An essay by Rebecca Fowler

Across the world women are waiting longer than ever to have kids. Whether it is because they want to focus on their careers or they haven’t yet found a suitable partner, the average of a women giving birth has increased dramatically over the past decade. Social egg freezing, or oocyte cryopreservation has become increasingly common across the globe. While this technology is often framed as a point of empowerment for women, it requires careful analysis to truly understand the role of reproductive technologies within specific cultures, and society more broadly. It is important to critically question why are women seeking to freeze their eggs in the first place. Why are women consenting to this procedure? In doing so are they simultaneously consenting to other systems of oppression? Consent plays an important role in navigating the ethics and powers at play in regards to egg freezing. When using an intersectional feminist framework to deconstruct egg freezing it is important to make the distinction between consent and informed consent.  It is often assumed that all consent is informed, and thus very little distinction is made publicly between the two. However it has become evident that there are a multitude of exterior powers informing a women’s desire to access egg freezing, thus impacting the power and legitimacy of informed consent. Both specific individuals and society have a vested interest in the usage and success of egg freezing, resulting in a diluted understanding of what it means to consent versus practice informed consent. In China specifically, egg freezing laws reinforce gender stereotypes and prohibit women from accessing the technology without a legally recognized partner.

For the purpose of this paper the distinction between social egg freezing and medically necessary egg freezing is important. Social egg freezing refers to women who freeze their eggs as an “insurance policy”, or a means of avoiding age-related infertility later in life. In “Reproductive Choice and Egg Freezing” by Angel Petropangos she defines medical egg freezing as, “…the use of egg freezing technology by women who are diagnosed with cancer or other serious disease whose treatment and/or progression can damage reproductive organs” (Petropangos 2). Egg freezing in this paper will always be referring to social egg freezing.

Deconstructing this technology through a feminist lens requires the recognition of societal ideologies that influence the value placed on family and kinship. The pressure to produce a family has become so deeply engrained in both western and eastern society. This pressure has been institutionally internalized in such a way, that it is often unrecognizable as a cultural oppression. The value placed on the family unit, motherhood, and kinship plays a significant role in how women interpret their potential worth in society, and in turn impacts the way many women move through their lives. What fuels a women’s desire to freeze her eggs and “secure” future children? I would argue in many cases it is fear. In a society where a women’s worth is determined based on her ability to reproduce biological children, it seems reasonable that women will seek out any, and all means possible to bare children. In “Fertility Penalty: Social egg freezing: the prospect of reproductive immortality or dangerous delusion?” by Gillian Lockwood she explores the complicated balance between motherhood and career building. Lockwood states, “Sociological and demographic pressures conspire to encourage women to defer and delay childbearing and many, on current projections, will end up involuntarily childless as a result” (Lockwood 339). The fear of social alienation as a result of “failure” to start a family, acts as the catalyst for egg freezing. Similar to the way in which the pressure for women to join the workforce acts as a catalyst in deferring motherhood. Failure to discuss and understand how the powers that fuel egg freezing, ultimately results in uninformed consent. During the past few decades it has become increasingly difficult for women to gain momentum in their careers while simultaneously starting a family. The family unit holds a tremendous amount of value in the United States, and is a large contributing factor to one’s status within society.

While there has been increasing support for the visibility of women in the workplace, the expectation that women will marry and start a family still holds true. Lockwood states,  “The ‘fertility penalty’, that is the loss in lifetime earnings as a result of time lost out of the labor market, is actually higher for low-skilled… This is because lower skilled women will be away from work longer (because of extra pregnancies and unaffordable child care) and may need to accept very low paid work to get the shorter or more flexible hours they need to be able to return to work at all” (Lockwood 337). As a culture we have created an environment in which women are penalized in the workplace for having a child. Simultaneously, women who opt to focus on their career in place of children often face stigma and scrutiny.

How is this connected to consent and informed consent? It is important to recognize the way this cultural ideology fuels the desire and phenomenon of egg freezing. Consent is defined in the dictionary as an “agreement or permission to do or allow something”. Informed consent however, is defined as “consent given by a person who has a clear appreciation and understanding of the facts, implications, and future consequences of the action” (Merriam-Webster Dictionary). In distinguishing consent from informed consent, it is imperative to recognize the difference between simply “agreeing” to something, versus understanding both the immediate and future implications of “agreeing”.

