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If Singapore allows social egg freezing, here are some issues that should be addressed

The Government is expected to give a response in a White Paper by the end of the year after the women’s wing and youth wing of the ruling People’s Action Party proposed lifting the current ban on social egg freezing for single women.

An employee demonstrates the process to extract eggs at a fertility clinic in northern Taiwan.

An employee demonstrates the process to extract eggs at a fertility clinic in northern Taiwan.

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The Government is expected to give a response in a White Paper by the end of the year after the women’s wing and youth wing of the ruling People’s Action Party proposed lifting the current ban on social egg freezing for single women.

Part of the Government’s deliberation process will undoubtedly involve examining some of the pertinent ethical challenges and pitfalls of social egg freezing.

This matter was raised earlier in the year when there was a debate on permitting social egg freezing in Singapore to address the drastic drop in fertility rates caused by the increasing social trend of late marriages and delayed childbearing within the country.

One foreseeable problem of social egg freezing is that there will be an accumulation of excess unused and unclaimed frozen eggs in storage within fertility clinics.

Indeed, an Australian study reported that the majority of women who freeze their eggs do not eventually utilise them.

In that particular study, researchers surveyed nearly 100 women who had elected to freeze their eggs between 1999 and 2014 for the purpose of delayed childbearing.

They found that just 6 percent of the women had utilised their frozen eggs at the time of the survey, with 3 per cent having given birth using the frozen eggs.

Moreover, there will likely be foreigners who freeze their eggs in Singapore who may not be reached after returning home.

Another problem is the frozen eggs of deceased patients. Can these be claimed by their widowed spouse or next-of-kin for overseas surrogacy arrangements?

A set of clear directives by the authorities on managing unused and unclaimed frozen eggs in storage is therefore necessary.

One suggestion is to make patients sign a form consenting for their eggs to be disposed of should they die or when they had not paid storage fees for a certain number of years, for example, three years.

Another suggestion is to place a limit on the storage duration of frozen eggs, for example, 20 years. After that, there would be mandatory disposal of the frozen eggs.

PREVENTING UNAUTHORISED USE OF DISPOSED EGGS

Stringent regulations should be enacted to prevent unauthorised use of patients’ disposed frozen eggs without their explicit consent.

Most commonly, disposed frozen eggs are just assumed to be “clinical waste”, so it is convenient to use these for training of new laboratory workers involved in in-vitro fertilisation (IVF) procedures.

Currently, this is a hazy and ill-defined ethical issue, because unlike research and treatment, unauthorised use of disposed frozen eggs for training does not produce a “document trail” that can be easily traced, in the form of patents, journal articles and birth records.

This is a clear violation of the patient’s individual autonomy and privacy, if she had not given prior consent for her reproductive material to be used for such a purpose.

DONATION OF UNUSED EGGS

Another important consideration is the option of donating unused frozen eggs to other patients who are infertile.

In such a case, there are three pertinent issues that must be addressed.

1. Spousal consent

Spousal consent ought to be sought at the time of egg donation to other patients.

No doubt, women freeze their eggs when they are single, but their marital status might change at the time they wish to donate their eggs to someone else.

In that case, the authorities should ensure informed consent from the donor’s spouse, because of the possibility of accidental incest between the couple’s children and unknown donor-conceived offspring. It is only right that he be made aware and consent to accepting such risks for his children.

More importantly, the donor’s husband must also consent to forego any future offspring with the donated frozen eggs.

This is particularly significant if his wife, the prospective donor, is already near or past the age of menopause.

2. Making known lower chances of conception

The prospective recipient patients of the donated eggs must be duly and rightfully informed that chances of conception with the unused frozen eggs are significantly lower than fresh donor eggs, lest they get a raw deal upon spending so much money on IVF treatment.

The freezing process always results in some damage to the egg, however minimal, so frozen donor eggs are not nearly as good as fresh donor eggs.

Moreover, women tend to be much older in social egg freezing, compared to the younger age of fresh egg donors.

The older donor age would thus translate to lower egg quality and hence, reduced chances of IVF success for the recipients.

It is also likely that prospective donors would have utilised their best eggs for their own fertility treatment, so the donated unused leftovers may be of questionable quality.

3. Conflict of interest

There is a conflict of interest faced by fertility doctors in persuading their former patients to donate unused frozen eggs, since they will be earning extra medical fees by performing the donation procedure on other patients.

Moreover, there is also the risk of the doctor-patient fiduciary relationship being abused during the consent process, particularly if doctors know that their former patients are grateful to them for previously successful treatment.

This is why the authorities should ban solicitation of egg donation by doctors on behalf of other infertile patients.

Additionally, fertility clinics should not exercise control over the distribution and allocation of donated frozen eggs to other patients.

Instead, this should be handled directly by the authorities, based on a centralised donor registry and waiting list of potential recipient patients, as is now practised for organ donation in Singapore.

A POSSIBLE ALTERNATIVE WIN-WIN PARTNERSHIP

Perhaps, there could be a better and more efficient alternative to donation of unused frozen eggs.

This could involve infertile women sponsoring the egg freezing of younger fertile women, in return for donation of some of their retrieved eggs, thus leading to a win-win situation for both parties concerned.

On one hand, this would remove the financial constraints on egg freezing for younger women with less accumulated savings and act as an incentive to encourage single women to freeze their eggs at a younger age, which could greatly improve their chances of future reproductive success.

On the other hand, infertile patients receive fresh egg donation from younger women, instead of unused frozen eggs of older women, which would significantly improve their chances of IVF success.

Moreover, such a “freeze and share” scheme would likely reduce the accumulation of surplus unused and unclaimed frozen eggs in storage.

It was reported a few years ago that infertile Singaporean women spend much money on commercialised egg donation overseas, since donated eggs are so difficult to obtain here.

Would it not be better if they instead spend their money in Singapore on subsidising egg freezing for single women in return for donated eggs?

In conclusion, there is a dire need for comprehensive legislation and clear directives for handling unused and unclaimed frozen eggs, if social egg freezing is to be permitted in Singapore.

Otherwise, this would likely lead to unnecessary disputes and unethical practices arising from legal loopholes, as well as undeclared and unresolved conflicts of interests.

Most importantly, these will protect the rights and welfare of patients.

 

ABOUT THE AUTHOR:

Dr Alexis Heng Boon Chin is an associate professor of Biomedical Science at Peking University, China. He had previously worked in the field of human clinical assisted reproduction research in Singapore, and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies, in addition to also having published more than 250 scientific journal articles.

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