Skip to main content
Top
Published in: Journal of Bioethical Inquiry 4/2021

01-12-2021 | Fertility | Original Research

Between “Medical” and “Social” Egg Freezing

A Comparative Analysis of Regulatory Frameworks in Austria, Germany, Israel, and the Netherlands

Authors: Nitzan Rimon-Zarfaty, Johanna Kostenzer, Lisa-Katharina Sismuth, Antoinette de Bont

Published in: Journal of Bioethical Inquiry | Issue 4/2021

Login to get access

Abstract

Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between “medical” and “social” egg freezing (MEF and SEF)—contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the “regulatory boundary-work” around the “medical”–”social” distinction in different egg freezing regulations. Based on systematic documents’ analysis we present a cross-national comparison of the way the “medical”–”social” differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness—highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between “medical” and “social” are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects.
Literature
go back to reference ASRM—Ethics Committee of the American Society for Reproductive Medicine. 2018. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: An Ethics Committee opinion. Fertility and Sterility 110(6): 1022–1028. ASRM—Ethics Committee of the American Society for Reproductive Medicine. 2018. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: An Ethics Committee opinion. Fertility and Sterility 110(6): 1022–1028.
go back to reference ASRM (Practice Committees of American Society for Reproductive Medicine) and SART (Society for Assisted Reproductive Technology). 2013. Mature oocyte cryopreservation: A guideline. Fertility and Sterility 99: 37–43. ASRM (Practice Committees of American Society for Reproductive Medicine) and SART (Society for Assisted Reproductive Technology). 2013. Mature oocyte cryopreservation: A guideline. Fertility and Sterility 99: 37–43.
go back to reference Austrian Bioethics Commission. 2015. Stellungnahme der Bioethikkommission beim Bundeskanzleramt zum Entwurf eines Bundesgesetzes, mit dem das Fortpflanzungsmedizingesetz, das Allgemeine bürgerliche Gesetzbuch und das Gentechnikgesetz geändert werden (Fortpflanzungsmedizinrechts-Änderungsgesetz 2015 – FMedRÄG 2015) [Statement of the Bioethics Commission at the Federal Chancellery on the Draft Federal Act Amending the Reproductive Medicine Act, the General Civil Code, and the Genetic Engineering Act (Reproductive Medicine Law Amendment Act 2015 - FMedRÄG 2015)]. https://www.bundeskanzleramt.gv.at/dam/jcr:ecbae513-5ea7-4c76-867e-6316bff33baf/FMedRAEG_2015.pdf. Accessed 30 July 2020. Austrian Bioethics Commission. 2015. Stellungnahme der Bioethikkommission beim Bundeskanzleramt zum Entwurf eines Bundesgesetzes, mit dem das Fortpflanzungsmedizingesetz, das Allgemeine bürgerliche Gesetzbuch und das Gentechnikgesetz geändert werden (Fortpflanzungsmedizinrechts-Änderungsgesetz 2015 – FMedRÄG 2015) [Statement of the Bioethics Commission at the Federal Chancellery on the Draft Federal Act Amending the Reproductive Medicine Act, the General Civil Code, and the Genetic Engineering Act (Reproductive Medicine Law Amendment Act 2015 - FMedRÄG 2015)]. https://​www.​bundeskanzleramt​.​gv.​at/​dam/​jcr:​ecbae513-5ea7-4c76-867e-6316bff33baf/​FMedRAEG_​2015.​pdf. Accessed 30 July 2020.
go back to reference Baldwin, K., L. Culley, N. Hudson, and H. Mitchell. 2014. Reproductive technology and the life course: Current debates and research in social egg freezing. Human Fertility 17(3): 170–179. Baldwin, K., L. Culley, N. Hudson, and H. Mitchell. 2014. Reproductive technology and the life course: Current debates and research in social egg freezing. Human Fertility 17(3): 170–179.
