3 April 2017
Appeared in BioNews 895More women are choosing to freeze their eggs than ever before (see BioNews 845). Social and demographic change means the average age of a first-time mother in the UK has risen to 30.3. Since a woman's fertility starts to decline more rapidly from the mid-30s onwards, there is a concern that this trend may now account for many of the one in seven couples who want a family yet face fertility problems. To explore this recent phenomenon Dr Zeynep Gurtin, a medical sociologist from the University of Cambridge, organised an event held on 25 March called 'The Future of Female Fertility? Egg Freezing and Social Change'.
The strongest uptake in egg freezing has been by 'social egg freezers', the cohort of women insuring themselves against age-related fertility decline. Despite growing usage, the technology is still in its infancy. Clinical efficacy data is scarce (a 14 percent success rate is estimated) and little is known about the social causes and consequences of egg freezing. Furthermore, coverage in the media is polarised; egg-freezing is either hailed as an empowering technology – 'the new Pill', or scorned as the preserve of 'the desperate woman, on the prowl for a baby daddy' or 'the hard-headed careerist who is willing to pay to put off the ticking of her biological clock' (1). Dr Gurtin stressed the urgent need for full and frank public debate before introducing three speakers, each with their own fascinating perspective on the topic.
The first speaker was Professor Marcia Inhorn, an anthropologist from Yale University, who presented her novel study of the social and demographic drivers of egg-freezing in the US. Professor Inhorn had constructed a very personal and revealing profile of women who choose to freeze their eggs; the majority of whom were urban, affluent, highly educated professionals in their late 30s. She was quick to point out that these women did not fit the trope of the Sheryl Sandberg 'Lean In' woman, who 'wants it all' and would defy biological imperatives in order to first climb the career ladder. These women deeply desired a family but had simply never found the right partner.
The problem, Professor Inhorn argued, is a dearth of eligible men. At first glance the reasons for this demographic disparity signify progress; women are more educated, getting top jobs and taking more control of their lives than ever before. However, there are currently four college graduate women for every three men in the US; educated women are therefore competing over fewer educated men. These men can be intimidated by high status and opt to 'marry down' (the 'emasculation thesis'). The dwindling pool of suitors left at the top can then choose to play the field and never settle (the 'Peter Pan thesis'). And finally, the limitless choice offered by online dating puts us all in a state of perpetual dissatisfaction ('the soulmate thesis'). Left thinking 'why me?', the choice for these women is one of necessity. Egg freezing is a way of buying more time, of preserving not postponing their fertility. Professor Inhorn brilliantly articulated the shame and stigma that can accompany singledom and childlessness for these women. For them, egg freezing is not a statement of female empowerment but a very private decision that can carry as much sadness as it does hope.
The next speaker was Emily Jackson, professor of law at the London School of Economics (LSE), who tackled some of the key legal issues surrounding egg freezing. The most significant piece of legislation (the Human Fertilisation and Embryology Act 1990) puts a ten-year storage limit on frozen eggs and was introduced over 25 years ago to mitigate the then unknown risks of storage. This out-dated law is deeply harmful, said Professor Jackson. Firstly, it incentivises women to delay freezing their eggs long after the optimal age, since if they freeze too young it is less likely the eggs will be used. Then, once frozen, a 'non-biological clock' starts ticking and women must weigh up wasting a large sum of money if their ten years runs out (around £4000 per freezing cycle in the UK) or using their eggs before being truly ready to give up finding a partner.
Professor Jackson stressed that women must be armed with better information to tackle these difficult decisions. Women tend to underestimate their fertility decline and overestimate the success of reproductive technologies, in part due to clinics that oversell egg freezing as a miracle technology and downplay the discomfort, risks and personal hardships involved. Professor Jackson's message was clear and convincing - at this nascent stage, egg freezing is an ambiguous technology and our primary concern should be informed consent.
The final speaker was Wendy Sigle, professor of gender and family studies at the LSE. Professor Sigle took a more theoretical approach, exploring cultural representations of fertility and expertly exposing their underlying assumptions. For example, it is assumed that successful women must postpone their fertility in favour of a career - implicit in Apple and Facebook's policy of paying for female employees to freeze their eggs. It is also assumed that age-related infertility is a woman's problem to be medicalised away. Perhaps the real problem we are failing to acknowledge, showed Professor Sigle, is the failure of institutions to support early families.
She went on to challenge the exclusionary cost of egg freezing, asking whether it could ever be considered compatible with social progress. Even if we concede that egg freezing can help some women, it helps only the privileged few.
All three speakers offered brilliant insights on the topic. While Professor Inhorn described the lives of women for whom egg freezing offers real hope, the surprising fact is that very few women who freeze their eggs ever use them. Perhaps, as Professor Jackson suggested, the current opportunity offered by egg freezing does not outweigh the burden of choice on the individual and the cost to society at large. Finally, Professor Sigle's talk posed the most difficult question; can egg freezing be considered a feminist technology? Should we really be addressing the failures of a social fabric that requires women to preserve their fertility at all? This event was an exciting opening to an urgently needed discussion and is the first in a series of 'fertile conversations' that should be eagerly anticipated.