Freezing fertility: oocyte cryopreservation and the gender politics of aging

Freezing Fertility: Oocyte Cryopreservation and the Gender Politics of Aging embarks on a discussion of the politics of reproductive aging through the lens of assisted reproductive technologies (ARTs) such as in vitro fertilization (IVF) and OC (oocyte preservation). OC or egg freezing has emerged as a new form of reproductive intervention which has ramifications for the ways in which women reframe their reproductive life cycle with social pressures regarding motherhood and maternity. Firmly embedded within the emerging OC “industry” in the Western world including the United States, the United Kingdom and Europe, Lucy van de Wiel identifies the life cycle of an egg after extraction and into becoming an embryo. Through each of these key stages, she reflects upon what leads women to choose to freeze their eggs, and what forms of social and political infrastructures promote the rise and proliferation of the OC industry.

Lucy van de Wiel begins her discussion of oocyte cryopreservation or egg freezing (used interchangeably throughout) by suggesting that exists in a liminal space: temporally and in practice. Geared towards the future, and yet embedded in the present – OC is an important moment in women’s understanding, articulation and control over their fertility. Van de Wiel dissects Western media reportage (focusing on British, American and Dutch news stories) to understand the social ramifications of the emerging popularity of OC amongst a particular demographic. This popular representation of this particular demographic shifts between women who “have it all” and those who really benefit from OC. Judgmental and moralistic, the appraisal of those women who choose to freeze their eggs – at whatever age – social conversations position the practice as posing a threat to socially accepted roles that women have always occupied. This first chapter, titled, “Making Fertility Precarious: Egg Freezing and the Politicization of Reproductive Ageing” sets the tone for the rest of the book: by flagging many of the themes that will come later in more elaborate and nuanced discussions.

In Marieke Schellart’s rendition of her journey towards opting for OC (in the documentary Eggs for Later), Lucy van de Wiel unpacks the motivations and anxieties that accompany the decision to safeguard one’s fertility as a woman progresses in her adult life cycle without conceiving. “Freezing in Anticipation: Fertility Planning with Eggs for Later” is thus a testimonial of the varied “regimes of anticipation” (61) that accompany a woman’s desire for birthing and motherhood. In the regimes of anticipation, “desired fertility-parenthood” and “undesirable infertility-childlessness” (66) seem to coalesce into seeking OC, and creating a particular trajectory of hope and fear. In Schellart’s rendition are dilemmas of explaining why OC is required to circumvent anticipated infertility as a result of the inability to cohabit and conceive a child through heterosexual partnering. The act of opting for OC in Schellart’s narrative echoes other Western women’s navigation of their agency and social pressure in seeking to undertake “fertility planning,” as fears of declining fertility begin to loom large over the horizon. As an individualized process, fertility planning involves perpetually being in a “state of bodily futurity.” OC is manufactured as being pre-emptive and responsible, but carries with it the implicit assumption that birthing for women is compulsory and binding – as a necessary reproductive orientation (72). In reading Eggs for Later as a moment of decisive indecision about the future capacity to birth and mother, Van de Wiel seeks to explore the vicissitudes of fertility technologies as circumventing supposed “disasters” of failed fertility, as well as, the power of individualized choice.

