In this slide show, issues regarding egg storage for social reasons is discussed

1. Dr. S. Selva FRCOG
Mahkota Medical Centre,
Melaka, Malaysia
Elective oocyte storage -
Ethical, Legal, Religious issues
in Asia

2. The practice of egg freezing reached a new milestone in 2012, when the
American Society for Reproductive Medicine removed its designation as
“experimental”.
Studies of the safety and efficacy of egg freezing led the ASRM to
recommend egg freezing for patients facing infertility due to gonadotoxic
therapies, but prompted continued caution against egg freezing when
undertaken for non-medical reasons.
The European Society of Human Reproduction and Embryology has more
explicitly supported non-medical egg freezing.

3. Common Terminology
Egg Freezing
Egg Banking
Elective Oocyte storage

4. Reasons for Egg Freezing
Medical
Non Medical

5. Medical Reasons
• Cancer (egg freezing or ovarian tissue banking)
• Autoimmune diseases and haematological diseases
• Genetic conditions that can lead to premature ovarian failure
• BRCA1 and BRCA 2
• Male partner unable to produce semen on the day of oocyte
retrieval
• Patients unwilling to cryopreserve embryos due to ethical or
religious reasons

6. Non- medical Reasons
Elective or Social egg freezing
AGE -banking (anticipated
gamate exhaustion) Stoop et al 2014

7. Reasons for non medical
egg freezing
• lack of a suitable partner (ESHRE Task Force on Ethics and :aw et al., 2012 Witkin et al., 2013)
• Concerns about advancing age
• desire to postpone childbearing (completing education,
career advancement, reaching sufficient level of
maturity, financial stability, emotional support)

8. Egg freezing and childbearing for gays,
lesbians and unmarried persons
Gay male couple could procure a frozen donor egg
and the services of a surrogate mother in
order to complete IVF
A lesbian couple might freeze their eggs while
searching for donor sperm.

9. Is Egg freezing “preventive
Medicine “ for age related fertility
The ethical debate also calls for a more careful
consideration of whether age-related fertility decline
should count as a medical justification for fertility
preservation

10. Is Egg Freezing Safe
• Harm to children born from egg freezing - long term study data is still
not available.
• No differences have been found between the use of vitrified or fresh
eggs in the rates of obstetrical problems (including gestational
diabetes, preterm births,gestational age at birth, APGAR scores, natal
anomalies, birth defects, admission to a neonatal ICU, or perinatal
mortality) (Cobo et al, 2014; Noyes et al., 2009).
• The limited data available suggests no increased risk of chromosomal
anomalies or significant physical or developmental deficits in the
babies created (Chian et al., 2008; Cobo et al., 2014; Setti et al., 2013),
• higher miscarriage rates in pregnancies with frozen thawed eggs in
infertile patients. Setti et al (2013)

11. How successful is egg freezing?
With vitrification there are no significant differences reported in live birth
rates between fresh or frozen eggs (Kushnir et al., 2015).
The age at which a woman freezes her eggs remains an important predictor of
success(Rienzi et al., 2012; Ubaldi et al., 2010).
Take home baby rates ranging from ~61-77% for women aged 30-35;
A far greater range for women over 35 years of age at freezing, i.e., ~18-62%
(Bianchi et al., 2012; Cil et al., 2013 [with infertile women]; Devine et al., 2015; Mesen et al., 2015)
The likelihood of each frozen egg resulting in a live birth has also been
reported to vary, from ~4-14% (Chang et al., 2013; Goldman et al., 2013).
The experience and expertise of the IVF center is also likely to make a
difference.

