THINK—Social egg freezing

Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor at the Ethos Institute for Public Christianity (http://ethosinstitute.sg).

PREFACE

It should not come as a surprise when a Methodist asks point-blank, “What’s our church’s stand on social egg freezing?”

We can point to the three general rules formulated in the 18th century by the first Methodist societies: first, do no harm. Second, do good. Third, to attend to all the ordinances of God. But how do these rules play out for 21st century issues such as the use of social egg freezing (SEF)? The Methodist Social Principles (MSP), outlined in The Book of Discipline of The Methodist Church in Singapore, are one attempt to articulate what doing good and doing no harm look like in the present day. They set out the church’s views on contemporary issues such as abortion, homosexuality and surrogacy. Understandably, the MSP make no mention of SEF as it is a fairly new issue to Singapore. The nearest they come to it is in a broadly stated principle that “married couples who are burdened with the problem of infertility should prayerfully examine their motives for wanting a child and consider and understand the medical, spiritual, moral and legal implications of assisted reproductive procedures”.

Dr Roland Chia’s article on SEF spotlights how the legalisation of this practice of SEF comes loaded with ethical and moral implications. These implications throw into relief the rules of doing good and doing no harm. The potential risks arising from non-medical use of medical technology, safety concerns, disingenuous communication of success rates, and the wider social implications of using SEF for deferring procreation, all correspond to the MSP concerns within the spheres of science and technology, community life, family, and social well-being, to name some examples. It stands to reason that our commitment to the rights of women cannot be held separate from the rights of children, families, society, and the common good.

Dr Chia reminds us that SEF has the grave potential to do harm, both in calculable and incalculable ways. This is inordinately damaging to women, not to mention the detrimental effects on children and society at large as well. His article is thus both an example and a summons to, in the words of our MSP, “cultivate and practise the virtues of the Christian life… and manifest them in the way we think and the way we live”.

May the Holy Spirit grant us all the virtue of prudence in a fast-advancing world of scientific discoveries and novel applications.

Assistant Pastor, Sengkang Methodist Church

On 5 April 2022, the Singapore Parliament gave its unanimous support for the 25 action plans proposed in the White Paper on Singapore Women’s Development (released on 28 March), after a nine-hour debate. One of these action plans is the legalisation of social egg freezing (SEF).1

More specifically, Parliament accepted the White Paper’s recommendation that women between the ages of 21 and 35 be allowed to freeze their eggs, regardless of marital status. However, only married women will be allowed to use their frozen eggs.

SEF must be distinguished from medical egg freezing.

Medical egg freezing is a method used to preserve eggs so that young women undergoing medical treatment (e.g. chemotherapy) would have a chance to conceive biological children in the future. SEF, however, refers to healthy women who wish to use this technology for non-medical reasons, such as the desire to postpone childbearing while focussing on career advancement.

Unlike medical egg freezing, SEF raises serious ethical and social concerns. However, most articles on this topic published in our local media fail to address the ethical quagmire associated with this procedure. They focus instead on its current low success rate and its high financial cost (average cost of one cycle in Singapore is $10,000).

In this article we examine, albeit briefly, the fundamental ethical and social concerns surrounding SEF.

The key ethical issue related to SEF has to do with its use for non-medical reasons. The technology is not used to treat an illness, but to address a non-medical issue—natural ageing—or to support and promote a lifestyle option or preference.

We should exercise exceptional caution here because the use of medical procedures on healthy people is not only an ethically problematic practice, but also one with serious social consequences.

As Angel Petropanagos et al put it:

Social egg freezing uses medical technology to respond to a nonmedical problem—natural ageing. Physicians should therefore move beyond a discussion of the potential benefits, risks and financial costs to address societal implications.2 SEF poses some risks to women that should not be taken lightly.

The most important medical risks associated with egg freezing are those that result from ovarian stimulation. As Petropanagos et al report, mild-to-moderate ovarian hyperstimulation syndrome could result in fatigue, nausea, headaches, abdominal pains, breast tenderness and irritability.

However, severe hyperstimulation could cause blood clots, shortness of breath, abdominal pain, dehydration and vomiting that require admission to hospital. In rare cases, it can even result in death.3

Women who attempt to have a child by using their frozen-thawed eggs will also be vulnerable to the risks of IVF such as multiple pregnancy, pregnancyrelated hypertension, premature delivery and infants with low birth-weight.

It must be reiterated that these risks are borne by women who have elected to undergo this procedure not because of medical reasons, such as preserving fertility ahead of cancer treatment. They have elected to do so for “social” reasons, such as career considerations or because they have not met the right partner.

