I own the full copyright to this article. I do NOT agree to any distribution to any media/blogs/ news agencies without my consent. You may not copy, reproduce, republish, download, post, broadcast, transmit, make available to any publications, or otherwise any use of the content below in any way. Any use of this content requires my prior written permission and consent.

The topic of social egg freezing in Singapore is suddenly revived with fervour due to an SCMP article titled “Singapore’s egg-freezing ban forces women to head abroad for fertility treatment” on 4th June 2021. It later appeared on Yahoo News.

Many women (and some men) are offended after reading the article and understandably so. As someone who had previously undergone social egg freezing / Elective Oocyte Freezing, I will attempt to explain here why women are upset, balanced and comprehensive ethical and moral arguments and why wanting to have the choice of preserving one’s fertility is not “profoundly selfish”.

(Background: In November 2020, I wrote an 8000-word article detailing my personal journey of egg freezing in Singapore in 2018, complete with photos, videos & everything you need to know about my experience. Despite fearing blowback, I mustered the courage to write and share the article publicly, in hope that it will be a useful resource for other women to make an informed decision.)

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CONTENT

Why are women upset about the article?
What this article is NOT about

• Moral & Ethical acceptability of fertility preservation for non-medical reasons
  

  (Reasons for & against social egg freezing in Singapore)
  1. Modern working women’s dilemma
  2. Egg freezing/ovarian or oocyte preservation as an insurance
  3. Genetic relatedness to child
  4. Medical risks of late pregnancy for mother and child
  5. Primum non nocere (“First do no harm”)
  6. Technical considerations
  7. Oocyte preservation as an alternative to less-morally desirable options
  8. Gender equality in reproduction

• “Profoundly selfish act” – understanding the statement by the National Council of Churches of Singapore

Context to which the comment is made
Why the unnecessarily harsh comment?

• Addressing & providing alternate views to the statement

  1. Ethical and social issues
  a) Caring for parents who might be aged or sick
  b) Financial debts & commitments
  c) Readiness of the male partners
  d) Penalty to women’s career
  2. False hope
  3.Pressure on women
  4. Risks
  5. Children’s welfare
  6. Medicalisation and commodification

• Why should we deny such treatment to women who are planning ahead for their families?
  

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Why are women so offended by the article?

Two reasons:
1. The longstanding ban on egg freezing by the Ministry of Social and Family Development
2.  “Profoundly selfish act” – a comment by the National Council of Churches of Singapore (“NCSS”) about egg freezing

What this article is NOT about

Before we venture further, I have seen, read, and heard many arguments on this and some have stated:
a) The state regulations and/or the church was made by men
b) Old men who are not up with the times
c) Misogynistic rules
d) Outdated doctrines

I’d like to strongly state that personally, to me, I don’t think that the gender of the church or government leaders that made the statements have any bearing on the whole egg freezing discourse. I also don’t want to go down the rabbit hole if this is misogynistic or anti-women.

I’d like to focus on the discourse of why social egg freezing is still banned (and why is it such a divisive issue?). Below, I expound on the ethical, moral and personal reasons women go for egg freezing, and for many-layered reasons, the choice for freezing one’s eggs might not be a “profoundly selfish act”.

It can be argued that egg freezing is a more selfless than selfish act as it entails invasive physical, emotional and psychological risks to the mother/ woman who’s merely trying to conceive later on in life and give the prospective child the best genetic chance possible.

Ban on social egg freezing in Singapore

Many women feel that the ban on social egg freezing in Singapore is an archaic and outdated regulation that should be reconsidered Many believe that in this day and age, a woman’s body and choice about her fertility preservation should be hers alone. It shouldn’t be dictated by the State (or condemned by any religious body). We are not trying to play God or alter DNA by freezing our eggs.

