What if you could stop time? That’s the proposition that egg freezing makes in response to the otherwise inevitable decline of our body that comes with ageing.
Egg freezing has been in the spotlight in Singapore of late. The ban on social egg freezing—that is, for perceivably “social” reasons to delay childbirth such as wanting to take the time to find a suitable partner or pursue a career—was recently debated in Parliament. These social reasons are as opposed to medical grounds such as the need to go through cancer treatment that may be detrimental to a woman’s eggs. Ms Cheng Li Hui, the MP for Tampines GRC, proposed that the government review this policy and allow healthy women to store their eggs until they are ready to have children.
Separately, Facebook and Apple recently made headlines by offering to give female employees US$20,000 of egg freezing benefits for which the public response was mixed.
Why should you care about this? First things first.
What is Egg Freezing?
Egg freezing, or oocyte cryopreservation, is an assisted reproduction technology (ART) technique that involves freezing and stowing away a woman’s unfertilised eggs for conception at a later stage of her life. This is done to preserve the quality of the eggs, which otherwise declines with time. Other ARTs include the more common in vitro fertilization (IVF). The process looks something like this:
1. Hormone injections over about 2 weeks to stimulate the ovaries to produce more eggs.
2. Regular ultrasound scans and blood tests to ensure that hormone injections are taken to well.
3. Extraction of eggs during a 15-minute procedure involving sedation or a general anaesthetic with a needle through the vaginal wall.
4. Incubation of extracted eggs to allow for as many of them to mature as possible.
5. Flash freezing or vitrification of mature eggs (the only ones that can be fertilised to -196°C using liquid nitrogen.
6. Transfer of frozen eggs to a secure storage facility.
As part of the treatment, women typically undergo multiple egg collection and freezing cycles to obtain enough frozen eggs to have a reasonable chance of future pregnancy.
So, Why Should I Care?
There are many reasons why people may choose to have children later in life, whether as a personal or professional choice or for medical reasons. A lot of consideration goes into the decision of whether to have children, with even more reasons to delay it. As people take the time to be ready to start trying, medical methods to preserve their fertility such as egg freezing safeguard any future plans to start a family.
One important factor to a woman’s fertility is her age. Women are born with all the eggs they will ever produce and with time, the quality and quantity of these eggs decline. The quality of eggs is not measured on a spectrum of healthiness, but is a binary state of either normal or abnormal. According to studies of embryos created from eggs of different ages, women in their early 20s have about 20% abnormal eggs, while women in their 40s have upwards of 80% abnormal eggs. At this point, an alarm might be going off in your head because once an egg becomes abnormal, it cannot become normal again.
Until recent years, flash freezing a woman’s eggs and storing them for years before she is ready to use them to get pregnant must have sounded like something right out of a sci-fi flick. But the times are different now. It is entirely possible, and 90% of the frozen eggs survive post-thawing. This comes as a timely answer to the prayers of many women and couples of today who are having children later in life.
After all, even as our time frame for childbirth adapts with the times, our body doesn’t.
Another reason to delay conception is a woman’s medical condition or circumstances. Medical conditions such as endometriosis can damage fertility. Some medical treatment can be detrimental to the quality of a woman’s eggs. This includes many cancer treatments including chemotherapy and radiation therapy as well as pelvic surgeries. Egg freezing is therefore a way of insurance against potential medical afflictions that are detrimental on fertility, including having to undergo cancer treatment. More recently, some people are worried about the effect of the Covid-19 vaccine on their chances of getting pregnant. Without enough research on the subject, people are increasingly looking to fertility treatments such as egg freezing as a precaution.
What a woman wants to do with her body is her prerogative, and childbearing and egg freezing are more than just women’s issues. Government policies around these issues inevitably affect society as a whole, including heteronormative and non-heteronormative couples and single parents.
Why is Social Egg Freezing Banned?
While some countries allow egg freezing, it is still prohibited in Singapore despite its low fertility rate of 1.14 in 2020—the lowest figure recorded in the country’s history. Only women who have medical grounds, including cancer treatment, are allowed to consider egg freezing. As a result, many women in Singapore head overseas for the procedure.
The Ministry of Health has not made clear its reasons for the ban, merely citing “ethical and social concerns.”
Perhaps it is not ready for a sudden onset of social egg freezing in terms of infrastructure and security. Having always prohibited egg freezing, Singapore does not have an egg bank. If or when it does, efforts will have to be made to prevent security breaches. Case in point: in 2020, a Cleveland fertility clinic lost 4,000 eggs and embryos.
On that note, similar to ethical reasons behind the ban of surrogacy in Singapore, allowing women to freeze their eggs without medical grounds may mean normalising putting a price tag on human life and exposes women to the potential of commercial exploitation. While egg trading is illegal in Singapore, egg donation is not. Egg trading forums exist on which young women in Singapore have been reported to sell their eggs for some extra cash.
As money comes into the picture, some may argue that the cost far outweighs the potential return. The estimated cost of one cycle of egg freezing goes upwards of $10,000 and women typically undergo multiple cycles to obtain enough frozen eggs for a reasonable chance at pregnancy. At 30, women can expect a success rate of 5 to 8% for every egg she has frozen. For women who are in their late 30s or older, on the other hand, the likelihood of success is between a mere 2 and 4% per egg. There are also social harms to consider, including exacerbating a class divide based on who can afford to access egg freezing.
Also, many women freeze their eggs and end up not using them. A ten-year study recorded in 2019 that only 129 or 20% of the women who had frozen their eggs at two of London’s largest fertility clinics returned to use them. Of these, only 21% of these ended up becoming a mother with those eggs. Additionally, although most women who freeze their eggs for social reasons state that their main motivation is to “buy time” to find a suitable partner, half of the women were still single when they returned to use their eggs. Singapore has always been traditional in its ideas of what family looks like, and it is hard to imagine the country condoning non-nuclear family structures.
Ultimately, ARTs such as egg freezing can help provide women beyond the optimal childbearing age with some reassurance that they can overcome the natural limitations of their body, especially as having children is happening later in life for many people today.
It remains important, nevertheless, to ruminate on the additional risks and emotional, physical and financial costs of delayed pregnancy, with and in spite of egg freezing. As part of the big picture, however, making social egg freezing legal may have irreversible adverse effects on the value of human life and of family building.
What are your thoughts on egg freezing in Singapore? Should the government revisit its policies on ARTs like egg freezing?