To be informed is to understand the implications of the technology. Consent to social egg freezing, subtly acts as consent to gender roles and expectations in an almost unrecognizable way. It is these gender roles and expectations that inform many women’s decision to access egg freezing. It is advertised under a framework of empowerment and bodily autonomy, while actually reinforcing detrimental systems of oppression. Additionally, it provides women with a false sense of security that children are inevitable once the eggs are utilized. In  “Social Egg Freezing: Should it be Permitted in Singapore” by Lee Kuan Yew she states, “However, critics argue that this might give a false sense of security and encourage them to delay marriage and parenthood”(Yew 7). There are enormous costs to delaying motherhood based on sheer reliance on reproductive technologies. Lockwood describes these costs in terms of personal unhappiness as well as significant social and economic implications (Lockwood 336). Egg freezing is framed as the “insurance policy” on motherhood, however it fails to address the ramifications to women physically and emotionally if the technology fails to produce a child. This is because egg freezing can act as a band-aid to deeper societal inequalities.

Understanding the way egg freezing is framed and presented is key to dissecting issues of informed consent. The way in which information about egg freezing is presented to its target audience plays a tremendous role in how and why egg freezing is utilized. When presented under the framework of bodily autonomy and female empowerment, egg freezing appears to support feminist values to its core. In an essay regarding the biomedical ethics of plastic surgery Leonore Tiefer states, “Those in the first group feel that the issue of ‘choice’ regarding cosmetic surgery is fraught because the context within which women make their decisions is filled with misogynist influences” (Tiefer 473). This ideology should be applied to our understanding of “true” bodily autonomy and informed consent in regards to reproductive technologies. How do we come to understand these technologies as liberating while simultaneously understanding the context in which these decisions are made? Is informed consent valid, if the context is a heteronormative, sexist society?

Corporations such as Google and Apple have now started to cover egg freezing for their female employees. In doing so they are able to avoid addressing their unreasonable work structure and sexist values under the guise of “empowering women”. By presenting egg freezing as guaranteed motherhood in the future, it appears that these companies are addressing both the desire for women to further their careers and the value of motherhood. However these companies have a vested interest in the utilization of egg freezing by their female employees. Yew goes on to explore the impacts of companies adding egg-freezing benefits. She states, “This could even undermine efforts to address other workplace barriers to parenthood” (Yew 7). Companies who provide these types of benefits are too quickly seen as except from further policy adjustments (i.e. longer maternity leave etc.)

Thus it is important to recognize how these companies impact the dissemination of knowledge around reproductive technologies and in turn the context of informed consent. An initial Time article on the new egg freezing benefits concluded with,  “And if your boss is offering it up to you for free, what do you have to lose?” This questions demonstrates the lack of reliable information on the physical and social impacts of wide spread egg freezing. It also exemplifies the power corporations have in shaping normalcy in regards to reproduction and gender expectations.  This framework is a misrepresentation of the ultimate implications of egg freezing and dilutes the validity of informed consent. These companies have the power to normalize egg freezing, through the manipulation of information, at the long-term expense of women.

The media and pharmaceutical companies play a vital role in controlling the “factual” information provided to patients about egg freezing. The profitability of egg freezing also acts as a huge motivator for both doctors and corporations. How does the media glorification of egg freezing impact the information women have access to? How does this glorification dilute the reality that egg freezing does not guarantee children in the future? Why is no one talking about the potential physical ramifications to women’s bodies as a result of egg freezing? When the authority responsible for informing women is the same authority that benefits from the outcome, women are denied the opportunity to practice truly informed consent. Egg freezing facilities offer intentionally manipulative information and images on their webpages. On the “Fertility Institute of Hawaii” webpage the largest image on the screen is a mother holding her baby. Immediately one would assume that any the listed reproductive technologies would inevitably lead to a child. Additionally under the tab “Egg Cryopreservation” it concludes three brief paragraphs with, “Now women interested in freezing their eggs can consider the option of waiting until they wish to conceive at a later date of their own choosing.” This is incredibly deceiving as there is no mention of the physically taxing egg collection process or emotional implications should the procedure not work. The media further perpetuates misinformation with images such of a clock frozen in ice, representative of egg freezing’s ability to “stop time”. Television and magazine articles glamorize the phenomenon of egg freezing parties and other social gatherings.

How in this case can it be considered informed consent when the medical information provided is easily and knowingly misperceived and understood? However, companies and media images are not alone in influencing consent. Physicians play an enormous role in how, and with what information, patients are informed. In “Fertility Preservation for Medical Reasons and Reproductive Justice”, Seema Mohapatra explores issues of consent, empowerment, and bodily autonomy in regards to reproductive technologies. She describes a guideline passed by the American Society of Clinical Oncology that recommended that oncologists, “…address the possibility of infertility with patients being treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists” (Mohapatra 609). It is important to note here the use of the phase “appropriate patient”. In our current system, it is up to a doctor’s subjective discretion to determine the way information is provided. Additionally, one study suggested that oncologists are less likely to discuss fertility preservation for medical reasons with African American women than white women. It feels safe to assume that this subjectivity carries over into the wide pool of information that women need to practice informed consent.