For many single women, they find it exasperating is that while there is technology available that can afford them time to possibly find someone right for themselves, and still have a child eventually, but regulations are getting in the way of that. To them, even if they don’t end up meeting someone right or choose to have a child, at least that’s a life decision/path that they have chosen themselves. Not an option that was taken off the table for them arbitrarily.

One thing is clear, women in Singapore are strongly and loudly making the point: My body, my eggs, my right and freedom to choose.

On Instagram, there are a few accounts debating fervently about the ban on social egg freezing. On myeggsmytime, many women stated reasons why they will consider egg freezing in Singapore. As women, we are already bounded by many rules and expectations. When these regulations and careless comments are “imposed” upon us, we refuse to be unfairly moulded to fit into anyone else’s moral rulebook. No one likes to be told what to do or what we can do by the authorities, especially about our bodies.

I find it extremely exasperating that in all these debates or comments by authorities, a large premise of the arguments is that women are selfish as we view and want egg freezing as either fertility insurance, quick fix, easy solution or selfish decision. This is a problematic narrative that can’t be further from the truth. I can safely say that for most of us women, we will definitely prefer natural conception and birth. I had conversations with at least 200+ women and most of them are afraid of the process. They shiver in trepidation at the thought of having to inject themselves.

If given a choice, will I go through egg freezing? A resounding NO. Why would I/any woman put our bodies through the disparaging emotional and physical torture, knowing fully well that there are future ramifications that I might not see?  Why will I electively choose to inject myself daily and eat hormone pills? It is an invasive, expensive and tiring process.

In case you wish to argue that “but that’s your own decision, just own it”. I am and I do own it but I don’t wish egg freezing to be seen as something trivial or selfish. This is not some quick fix aesthetic procedures I am making. These are serious decisions women are making (and sometimes, struggling) with our bodies, our health and finances. For our future. For our unborn child that we might wish to have and may not be able to.

So, what are some of the ethical and moral arguments that have prevented the lift of the ban on social egg freezing in Singapore, even in 2021?

Moral & Ethical acceptability of fertility preservation for non-medical reasons

Reasons for & against social egg freezing in Singapore

• Modern working women’s dilemma

Most modern societies are organized in ways that make it difficult for women to have children at what would be biologically the best age for reproduction. In modern societies, many women enter the workforce in their mid-20s and it takes a few years before they achieve sufficient social and financial stability to start a family in a planned and responsible manner.

Natural fertility for women tends to decline at around the age of 35. The early decline is present in a proportion of women who may be genetically predisposed to early menopause – they won’t be aware of this until it has already happened and it will be too late to start a family.

Natural fertility in men tends to decline at a later age. 

• Egg freezing / ovarian or oocyte preservation as an insurance

It is already morally acceptable practice to preserve oocytes or ovarian tissue in women with catastrophic illness (e.g. ovarian cancer, breast cancer) to permit them to start families when their treatment is completed

In women who are well, oocyte or ovarian preservation does not serve a clear and present need, but insurance that they still retain the ability to start a family should they be struck with a catastrophic illness.

• Genetic relatedness to child

Women who for various reasons, are only able to attempt starting a family later in life, may find themselves to be infertile hence compelling them to undergo IVF or adopt children; the children are genetically unrelated to them and they have been deprived of an opportunity to have an offspring that is genetically related to them by early oocyte harvest or ovarian preservation

• Medical risks of late pregnancy for mother and child

• Mother
  • Pregnancy at a later age, natural or artificially assisted, is associated with a higher incidence of risks and complications
• Child
  • Negative consequences on the psychosocial development of the child for mothers who have children very late in life
  • Early harvesting of oocyte and ovarian tissue ensures the best quality oocytes used for subsequent pregnancies and minimizes chances of genetic abnormalities as compared with women who have children later in life using oocytes available at that current age – this is a selfless act by a mother acting in the interest of her future child, the mother bears the risk of ovarian stimulation/harvesting surgery

• Technical considerations

Mature oocytes are known to be especially vulnerable to cryopreservation – better to harvest young oocytes. 