go back to reference Baldwin, K., L. Culley, N. Hudson, H. Mitchell, and S. Lavery. 2015. Oocyte cryopreservation for social reasons: Demographic profile and disposal intentions of UK users. Reproductive BioMedicine Online 31(2): 239–245. Baldwin, K., L. Culley, N. Hudson, H. Mitchell, and S. Lavery. 2015. Oocyte cryopreservation for social reasons: Demographic profile and disposal intentions of UK users. Reproductive BioMedicine Online 31(2): 239–245.
go back to reference Baldwin, K., L. Culley, N. Hudson, and H. Mitchell. 2018. Running out of time: Exploring women’s motivations for social egg freezing. Journal of Psychosomatic Obstetrics & Gynecology 40(2): 166–173. Baldwin, K., L. Culley, N. Hudson, and H. Mitchell. 2018. Running out of time: Exploring women’s motivations for social egg freezing. Journal of Psychosomatic Obstetrics & Gynecology 40(2): 166–173.
go back to reference Bernstein, S., and C. Wiesemann. 2014. Should postponing motherhood via “social freezing” be legally banned? An ethical analysis. Laws 3(2): 282–300. Bernstein, S., and C. Wiesemann. 2014. Should postponing motherhood via “social freezing” be legally banned? An ethical analysis. Laws 3(2): 282–300.
go back to reference Borovecki, A., P. Tozzo, N. Cerri, and L. Caenazzo. 2018. Social egg freezing under public health perspective: Just a medical reality or a women’s right? An ethical case analysis. Journal of Public Health Research 7(1484): 101–105. Borovecki, A., P. Tozzo, N. Cerri, and L. Caenazzo. 2018. Social egg freezing under public health perspective: Just a medical reality or a women’s right? An ethical case analysis. Journal of Public Health Research 7(1484): 101–105.
go back to reference Bos, A.M.E., P. Klapwijk, and B.C.J.M. Fauser. 2012. Brede steun voor eicelbank in Nederland [Broad support for egg bank in the Netherlands]. Ned Tijdschr Geneesk 156(A4145): 1–6. Bos, A.M.E., P. Klapwijk, and B.C.J.M. Fauser. 2012. Brede steun voor eicelbank in Nederland [Broad support for egg bank in the Netherlands]. Ned Tijdschr Geneesk 156(A4145): 1–6.
go back to reference Calhaz-Jorge, C., Ch. De Geyter, M.S. Kupka et al. 2020. Survey on ART and IUI: Legislation, regulation, funding and registries in European countries. Human Reproduction Open 1: 1–15. Calhaz-Jorge, C., Ch. De Geyter, M.S. Kupka et al. 2020. Survey on ART and IUI: Legislation, regulation, funding and registries in European countries. Human Reproduction Open 1: 1–15.
go back to reference Denzin, N.K., and Y. Lincoln, eds. 1994. Handbook of qualitative research. Thousand Oaks, CA: Sage. Denzin, N.K., and Y. Lincoln, eds. 1994. Handbook of qualitative research. Thousand Oaks, CA: Sage.
go back to reference Dondorp, W., and G. de Wert. 2009. Fertility preservation for healthy women: Ethical aspects. Human Reproduction 24(8): 1779–1785. Dondorp, W., and G. de Wert. 2009. Fertility preservation for healthy women: Ethical aspects. Human Reproduction 24(8): 1779–1785.
go back to reference Eleveld, A., and O. van Vliet. 2013. The Dutch welfare state: Recent reforms in social security and labour law. Diritto Pubblico Comparato Ed Europeo 4: 1371–1399. Eleveld, A., and O. van Vliet. 2013. The Dutch welfare state: Recent reforms in social security and labour law. Diritto Pubblico Comparato Ed Europeo 4: 1371–1399.
go back to reference ESHRE Task Force on Ethics and Law. 2012. Oocyte cryopreservation for age-related fertility loss. Human Reproduction 27(5): 1231–1237. ESHRE Task Force on Ethics and Law. 2012. Oocyte cryopreservation for age-related fertility loss. Human Reproduction 27(5): 1231–1237.
go back to reference Flatscher-Thöni, M., and C. Voithofer. 2017. Eizellenspende und PID: Offene Fragen des FMedRÄG 2015 [Oocyte-donations and PID: Open questions about the Austrian Artificial Procreation Act 2015]. Imago Hominis 24(1): 5–59. Flatscher-Thöni, M., and C. Voithofer. 2017. Eizellenspende und PID: Offene Fragen des FMedRÄG 2015 [Oocyte-donations and PID: Open questions about the Austrian Artificial Procreation Act 2015]. Imago Hominis 24(1): 5–59.
