Monday, June 3, 2013

Family Planning at the Cusp of a Career, Part II: Get busy fertilizing or get busy freezing?

In my last post, I discussed an all-too-familiar concern of many young professional women (and a recent campaign bringing it to the fore): the competing desire to have a successful career and the ever-increasing risk of age-related infertility. The problem, of course, is that many young, professional women “spend [their] prime baby-making years in the trenches” and put children on hold until later in life. The average age for entering medical school students at UC Davis, for example, is 25, making the average age at graduation roughly 29. The next three to five years are spent in grueling residency programs, resulting in new doctors finally beginning their careers between the ages of 32 and 34. By then, even the healthiest young female doctor’s fertility has already started its rapid, irreversible decline, while the young woman has barely had time to establish herself in her profession.

The response to this dilemma from some, including the aforementioned campaign, is to pressure women to conceive earlier lest the prospective mother “fritter away” her twenties. (N.b., Of course, I can only speak accurately for myself here, but I would imagine many women would not characterize the time they spent in graduate school or the professional trenches -- working toward their goals and overcoming ubiquitous male preference -- as time “frittered” away.). Other women, though, are turning to technology to give them ultimate control over family planning. How? By flash-freezing their healthy eggs and storing them for future use.

The flash-freezing process is fairly simple and can be completed over the course of a few months: the woman takes hormones throughout her menstrual cycle and is monitored for a period of time by physicians until her eggs are ready to harvest. At that time, they are removed trans-vaginally, frozen, and preserved until the woman is ready to have them fertilized. Cost estimates for the procedure range from roughly $2,200 to $18,000, and the technique has dramatically increased in popularity since last fall, when the American Society for Reproductive Medicine lifted its “experimental” label on the practice. Since then, a number of women, including Yale professor Marcia Inhorn, have published books and op-eds imploring their younger counterparts to take advantage of the technology while their ova are still healthy and, as a result, take greater control over their careers.

But the procedure, unsurprisingly, is not without risk and certainly gives rise to other ethical concerns. First, the technology is so young that there has been very little research done as to its long-term success. Indeed, as author Miriam Zoll recently wrote, “The only thing we really know about [the procedure] is that an estimated 1000 babies have been born to women younger than thirty years of age who were facing life-threatening illnesses. . . . We don’t know if these live births were the result of 3,000 or 10,000 trials. We have no information about how many miscarriages or stillbirths may have ensued, and we have no idea how flash freezing might affect offspring’s health later in life.” Further, as Professor Inhorn has acknowledged, as a result of the availability of the procedure, “employers may come to expect women to postpone childbearing through egg freezing” and “[w]omen may be pushed into a burdensome and costly medical procedure that cannot provide guaranteed future fertility outcomes.”

The counter to the latter concerns, I think, is that similar arguments could be made against various forms of contraceptives, but since their introduction in the early twentieth century, the feminist response has been predominantly positive; indeed, the increased ability to plan one’s family has largely been credited as one of the primary reasons women have gradually moved out of the domestic sphere and into the marketplace. Might this same technology effect a similar result? That is, now that young women have entered the professional workforce, perhaps allowing them to postpone childbirth into their forties -- when they are still able to carry children and presumably are in better positions, professionally -- will increase the number of women who make it to the “top” of corporations and law firms around the country. Now that we have our foot in the door, perhaps this technology is the ticket -- at least for some women -- to finally climb the corporate ladder on their own terms and at their own pace.

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