In the chapter “Frozen Eggs and the Financialization of Fertility: Distributing Reproductive Aging in the Reproductive Industrial Complex,” the OC emerges as a “cultural entity” (88). In breaking down the meanings and practices associated with this new cultural entity, Van de Wiel discusses the participatory infrastructures that create value out of the frozen human egg. The first form of value creation is the imaging/visualization of the human oocyte/egg through the photograph of the “microscopic examination of the extracted egg” (89) that provides social meaning to an otherwise standard laboratory entity. Almost akin to the ultrasound image of the fetus (Taylor 2002). From this image emerges a “viable extracorporeal” (88) entity that signals towards “emerging political economies of fertility preservation” (88). These emerging economies form the second form of value that frozen eggs are imbued with through financial investment in cryo-banks and related start-ups that popularize and incentivize egg freezing amongst women of a certain age group. Van de Wiel calls this the “platformization of reproductive care” (96), wherein corporate investment in fertility extension is based on anticipating future infertility (Martin 2010). Here, big finance is seen to invest in the temporalization of fertility through the valuation of “eggs per baby” (97). Women through different age thresholds may be nudged into extracting and freezing multiple eggs for future use: for instance, women under 38 are “advised” to freeze at least 15–20 eggs to circumvent failed fertilization through IVF. Yet, the failure is forever on the woman’s anticipate/unanticipated fertility decline and never a fault of the technology. This is evident in the ways in which OC promises both “fertility accumulation” (99–101) through the freezing of multiple eggs and a “promissory value through promised genetic links and future kinship” (102). With the emergence of a financial infrastructure through fertility lenders, loan companies and IVF clinics promoting loans for OC, the advertising around fertility protection in the face of inevitable decline has exacerbated the “pricelessness of frozen eggs,” akin to what Zelizer (1994) discussed with reference to children’s insurance in late nineteenth- and early twentieth-century America. However, not everyone can afford to anticipate their fertility decline, and taking fertility loans means that access to OC is also limited to the affluent few. According to Van de Wiel, the emerging financial infrastructure and capital investment in the fertility industry is also to a large extent exacerbating existing class differences, encouraging elite/affluent childbearing. Essentially, in the investment that global conglomerates such as Google and Facebook in suggesting OC for their female employees, Van de Wiel finds a reframing of the relationship between labor, women’s reproductive lives and global capitalism. Here, women’s labor – biological and social – continues to be an ongoing negotiation, with little or no infrastructural support from states and employers. Similar to Roberts’ conceptualization of the “traffic in eggs” that female kin in Ecuador enter into, in Van de Wiel’s reading this “traffic” is reenacted between women and fertility companies.

As OC facilitates the artificial fertilization into embryos, the use of time-lapse technology Eeva (early embryo viability assessment) to visualize and anticipate the formation of successful embryos through IVF – becomes more important. In the chapter on “Aging Embryos and Viable Rhythms: The Visualization and Commercialization of Time-Lapse Embryo Selection,” Eeva becomes the source of engaging with the process of facilitating viable embryos. Suddenly, embryonic aging and its visual metaphors through Eeva become an important source of the commercialization of the OC process within IVF. In this chapter, Van de Wiel explores the dynamism of commercialized OC and its concomitants offshoots that foster linked anxieties around fertility. The visualization of embryonic aging in IVF through time-lapse imaging is undertaken to provide more robust embryo selection. By taking photographs of the embryo in the incubator every 5–20 minutes, the time-lapse technology quickens the pace of fertilization and life formation, creating interventionist discourses around the formation of life (Franklin 2014). Embryonic personhood seems to come alive in the Eeva image adding to the pro-life conversations against abortion. But this is a mere illusion, as Van de Wiel notes, providing false promises through the increased dependence upon datafication of embryo selection through the operationalization of particular algorithms. The increasing algorithmization of potentialities is what helps financial support to come in for the technology by promising the promise of life through IVF.

