In September 2016, Samantha Jefferies, the 42-year-old widow of a Falklands war veteran, won a High Court case enabling her to keep frozen embryos that she and her husband had created (BBC News, 2016). Despite the couple having signed consent forms entitling them to 10 years' storage and posthumous use of embryos, the Sussex Downs Fertility Centre contended that the embryos must be destroyed as a 2-year storage period had expired. The clinic, however, later changed its position to support Mrs Jefferies.
The Human Fertilisation and Embryology Authority (HFEA, 2016) notes that ‘the standard storage period for eggs is normally 10 years. This period can be exceeded only in certain circumstances’. But in an article that was written before the outcome of the High Court case was known, Professor Emily Jackson (2016: 1) argued that both the statutory time limit and the possible exceptions that permit extensions are not fit for purpose: ‘They work against good clinical practice and potentially represent an interference with a woman's right to respect for her family life, which is neither necessary nor proportionate.’
Leaving aside the debate over egg storage times, let us consider whether there are ethical concerns over the principle of egg freezing itself. Philosopher Dr Angel Petropanagos (2010) identified two main reasons for freezing eggs: ‘medical’, which applies to those women with a serious disease whose treatment may damage reproductive organs; and ‘social’, which uses egg freezing technology to guard against the possibility of age-related infertility.
Petropanagos (2010: 2) cites opponents of age-related egg freezing, who variously: describe it as an ‘expensive confidence trick’ or a ‘contestable form of wishful medicine’; encourage women to have children at a younger age or ‘live with their life choices’; and yet praise ‘disease-related egg freezing for giving women with cancer hope and future reproductive options.’ Petropanagos argues that it is not clear whether a strict ban on age-related egg freezing is morally justified, given the permissibility of disease-related egg freezing.
Harwood (2015) points out that although the American Society for Reproductive Medicine withdrew its designation of egg freezing as ‘experimental’ in 2012, it cautioned against age-related egg freezing. In contrast, age-related egg freezing has received more explicit support from the European Society of Human Reproduction and Embryology. The ethical issues in relation to age-related egg freezing identified by Harwood (2015) include commercial exploitation, women feeling pressurised to undertake egg freezing and how egg freezing may have an impact on sex inequality and professional norms. Additionally, should age-related fertility decline be seen as a medical justification for the preservation of fertility? Harwood's recommendation is that the principle of autonomy ought to be asserted, while encouraging the provision of more information on use and outcomes.
In the UK, the HFEA (2016) states that, up to December 2012, 20 babies were born in the UK following the use of their mothers' own frozen eggs, and that ‘around 18 000 eggs [had] been stored in the UK for patients' own use.’
One regularly stated reason for undertaking age-related egg freezing is to allow a woman's career to develop without the interruption of pregnancy in her 20s or 30s. This aspect is addressed by Robertson (2014: 10), who cites the work of Sarah Elizabeth Richards, an egg-freezing enthusiast, but he warns that she ‘ignores in her fervency the lower success rate with freezing eggs after 35’. Nor does Robertson share Richards' view that egg freezing is a ‘“culture narrative shift” that allows women to “reschedule” their motherhood through technology.’ Robertson (2014: 10) further cites a disquieting report about a law firm that offered egg freezing as a fringe benefit to new female employees, ‘reassuring them that devotion to the firm would not wreck their family plans. No worries, they could simply put them off with egg freezing.’ But when might an attractive option that allows a woman to prolong her career by postponing pregnancy through egg freezing become a corporate expectation, and to what extent might subtle pressure result in freedom of choice mutating into a tyranny?
I am troubled by the notion that, where family plans are concerned, ‘they could simply put them off with egg freezing.’ Brian Appleyard (2011) is clear that the notion of simplicity has become a brand and a cult, where people crave simple lives and simple solutions. We are, he argues, naturally complex creatures who are being simplified out of existence.
No doubt egg-freezing technology will continue to develop and evolve, and who knows what future challenges it will bring to the practice of midwifery and the care of older mothers who have undertaken age-related egg freezing. But it is perhaps worth considering the possibility that while technology scampers on ahead, simple solutions may not be easily applied to the complex creatures that we are, and we might end up trudging far behind, dragging our ethical dilemmas with us.