12. What is the best time for a woman to
freeze her eggs
They found that a woman needs to be under 39 years of age for egg
freezing to be cost effective relative to undergoing multiple rounds of
IVF at this older age. Devine et al. (2015)
Mesen et al. (2015) found that egg freezing provided the greatest improvement
in the probability of a live birth compared to no action, when performed at 37
years of age (51.6% vs. 21.9%).
The highest probability of a live birth occurred when egg freezing was
performed at under 34 years of age (>74%), but was most cost effective at age 37,
at $28,759 per each additional live birth in the oocyte cryopreservation group.
Thus, in general, it appears that it is best to freeze before age 37.
Currently, the average reported age of women who freeze their eggs is 38 years, but that may be too late
By 38 years, the quality of a woman’s eggs is already in decline. Unfortunately, studies have shown that women
do not consider egg freezing until precisely that age: late 30s or older.
The ideal age for egg freezing is reportedly 30–35 years, but these younger women tend not to consider egg
freezing because they believe they have plenty of time and/or they underestimate their natural fertility decline
after age 35 years.

13. Who Pays for egg freezing
• Generally insurance does not pay for any form of
egg freezing

14. Who Pays for egg freezing
• Woman’s Parents

15. Who Pays for egg freezing
• Companies like Facebook and Apple offer their
female employees to freeze their eggs

16. Arguments favouring egg freezing
• Promotes gender equality in employment and educational endeavours
• enhanced reproductive freedom and reduced time pressure
• More equal amount of time to find a partner
• possibility to have genetically- related child when no partner available
• women should not be blamed for their “perpertual postponement “ of pregnancy
• Avoidance of self blame; “I want to know I did everything I could and not blame myself later”

17. Arguments favouring egg freezing
• reduced need for oocyte donors
• reduced number of inefficient infertility treatments
being performed today at advanced maternal ages
• more time to become emotionally and
psychologically ready to be a parent
• Benefits of being an older parent, including benefits
for the child

18. Arguments against egg freezing
• Raising false hopes
• low success rates of egg freezing for women in their 40s.
• Perhaps the greatest risk, however, is for a woman to be given false
hope that leads her to put off childbearing.
• Discovering later that none of her frozen eggs produced a baby when
she returned to use them may mean that she missed her reproductive
window of opportunity to become pregnant with her own eggs.

19. Arguments against egg freezing
• Commercial exploitation, preying on women’s
anxieties

20. Arguments against egg freezing
• And regardless of the age when eggs were frozen, health concerns do remain for
women becoming pregnant later in life (higher risk of high blood pressure, gestational
diabetes, placenta praevia, miscarriage, and early delivery because of eclampsia)
than for younger pregnant women

21. Arguments against egg freezing
• Harm to children born from egg freezing - long term study data is still not available.
• Harm to children caused by having older or elderly parents (likely hood of the death of a parent
when child is young)

22. Arguments against egg freezing
• class divide between those who can afford and
those who cannot afford

23. Arguments against egg freezing
• Companies like Facebook and Apple offer their
female employees to freeze their eggs

24. Arguments against egg freezing
• reduced focus on necessary societal changes (e.g.
flexible work environments, better leave policies) so
women can have children in their peak fertile years.

25. Arguments against egg freezing
• overemphasis on need for a genetic connection between
parent and child, possibly stigmatising other ways of
pursuing parenthood

26. Religious objections
• In Malaysia egg
freezing is not allow
for Muslims
• Catholic view of pre
creation is
inseparable from
married sexual
intercourse

27. Special Circumstances in Asia
• Due to conservative nature of the Asian Society,
transvaginal egg collection will not be allowed by
single Virgo intacta women.

28. Legal Issues in Asia
• Malaysia ; No law yet. Not allowed in Muslims
• Singapore: not allowed for non medical reasons
• Japan: No law but just guidelines for social reasons
1. Upper limit of egg retrieval is 40 yr, and Upper limit or usage is 45 yr (just a recommendation)
2. Needs first-person informed consent
3. Should be disposed by the will or death of first-person
4. Eggs can be used only for reproduction of first-person, other objectives are not permitted.
There are no penalty for doctor who don’t obey these guidelines.
• Korea there is no Law yet
• Taiwan: no law yet

29. Summary
• In the 90’s IVF caused ethical
debates but today it is an accepted
technology
• Egg Freezing especially for non-
medical reasons is being debated
now.
• The conservative nature of asian
women brings out more ethical
questions.
• My personal feeling is that in time
it will become more acceptable
even in Asian countries.