go back to reference Gemeinsamer Bundesausschuss (G-BA). 2021a. Beschluss- des Gemeinsamen Bundesausschusses über eine Richtlinie zur Kryokonservierung von Ei oder Samenzellen oder Keimzellgewebe sowie entsprechende medizinische Maßnahmen wegen keimzellschädigender Therapie [Decision of the Federal Joint Committee on a guideline for the cryopreservation of egg or sperm cells or germ cell tissue as well as corresponding medical measures due to therapy that damages germ cells]. https://www.g-ba.de/downloads/39-261-4393/2020-07-16_Kryo-RL_Erstfassung.pdf. Accessed 29 Sept 2021. Gemeinsamer Bundesausschuss (G-BA). 2021a. Beschluss- des Gemeinsamen Bundesausschusses über eine Richtlinie zur Kryokonservierung von Ei oder Samenzellen oder Keimzellgewebe sowie entsprechende medizinische Maßnahmen wegen keimzellschädigender Therapie [Decision of the Federal Joint Committee on a guideline for the cryopreservation of egg or sperm cells or germ cell tissue as well as corresponding medical measures due to therapy that damages germ cells]. https://​www.​g-ba.​de/​downloads/​39-261-4393/​2020-07-16_​Kryo-RL_​Erstfassung.​pdf. Accessed 29 Sept 2021.
go back to reference Gesetzliche Krankenversicherung. Stand: Zuletzt geändert durch Art. 38 G v. 20.8.2021 I 3932, § 27a SGB V Künstliche Befruchtung [Statutory health insurance. Status: Last amended by Art. 38 G v. 8/20/2021 I 3932. Section 27a of the Social Code Book V Artificial insemination]. https://www.sozialgesetzbuch-sgb.de/sgbv/27a.html. Accessed 29 Sept 2021. Gesetzliche Krankenversicherung. Stand: Zuletzt geändert durch Art. 38 G v. 20.8.2021 I 3932, § 27a SGB V Künstliche Befruchtung [Statutory health insurance. Status: Last amended by Art. 38 G v. 8/20/2021 I 3932. Section 27a of the Social Code Book V Artificial insemination]. https://​www.​sozialgesetzbuch​-sgb.​de/​sgbv/​27a.​html. Accessed 29 Sept 2021.
go back to reference Inhorn, M.C., D. Birenbaum-Carmeli, L.M. Westphal, et al. 2018. Ten pathways to elective egg freezing: A binational analysis. Journal of Assisted Reproduction and Genetics 35: 2003–2011. Inhorn, M.C., D. Birenbaum-Carmeli, L.M. Westphal, et al. 2018. Ten pathways to elective egg freezing: A binational analysis. Journal of Assisted Reproduction and Genetics 35: 2003–2011.
go back to reference Kılıç, A., and I. Göçmen. 2018. Fate, morals and rational calculations: Freezing eggs for non-medical reasons in Turkey. Social Science & Medicine 203: 19–27. Kılıç, A., and I. Göçmen. 2018. Fate, morals and rational calculations: Freezing eggs for non-medical reasons in Turkey. Social Science & Medicine 203: 19–27.
go back to reference Kingma, E. 2013. Health and disease: Social constructivism as a combination of naturalism and normativism. In Health, illness & disease. Philosophical essays, edited by H. Carel and R. Cooper, 37–56. Durham UK: Acumen.. Kingma, E. 2013. Health and disease: Social constructivism as a combination of naturalism and normativism. In Health, illness & disease. Philosophical essays, edited by H. Carel and R. Cooper, 37–56. Durham UK: Acumen..
go back to reference Kostenzer, J. 2020. Eizellen einfrieren für später? Die Kontroverse um Social Egg Freezing in Österreich [Freezing eggs for later? The controversy over social egg freezing in Austria]. Juridikum 2: 270–272. 10.33196/juridikum202002027001 Kostenzer, J. 2020. Eizellen einfrieren für später? Die Kontroverse um Social Egg Freezing in Österreich [Freezing eggs for later? The controversy over social egg freezing in Austria]. Juridikum 2: 270–272. 10.33196/juridikum202002027001
go back to reference Kostenzer, J., A. de Bont, J. van Exel. 2021a. Women’s viewpoints on egg freezing in Austria: An online Q-methodology study. BMC Medical Ethics 22(4): 1–12. Kostenzer, J., A. de Bont, J. van Exel. 2021a. Women’s viewpoints on egg freezing in Austria: An online Q-methodology study. BMC Medical Ethics 22(4): 1–12.
