly embraces the health risks the procedure involves, no one should deny her the right to have her eggs harvested and frozen while young.