Although the first healthy live birth from the frozen human oocytes refers to 1986, oocyte freezing has long been so inefficient that it is hardly considered an acceptable fertility treatment option. However, with the improvement of both the slow-freezing method and superfast cooling by vitrification, oocyte cryopreservation has become an effective technology with high survival rates after thawing.
The primary application of this new technology was to have oocyte banks for women who are at risk of losing their fertility due to cancer, cancer treatment or other serious diseases. However, not only cancers are at risk of losing their fertility, but also all women at the age of 30. Therefore, a choice of oocyte cryopreservation can also be useful for this group. Nevertheless, the expansion of the possibility of oocyte cryopreservation for “medical reasons” to oocyte cryopreservation for “non-medical reasons”, “social reasons” or “anticipated gamete exhaustion” (AGE-banking) was not satisfied with the same enthusiasm.
While there are no strong arguments against the principle of AGE-banking, the ethical issues that are raised about this technology point to legitimate concerns about how it should be offered to patients. Safety, obviously, is an important ethical issue for all new medical technologies.
Despite the initial opposition against AGE-banking for healthy women, AGE-banking quickly made it to the clinic. One of the reasons for this evolution may be that a number of initial ethical objections to oocyte cryopreservation for so-called “social” or “non-medical” reasons were not very convincing, especially given the contrast with the warm greeting of oocyte banking obtained in the field of oncofertility.
Arguments that we should not try to circumvent the natural boundaries, solve public problems with medical solutions or that AGE-banking will have a negative impact on society are either flawed or only partially convincing. The argument that we should allow AGE-banking to deal with gender inequality in terms of the maximum age at childbirth was rejected. However, the argument that female reproductive autonomy should be respected is that this technology may not only clinically, but also psychologically benefit patients and that it is incompatible with supporting egg donation by others, but not autologous egg donation.
However, even if there are good arguments to bring AGE-banking to the clinic side, a cautious approach is needed. First, the usefulness of the procedure may be low, and women may be overly optimistic about their chances of conceiving thanks to AGE-banking. Therefore, they must be properly counselled about their personal chances of success. Misleading of information by commercial companies and forced offers from the companies to their female employees should be avoided. Finally, it is necessary to think about an access to technology and health care costs’ reimbursement.
The difference between oocyte cryopreservation for medical reasons or non-medical/social reasons is unreasonable,
In principle, oocyte cryopreservation for healthy women can increase reproductive autonomy and benefit women both clinically and psychologically,
The biggest ethical issues are related to implementation in a clinical context,
Proper counseling aimed at providing realistic expectations regarding the success of the procedure and countering misleading information is a prerequisite that must be guaranteed at any time,