• Primum non nocere (“First do no harm”)

Medical professionals are obliged to do no harm to the patients. Oocyte retrieval without an immediate plan for pregnancy incurs risks to the patient without the immediate benefit of pregnancy.

However, this is balanced against the benefit of early oocyte retrieval minimizing genetic abnormalities to the future child, as well as the ability to preserve childbearing as insurance against women who may accidentally find that they are subfertile at a later age.

• Oocyte preservation as an alternative to less-morally desirable options

1. Proactive IVF

Proactive IVF involves the creation of embryos without an immediate plan for pregnancy and involves the use of donor sperm to fertilize the retrieved oocyte. The creation and storing of human embryos may be more morally sensitive than oocytes.

Despite this, the creation and storage of human embryos is already a common practice in IVF cases – multiple embryos are normally created, and amongst them, a few are selected for implantation.  This is not seen as a morally unacceptable practice. Some of the difficulties encountered in cases of proactive IVF in women who are doing this for non-medical reasons – the creation of embryos is using donor sperm, who may not be genetically related to the woman’s future spouse

• Gender-equality in reproduction

In some countries, preservation of sperm is well-accepted practice for men in jobs (e.g. working in toxic environments) or doing sports (e.g. football, cycling) that pose a potential threat to their fertility. These are men without medical problems and preemptively preserve their sperm for future use.

The window of opportunity to exercise the right to establish a family is much smaller for women than for men due to biological reasons; ovarian preservation permits women extension of their fertility period to enable them to start their families when in better socioeconomic situations if required.

Understanding the statement by the National Council of Churches of Singapore

“Profoundly selfish act”

Social Egg Freezing: Ethical and Social Issues: A Statement by the National Council of Churches of Singapore (full statement)

I’d like to give a proper context to which this comment appeared officially as a statement by the National Council of Churches of Singapore, on the circular “Social Egg Freezing: Ethical and Social Issues”, dated 10 March 2019, attached above. The full paragraph that contains the comment:

“Children’s Welfare Underlying the often heady rhetoric that champions the autonomy and rights of the contemporary woman, some commentators have rightly discerned elective egg freezing to be in essence a profoundly selfish act because it sees career as more important than the interests and welfare of the child. Children must be given the healthiest and best start in life. This surely includes parents who are young and energetic enough to nurture them. In many ways this is more important than financial stability, an argument often used to support egg freezing and deferred motherhood.

In addition, women in their 40s and even 50s who use this technique often place on their children the heavy burden of having to take care of their geriatric parents (often burdened with chronic health conditions) when they are just about to start out in life as working adults, amidst all the attendant responsibilities and challenges at this stage of their life (marriage, career, mortgage, starting a family, etc.). “

To be fair, the church did not categorically state that they found elective egg freezing as a “profoundly selfish act” but that “some commentators have rightly discerned” it to be. I don’t usually make any political or religious comment but found the formal statement baffling. I personally believe that this is an unnecessarily harsh formal statement by a highly-esteemed religious organisation. I understand if NCSS is not FOR egg freezing and wishes to encourage women to have children earlier in life but why make a blanket categorisation about women who want to preserve their fertility?

In addition, since Singapore is a largely secular country and as this is a formal statement by the National Council of Churches of Singapore, a religious organisation, does this only apply to followers?

For clarity purposes, this was a statement the NCSS made two years ago. Does it still stand? Does the National Council of Churches of Singapore still think this way? Well, we have to wait for another statement from them. In the meantime, let’s dissect the arguments brought forward in this statement.

Addressing & providing alternate views to the statement by the National Council of Churches of Singapore

• Ethical and Social Issues

  “While the Council appreciates the tensions that contemporary women face between pursuing a career and a child …” The NCCS statement presupposes that women who undergo oocyte preservation do so out of purely personal selfish reasons. This may be untrue in some circumstances.