Furthermore, in choosing to take this route, these women are also exposing their future offspring to considerable risks. These include congenital structural abnormalities, structural cardiac anomalies, and possible risk of cancer.4

Media hype about SEF tends to send the wrong message by presenting it as a panacea which guarantees that women can have a family later in life.

In its 2020 paper on SEF in the UK, the Nuffield Council on Bioethics notes that “Concerns have been expressed about the trivialisation of SEF in media coverage.”5

Clinics that advertise the procedure have also fuelled public misconceptions about the success of this procedure. “Some clinics’ advertising”, observes the Nuffield paper, “lacks clarity on success rates, costs and risks”. “Some clinics have been criticised for irresponsible marketing strategies...,” it adds.

Perhaps the legalisation of SEF in the UK in 2000 has given the media and fertility clinics more latitude to misrepresent the success of the procedure.

In reality, the success of SEF depends on many factors, including the age of the woman when the eggs were frozen and when they are used, the number of eggs procured, etc. A BBC article which discusses the success rate of SEF reports that according to the 2015 data in the UK, only “2% of all thawed eggs ended up as pregnancies and 0.7% as live births”.6

Given the current success rates, the National Council of Churches of Singapore (NCCS) warns, in its 2019 statement on SEF, that to portray egg freezing as “fertility insurance” is to fabricate a false hope.7

There are also a number of social issues surrounding the practice of SEF.

Once SEF is legalised and becomes mainstream, women may be subjected to subtle pressures—which can come in various forms—to make use of the medical technology. For example, in October 2014, Apple and Facebook announced that they will pay their female employees to freeze their eggs so that they can concentrate on their careers and delay having children.8

Pro-SEF social media influencers and algorithms that target women with SEF adverts can also influence women to take this option. Even physicians and family members can coerce women to take advantage of this medical technology so that they can “avoid future regret”.

This in turn may change women’s and society’s mindsets about career, marriage, and family. As Petropanagos et al put it:

Women are encouraged to freeze their eggs as a way to ‘have it all’ (that is, to have both a family and career), implying that for those women who want both these things, egg freezing makes this possible.9 SEF may also put a heavy and unnecessary burden on the next generation. As NCCS explains in its statement:

… women in their 40s and even 50s who use this technique often place on their children the heavy burden of having to take care of their geriatric parents (often burdened with chronic health conditions) when they are just about to start out in life as working adults, amidst all the attendant responsibilities and challenges associated with people at this stage of life (marriage, career, mortgage, starting a family, etc).10

And this will no doubt have wider ramifications for society.

There are many more ethical issues surrounding SEF that we are unable to discuss in this article, such as the commodification of women’s bodies and the medicalisation of childbearing.

But the issues that we have highlighted and briefly addressed should give all of us—especially Christians— pause about using this medical technology for nonmedical reasons.

1 White Paper on Singapore Women’s Development: Towards a Fairer and More Inclusive Society, 66. https://www.scwo.org.sg/ wp-content/uploads/2022/03/White-Paper-on-Singapore-WomensDevelopment.pdf. 2 Angel Petropanagos, Alana Cattapan, Françoise Baylis and Arthur Leader, “Social egg freezing: risk, benefits and other considerations”, Canadian Medical Association Journal, June 6, 2015, 187(9), 666-669. https://www.cmaj.ca/content/187/9/666. 3 Ibid. 4 Okun N. Sierra S. “SOGC Clinical Guidelines: Pregnancy Outcomes After Assisted Reproduction”, Journal of Obstetrics and Gynaecology Canada, 2014, 36:64-83. 5 Nuffield Council on Bioethics, Bioethics Briefing Note. Egg Freezing in the UK., 3. https://www.nuffieldbioethics.org/assets/pdfs/Eggfreezing-in-the-UK.pdf. 6 BBC, “Egg-freezing: What’s the Success Rate?’ 17 February 2020. https://www.bbc.com/news/health-51463488. 7 National Council of Churches of Singapore, “Social Egg Freezing: Ethical and Social Issues”, 3. https://nccs.org.sg/wp-content/ uploads/2019/03/NCCS-Social-Egg-Freezing.pdf. 8 Mark Tran, “Apple and Facebook offer to freeze eggs for female employees”, The Guardian, 15 October 2014. https://www. theguardian.com/technology/2014/oct/15/apple-facebook-offerfreeze-eggs-female-employees. 9 Petropanagos et al, “Social Egg Freezing”. 10 National Council of Churches of Singapore, “Social Egg Freezing: Ethical and Social Issues”, 3. https://nccs.org.sg/wp-content/ uploads/2019/03/NCCS-Social-Egg-Freezing.pdf.