go back to reference Kostenzer, J., A. de Bont, J. van Exel. 2021b. Unveiling the controversy on egg freezing in The Netherlands: A Q-methodology study on women’s viewpoints. Reproductive Biomedicine & Society Online 12: 32–43. Kostenzer, J., A. de Bont, J. van Exel. 2021b. Unveiling the controversy on egg freezing in The Netherlands: A Q-methodology study on women’s viewpoints. Reproductive Biomedicine & Society Online 12: 32–43.
go back to reference Lemoine M.E., and V. Ravitsky. 2015. Sleepwalking into infertility: The need for a public health approach toward advanced maternal age. The American Journal of Bioethics 15(11): 37–48. Lemoine M.E., and V. Ravitsky. 2015. Sleepwalking into infertility: The need for a public health approach toward advanced maternal age. The American Journal of Bioethics 15(11): 37–48.
go back to reference Martin, L.J. 2010. Anticipating infertility: Egg freezing, genetic preservation and risk. Gender and Society 4: 526–545. Martin, L.J. 2010. Anticipating infertility: Egg freezing, genetic preservation and risk. Gender and Society 4: 526–545.
go back to reference Möller K.H., and K. Makoski. 2020. Rechtliche Regelung der Reproduktionsmedizin in Deutschland [Legal regulation of reproductive medicine in Germany]. In: Diedrich K., M. Ludwig, and G. Griesinger, eds. Reproduktionsmedizin [reproductive medicine]. Springer Reference Medizin. Berlin, Heidelberg: Springer. Möller K.H., and K. Makoski. 2020. Rechtliche Regelung der Reproduktionsmedizin in Deutschland [Legal regulation of reproductive medicine in Germany]. In: Diedrich K., M. Ludwig, and G. Griesinger, eds. Reproduktionsmedizin [reproductive medicine]. Springer Reference Medizin. Berlin, Heidelberg: Springer.
go back to reference Pennings, G. 2013. Ethical aspects of social freezing. Gynecologie Obstetrique & Fertilite 41: 521–523. Pennings, G. 2013. Ethical aspects of social freezing. Gynecologie Obstetrique & Fertilite 41: 521–523.
go back to reference Petropanagos, A., A. Cattapan, A.F. Baylis, et al. 2015. Social egg freezing: Risk, benefits and other considerations. Canadian Medical Association Journal 187(9): 666–669. Petropanagos, A., A. Cattapan, A.F. Baylis, et al. 2015. Social egg freezing: Risk, benefits and other considerations. Canadian Medical Association Journal 187(9): 666–669.
go back to reference Pickard, S. 2016. Age studies: How we age and are aged through the lifecourse. London: Sage. Pickard, S. 2016. Age studies: How we age and are aged through the lifecourse. London: Sage.
go back to reference Radin, J., and E. Kowal. 2017. Introduction. In Cryopolotics: Frozen life in a melting world, edited by J. Radin and E. Kowel, 3–25. Cambridge, M.A: MIT Press. Radin, J., and E. Kowal. 2017. Introduction. In Cryopolotics: Frozen life in a melting world, edited by J. Radin and E. Kowel, 3–25. Cambridge, M.A: MIT Press.
go back to reference Rimon-Zarfaty, N., and M. Schweda. 2019. Biological clocks, biographical schedules and generational cycles: Temporality in the ethics of assisted reproduction. Bioethica Forum 11(4): 133–141. Rimon-Zarfaty, N., and M. Schweda. 2019. Biological clocks, biographical schedules and generational cycles: Temporality in the ethics of assisted reproduction. Bioethica Forum 11(4): 133–141.
go back to reference Robertson, J.A. 2014. Egg freezing and egg banking: Empowerment and alienation in assisted reproduction. Journal of Law and the Biosciences 1(2): 113–136. Robertson, J.A. 2014. Egg freezing and egg banking: Empowerment and alienation in assisted reproduction. Journal of Law and the Biosciences 1(2): 113–136.
go back to reference Shenfield, F., J. de Mouzon, G. Scaravelli, et al. 2017. Oocyte and ovarian tissue cryopreservation in European countries: Statutory background, practice, storage and use. Human Reproduction Open 1: 1–9. Shenfield, F., J. de Mouzon, G. Scaravelli, et al. 2017. Oocyte and ovarian tissue cryopreservation in European countries: Statutory background, practice, storage and use. Human Reproduction Open 1: 1–9.