Mohapatra continues on to discuss the meaning  “true” reproductive justice in regards to these technologies. She asserts the importance of health literacy as key aspect of informed consent; something our medical system is currently lacking. She describes health literacy as the ability to obtain, understand, and utilize health information to make sound health decisions (Mohapatra 626). Health literacy is currently not in effect due to the subjectivity involved in the dissemination of knowledge. Women are unable to easily access reliable and pertinent information. Additionally, physicians often have a personal vested interest in egg freezing such as a financial investment in the cryopreservation business or storage facility or an active role in fertility study. The overlap between physicians, profit, and patient care currently clouds the lines of informed consent.

Currently in China there are strict laws surrounding accessibility to egg freezing. Single women are banned from freezing their eggs, leaving the technology only available to those in a legally recognized marriage. As stated in “China’s ban on single women freezing their eggs has become a national conversation” by Richard Macauley, “In recent years the government has been trying to encourage women to give birth, rather than put off motherhood, and freezing eggs could act against that” (Macauley 2015).  This demonstrates how the motive of the government impacts a women’s bodily autonomy, and thus the context in which the decision to freeze one’s eggs is made. Within this context, married Chinese women who access egg freezing are not practicing informed consent.

Additionally, gender and age intersect deeply within Chinese culture. Chinese women over the age of twenty-seven are referred to as “leftover women”, an incredibly derogatory term. Macauley states, “Even the supposedly pro-women All-China Women’s Foundation (ACWF) filled its website with articles about the horrors of a women entering her late 20s without the prospect of starting a family on the horizon” (Macauley 2015). Here the societal pressures to start a family with a partner are evident, and undoubtedly affect a women’s desire to freeze her eggs. The laws preventing single women from accessing egg freezing subtly prevents women from starting non-nuclear families or choosing to raise a child alone. Similarly, in “Thirty-Seven and Counting” by Kate Lunau she explains why women in their late-thirties are seeking out social egg freezing. Lunau states, “They’re hoping that science can help them achieve a traditional family, ultimately one with a father who is known and present…” (Lanau 3). Women experience immense cultural pressure to conform to a traditional, heterosexual marriage, at a young age with the ultimate goal of producing children. In this quote it is evident that egg freezing technology is being negatively utilized to reinforce systems of oppression.

Conclusively despite the assertion that women are practicing informed consent in regards to egg freezing, and are in tern empowered, this does not hold true. A deep understanding and continuous conversations around gender roles and kinship must be the universal foundation prior to the widespread use of egg freezing. The dissemination of knowledge must be taken out of the hands of those directly benefiting (doctors, the government ect.) and instead be given to those invested in feminism and reproductive justice. Egg freezing has the potential to provide a variety of benefits to women, however we cannot reap such rewards until truly informed consent is practiced across the globe.

Works Cited:

1. “Fertility Institute of Hawaii.” Egg Cryopreservation. 5 April. 2016. Web.
2. Lunau, Kate. “Thirty-Seven and Counting.” Maclean’s43 (2012): 46-50. Academic Search Premier [EBSCO]. Web. 5 Apr. 2016.
3. Lockwood, Gillian M. “Social Egg Freezing: The Prospect of Reproductive ‘immortality’ or a Dangerous Delusion?” Reproductive BioMedicine Online3 (2011): 334-40. Web.
4. Mahapatra, Seema. “Fertility Preservation for Medical Reasons and Reproductive Justice.” Harvard Journal on Racial and Ethnic Justice 30 (2014): 601-30. Web.
5. Macauley, Richard. “Chinas Ban on Single Women Freezing Their Eggs Has Become a National Conversation.”Quartz. Quartz, 04 Aug. 2015. Web. 5 Apr. 2016.
6. Petropanagos, Angel. “Reproductive ‘Choice’ and Egg Freezing.” Cancer Treatment and Research. U.S. National Library of Medicine, 2010. Web. 5 Apr. 2016.
7. Tiefer, Leonore. “Female Genital Cosmetic Surgery: Freakish or Inevitable? Analysis from Medical Marketing, Bioethics, and Feminist Theory.” Feminism and Psychology (208): 476-79. Web.
8. Yew, Lee K. “Social Egg Freezing: Should It Be Permitted In Singapore?” (2012): n. pag. Web.