1. Caring for parents who might be aged or sick
   In modern society where many people have children at a late age, many women who graduate from school face the prospect of caring for their aged parents immediately upon entering the workforce. Accompanying social and economic pressures arising from this prevent women from starting relationships and starting a family at a young age. To defer childbearing for purposes of caring for aged or sick parents is not a selfish act.
2. Financial debts & commitments 
   Women are attaining higher levels of education and entering the workforce at a later age. Many may be saddled with debts and not ready to start childbearing, which itself is a large financial commitment.
   
   The Church advocates responsible parenthood, and timing childbearing to an age where a woman may provide well for the children is an extension of responsible parenthood.  The converse is true: women who enter unplanned pregnancies early in life (even in the context of marriage) are prone to multiple social and economic problems that affect themselves and their children, the latter are unwitting victims of poor parenthood planning.
3. Marrying later
   Women are marrying later as a result of entering the workforce later and entering committed relationships later.
   The woman has a responsibility to ensure that she is in a stable committed relationship before embarking on parenthood for the sake of the prospective child.
4. Readiness of the male partners
   Why do all the responsibility of childbearing and caregiving fall under the woman? How about the male partners? What if the male partners are not ready themselves? From my conversations with other women, there are women who are ready for children but not their partners. Some may have younger male partners, or that the male partners are simply not ready to have children despite being married.
5. Penalty on Women’s CareerEncouraging women to have children early will not only have societal implications but also economic as what basically needs to happen is for women to put their career in the backseat. It’s no secret that women’s careers are often penalised in various industries if they have kids. Most women just have no time to do it all – career, children, housework, caring for parents, husbands, social life – especially for those that cannot afford help.

A common social conundrum of the modern woman

For example, in my own case, while my career is important to me and I don’t deny focusing on it, I am also the primary breadwinner of my family. I graduated at 24 and we were in debt. I had to work hard to clear off the debt and work towards buying a 3 bedroom HDB as a family home. I was not in any financial situation to be able to have and care for a child.

Also, I also did not have the opportunity to meet the right partner. If I had, I would have settled down and focused on family planning earlier. I didn’t want to rush into a marriage because “time is running out” or that I am “over the hill”. I am cognizant that to have a stable family environment and provide for a child, I need to have the right life partner. I’d rather wait and marry later than be stuck in an unhappy marriage that ends up in a divorce or having the kids bear the brunt of it. 

My story is not unique. A lot of my female peers are facing the same issue – that they do desire to marry and settle down with a partner but have not found the “Right One”. Of course, detractors will then argue “she’s too picky”, “she’s too career-focused” but what is wrong with a woman wanting to better her life? Or to wait until she’s emotionally, financially, and psychologically ready for a child? Why put undue whole time pressure on women to have children, which in turn causes a lot of bad decisions to be made? 

• False hope

The NCCS statement opines that the probability of achieving a pregnancy from a preserved oocyte is between “4.5 to 14% per egg”.  This is not an insignificant figure and cannot be disregarded as false hope. This is also why during the extraction and harvesting, the medical doctors always advise keeping more eggs.

To an older woman who is facing a diminishing prospect of a successful pregnancy, oocyte harvest at a younger age does indeed offer her a better chance at successful childbirth than natural conception at that age.

Egg freezing is an invasive, exhausting and expensive treatment. Most women who are going through this have to struggle to overcome their fear. Those that go through the process will be advised not to see this as total “fertility insurance” as the odds are not in our favour. But we are also aware that the older our eggs are, the lower our chances are. I know of many women who are struggling to conceive naturally, even as they start family planning in their late 20s. If this is an added chance and women are aware of the probability, why are we so against letting women have that additional peace of mind?

• Pressure on women

The NCCS statement states that legalising this technology will place undue pressure on women to use this technology for future pregnancies. As with all medical therapies, patients only receive such treatment when they seek and agree to the treatment after receiving appropriate consultation and counselling. 