go back to reference Shkedi-Rafid, S., and Y. Hashiloni-Dolev. 2011. Egg freezing for age-related fertility decline: Preventive medicine or a further medicalization of reproduction? Analyzing the new Israeli policy. Fertility and Sterility 96(2): 291–294. Shkedi-Rafid, S., and Y. Hashiloni-Dolev. 2011. Egg freezing for age-related fertility decline: Preventive medicine or a further medicalization of reproduction? Analyzing the new Israeli policy. Fertility and Sterility 96(2): 291–294.
go back to reference Shkedi-Rafid, S., and Y. Hashiloni-Dolev. 2012. Egg freezing for non-medical uses: The lack of a relational approach to autonomy in the new Israeli policy and in academic discussion. Journal of Medical Ethics 38(3): 154–157. Shkedi-Rafid, S., and Y. Hashiloni-Dolev. 2012. Egg freezing for non-medical uses: The lack of a relational approach to autonomy in the new Israeli policy and in academic discussion. Journal of Medical Ethics 38(3): 154–157.
go back to reference Sontag S. 2018. The double standard of aging. In The other within us, edited by M. Pearsall, 19–24. Abingdon: Routledge. Sontag S. 2018. The double standard of aging. In The other within us, edited by M. Pearsall, 19–24. Abingdon: Routledge.
go back to reference van de Wiel, L. 2015. For whom the clock ticks: Reproductive ageing and egg freezing in Dutch and British news media. Studies in the Maternal 6(1): 1–28. van de Wiel, L. 2015. For whom the clock ticks: Reproductive ageing and egg freezing in Dutch and British news media. Studies in the Maternal 6(1): 1–28.
go back to reference von Wolf, M., A. Germeyer, and F. Nawroth. 2015. Fertility preservation for non-medical reasons—controversial, but increasingly common. Deutsches Arzteblatt International 112: 27–32. von Wolf, M., A. Germeyer, and F. Nawroth. 2015. Fertility preservation for non-medical reasons—controversial, but increasingly common. Deutsches Arzteblatt International 112: 27–32.
go back to reference Waldby, C. 2015. “Banking time”: Egg freezing and the negotiation of future fertility. Culture, Health & Sexuality 17(4): 470–482. Waldby, C. 2015. “Banking time”: Egg freezing and the negotiation of future fertility. Culture, Health & Sexuality 17(4): 470–482.
go back to reference Weber, R.P. 1990. Basic content analysis. Beverly Hills, CA: Sage. Weber, R.P. 1990. Basic content analysis. Beverly Hills, CA: Sage.
go back to reference Wrede, S., C. Benoit, I.L. Bourgeault, E.R. van Teijlingen, J. Sandall, and R.G. De Vries. 2006. Decentred comparative research: Context sensitive analysis of maternal health care. Social Science and Medicine. 63(11): 2986–2997. Wrede, S., C. Benoit, I.L. Bourgeault, E.R. van Teijlingen, J. Sandall, and R.G. De Vries. 2006. Decentred comparative research: Context sensitive analysis of maternal health care. Social Science and Medicine. 63(11): 2986–2997.
go back to reference Zarhin, D., M. Negev, S. Vulfsons, and S.R. Sznitman. 2018. Rhetorical and regulatory boundary-work: The case of medical cannabis policy-making in Israel. Social Science and Medicine 217: 1–9. Zarhin, D., M. Negev, S. Vulfsons, and S.R. Sznitman. 2018. Rhetorical and regulatory boundary-work: The case of medical cannabis policy-making in Israel. Social Science and Medicine 217: 1–9.
Metadata
Title
Between “Medical” and “Social” Egg Freezing
A Comparative Analysis of Regulatory Frameworks in Austria, Germany, Israel, and the Netherlands
Authors
Nitzan Rimon-Zarfaty
Johanna Kostenzer
Lisa-Katharina Sismuth
Antoinette de Bont
Publication date
01-12-2021
Publisher
Springer Singapore
Keyword
Fertility
Published in
Journal of Bioethical Inquiry / Issue 4/2021
Print ISSN: 1176-7529
Electronic ISSN: 1872-4353
DOI
https://doi.org/10.1007/s11673-021-10133-z

Other articles of this Issue 4/2021

Journal of Bioethical Inquiry 4/2021 Go to the issue