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Facebook and Apple – Increasing choice and control or creating biased solutions?

Reproductive technologies were in the headlines when Facebook and Apple announced they would offer female employees a $20,000 benefit to freeze their eggs. According to the report, this enables women to delay child bearing for different reasons and gives women more control. The announcement states that egg freezing is a pricey but increasingly popular option for women: The procedure typically costs up to $10,000, with an additional $500 for storage each year. After freezing eggs, in vitro fertilisation (IVF) can be used afterwards.

I wish to start with a disclaimer: I’m totally for increasing control and flexibility with reproductive technologies, I think the possibility as such is great, I cheer if some women genuinely wish to use this option, and I totally recognize that Facebook and Apple are just giving an option. However, there is room for questions. First, individual-level solutions are suggested where the actual issue is likely to be socially constructed, and secondly, IVF is seen merely as a handy option. These two are discussed in the following.


Social issues, individual solutions

What is the phenomenon that we are trying to solve? Apparently: many women struggle with connecting childbearing and careers. Is this a problem in women’s biology or work life and society? What is the reasonable target of intervention? To what should we put major efforts?

First, as asked in Wired, do we really want to support a society that requires us to work so hard that there is no time to raise children for those who wish to do so? Although an option is just an innocent option, it might create pressure to take that option. As Glenn Cohen, co-director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, posted last year:

Would potential female associates welcome this option knowing that they can work hard early on and still reproduce, if they so desire, later on? Or would they take this as a signal that the firm thinks that working there as an associate and pregnancy are incompatible?

Second, where are the other partners? If the problem is not just pregnancy, giving birth, and maternity leave, but also everything child-related after that, why not focus on dividing the costs of parenthood (perhaps with $20 000 per person) equally between the two partners – who often are dads. There is not a lot of discussion on men struggling with their careers due to children.

Third, what is the right time to have children? Although the first crucial career-building years might be during the “ideal childbearing years”, the career is not simple either after those years. It is not a well-known fact that the position of older or not-very-young women in the work market would be easy.

Women have, of course, many reasons for not having children early. But if a woman wants to have a child, pressures to postpone this with IVF are somewhat questionable.


The ‘neutrality’ of IVF

IVF is often presented as a simple sidestep to various aims; for example, in this case, delaying child bearing by freezing eggs. IVF is also present in a great amount of bioethical debates: it is the mechanism in scenarios including genetic testing, selection, and hypothesized manipulation of embryos before implantation. In other words, whenever it is discussed that embryos could be screened and selected against diseases of for desirable characteristics, IVF in involved. The bioethical debate is filled with ethical analyses of these issues, but often one aspect is missing: what IVF means to women. This should weight in the cost-benefit analysis.

For example Hilary Rose notes in her article[1] how the discussion on reproductive technologies homogenize “the parents” into only one unit, although actually only one parent undergoes the procedure. Rose comments especially the literature on genetic enhancements. As she asks, would women really choose to enter such invasive procedures simply to enhance their child? According to Rose, the idea of large-scale genetic enhancements is an “andro-centric science fantasy”.

Just to get the picture what IVF means to women and men, here is a description of the procedure by UK’s Human Fertilisation and Embryology Authority:

For women:

Step 1. Suppressing the natural monthly hormone cycle. As a first step of the IVF process you may be given a drug to suppress your natural cycle. Treatment is given either as a daily injection …or a nasal spray. This continues for about two weeks.

Step 2. Boosting the egg supply. After the natural cycle is suppressed you are given a fertility hormone called FSH (or Follicle Stimulating Hormone). This is usually taken as a daily injection for around 12 days. …

Step 3. Checking on progress. Throughout the drug treatment, the clinic will monitor your progress. This is done by vaginal ultrasound scans and, possibly, blood tests. 34–38 hours before your eggs are due to be collected you have a hormone injection to help your eggs mature.

Step 4. Collecting the eggs. In the IVF process eggs are usually collected by ultrasound guidance under sedation. This involves a needle being inserted into the scanning probe and into each ovary. The eggs are, in turn, collected through the needle. Cramping and a small amount of vaginal bleeding can occur after the procedure.

Step 5. Fertilising the eggs. Your eggs are mixed with your partner’s or the donor’s sperm and cultured in the laboratory for 16–20 hours. … After egg collection, you are given medication to help prepare the lining of the womb for embryo transfer. This is given as pessaries, injection or gel.

Step 6. Embryo transfer. For women under the age of 40, one or two embryos can be transferred. If you are 40, or over, a maximum of three can be used. The number of embryos is restricted because of the risks associated with multiple births. Remaining embryos may be frozen for future IVF attempts, if they are suitable.

For men:

Step 1. Collecting sperm. Around the time your partner’s eggs are collected, you are asked to produce a fresh sample of sperm. …

The risks in the procedure include, for example, drug reaction to fertility drugs (hot flushes, feeling down or irritable, headaches and restlessness), multiple births (twins, triples, or more, bringing risks both to mother and the unborn babies by being premature), and ovarian hyper-stimulation syndrome(OHSS).

Of course, many people make it without symptoms. But even without any symptoms, the procedure is invasive and hardly comfortable. Furthermore, the whole procedure is not a clear-cut answer to the age-issue: According to Ricki Lewis, the mechanism behind the maternal age effect is not well known and scientists are not sure why older eggs tend to end up with a wrong number of chromosomes.

To conclude: the existence of IVF is something to celebrate, its importance to many people is beyond words, and surely, the harm of the procedure might be almost meaningless for those who really need and want it. But suggesting that women to whom in vivo fertilisation is possible by just having sex or or artificial insemination would be happy to undergo the operation because it would be beneficial for your company, or it would be the “simplest” solution to social inequality, is just biased.

[1] Hilary Rose: Rose, Hilary (2002): “Building genetics from below”. In Bendelow, Gillian & Carpenter, Mick & Vautier, Caroline & Williams, Simon (edited) (2002): Gender, Health and Healing. Routledge, London, 49–67; 53-54.

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