There is no added pressure on women any more than new treatments such as using new classes of antibiotics or chemotherapy agents.

• Risks

While the NCCS detailed the risks of egg freezing, they ended this point with “The pressing ethical issue here is that, in the case of social egg freezing, healthy women have opted to take these unnecessary risks for themselves and their offspring because of certain lifestyle preferences.”

Again, why are women judged on their choices on preserving their fertility, lifestyle or career preference? Why should we deny treatments to women who are planning ahead for their families?

One shouldn’t be hasty in generalising and making a moral judgment that consists of many personal, emotional, and psychological layers. There may be a multitude of considerations for a woman who chooses to undergo ovarian preservation, many of which cannot be considered as “profoundly selfish”.

(If you are curious about the risks, my Egg Freezing in Singapore – Procedure, costs, benefits, risks & side effects article actually states the facts and risks in great detail.) 

• Children’s welfare

The NCCS statement states that children must be given the “healthiest and best start in life”, which “surely includes parents who are young and energetic enough to nurture them”. The NCCS statement argues that this is “in many ways, more important than financial stability”. Well, how about emotional maturity and stability? Are these not critical factors to raise children? 

What, and who is, to determine what is the “healthiest and best start in life” that NCSS refers to? Many research has consistently reported the social inequity divide for children that are from less privileged financial backgrounds. This affects the children’s education and social mobility. While money and income are not the most critical factors for raising a child, I am certain that most of us agree that financial stability is 

From a Organisation for Economic Co-operation and Development (OECD) report, has shown that “far too many children, students and adults from socio-economically disadvantaged backgrounds fall behind. In many countries, substantial learning gaps exist between students at opposite ends of the socio-economic scale, and these differences tend to increase in the transition into adulthood.” (Educational Opportunity for All – Overcoming Inequality throughout the Life Course, OECD)

“Children growing up in poorer families emerge from school with substantially lower levels of educational attainment. This is a major contributing factor to patterns of social mobility and poverty. (Poorer children’s educational attainment: how important are attitudes and behaviour?)

How about one from home? From Straits Times in 2018, “Nearly half of low-income students in Singapore are concentrated in the same schools, a report by the Organisation for Economic Cooperation and Development (OECD) has highlighted.

The report, released yesterday, found that 46 percent of disadvantaged students in Singapore were attending “disadvantaged schools” in 2015, up from 41 per cent in 2009. The OECD average is 48 percent. Disadvantaged students are those in the bottom quarter of the socio-economic index within their country, while disadvantaged schools are defined as those which take in the bottom quarter of the country’s student population.

The report, titled Equity In Education: Breaking Down Barriers To Social Mobility, said poorer students in such schools face a double disadvantage, as these schools may not have the best of resources, whether in teacher quality or financial resources. It recommended spreading out the share of low-income students across schools and improving social diversity in schools by reshaping school admission policies.”

• Medicalisation and commodification

The statement argues that social egg freezing, like other Assisted Reproductive Technology (ART), “furthers the medicalisation and commercialisation of women’s bodies”. Commodification is not a strong argument. In vitro fertilisation (IVF) already exists, is widely practised and widely accepted. Oocyte preservation is already done for women with cancer and desiring future pregnancy.  Oocyte preservation is not commodifying fertility any more than IVF or oocyte preservation for medical purposes.

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In summary,  no one should be hasty in generalising and making a moral judgment that consists of many personal, emotional, and psychological layers. There may be a multitude of considerations for a woman who chooses to undergo ovarian preservation / social egg freezing, many of which cannot be considered as a “profoundly selfish act”.

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I own the full copyright to this article. I do NOT agree to any distribution to any media/blogs/ news agencies without my consent. You may not copy, reproduce, republish, download, post, broadcast, transmit, make available to any publications, or otherwise any use of the content below in any way. Any use of this content requires my prior written permission and consent.