The discourse on eggs changes again when older women begin to embrace motherhood through fertility technologies. In Chapter 5 titled “Postfertile Conceptions: Egg Freezing and the Reinvention of Older Motherhood,” Van de Wiel analyses the mirror image of the conversation on egg freezing, in her engagement with online blogs and meetings convened by fertility companies to think about older motherhood. Public narratives on older motherhood present them as marked by particular forms of discourse involving kinship and reproductive aging as an inevitable trajectory of the female life course. In exploring these diverse narratives, Van de Wiel writes on three particular forms of intersections between egg freezing and older motherhood: first, the conceptualization of the idea of willfulness in thinking about older mothers and their desire for conception and aging at a later age; the second is the pursuit of biogenetic ties with the child through the intervention of ARTs such as egg freezing; and finally, posthumous conception amongst older female relatives that is also facilitated through an inverted and provocative discourse around OC. Thus, OC and its interactions with older motherhood have led to a form of “distributed reproductive aging,” that is facilitated through frozen cryo-eggs, age-specific reproductive embodiment and the aging of incubated embryos. “Willfulness” itself becomes complicit in a particular “cultural logic of aging,” which is seen in the largely negative portrayal of older mothers in the Western media, through terms such as “pensioner mothers.” The willfulness is seen as problematic especially in accusations targeted towards the older mothers’ decision to conceive children through IVF, wherein the generational logic of grandmother-mother is inverted, threatening social norms of birthing and care. This “unnaturalness of older motherhood” emerges from particular “chrononormativities of female fertility” that position reproductive decline with the declining desire for procreation and sexual intimacy – as well as fixed generational social roles.

In that sense, willfulness amongst older mothers is connected to notions of “deliberate delay” that older mothers are accused of in seeking to circumvent motherhood at the ideal age for the pursuit of other individual desires. This is what Van de Wiel refers to as the “geneaological stretch” (155) whereby “OC may stretch the lines of maternal genetic descent beyond the temporal distance that normally divides one generation from the next.” The destabilization of social linkages between age and mothering is evident through OC. However, this form of destabilization means that the younger women are implicated in seeking to freeze their eggs to circumvent older motherhood without a genetic connection. The importance of retaining a genetic connection with the child as a woman ages not only through the pregnancy, but also through the egg means that OC doubles up as a kinship technology. “Kinning extension” (157) emerges as an essential aspect of fertility extension technologies, enhancing the ability to be a conception technology despite reproductive decline – by promising desired kinship at all ages. Therefore, OC continues to be anticipatory at many levels: anticipating kinship as well as the absence of coupledom with the increasing disillusionment that women face regarding finding a suitable male partner – or Mr Right – to have a family with. Kinship is also the primary reason why posthumous conceptions through cryo-preserved eggs/embryos become an important source of recreating a “legacy.” Referring to contentious cases where parents of terminally ill adult daughters sought to freeze their eggs and then use the same to facilitate conception after the latter’s death – Van de Wiel speaks of how OC is leading to a multitude of questions and concerns regarding the “legacy in eggs.”

In the penultimate chapter (“Oocyte Futures: The Global Flow of Frozen Eggs”) of the book, Van de Wiel discusses the mobile forms that frozen eggs take transnationally. She engages specifically with two modes of travel: through the “deterritorialization of egg donation” (182) across continents and countries involving vast regulatory, financial and clinical networks of recruiters, providers and recipients; and through research-driven SCNT or the somatic cell nuclear transfer that is used to derive stem cells from human embryos generated from eggs fused with somatic cells, and not sperm. In the facilitated travel of frozen eggs between countries, some regions/nations appear to have more providers and others have recipients. For instance, Wiel mentions that Spain controls the donor egg market in Europe but the mobility of these donated eggs is subject to financial and institutional control, especially in countries such as the United States and the United Kingdom with a higher number of recipients. Most of the control in such contexts is through the entangled legal and financial provisions surrounding ethics and ethicality. The problem of ethics becomes even more complicated in the case of research-related involvement in the procurement of frozen eggs to generate newer forms of medico-scientific interventions in health. With reference to two particular case studies: in South Korea and in the United States, Wiel highlights the ways in which “bionationalism” comes to be invoked in sourcing and researching with donated eggs. In Korea, queries raised regarding the sourcing of altruistic eggs from donors for a scandalous SCNT arrangement that involved commercially sourced eggs that were misrepresented along with findings – became the source of bionationalism. Bionationalism mobilizes public opinion in favor of certain interest groups in favor of “politicized” scientific research. In the United States, George Bush undertakes a similar form of bionationalism in favor of protecting and adopting embryos formed from frozen eggs and in cold storage (Roberts 2007). This form of political intervention played in favor of pro-life and conservative politics in the United States.

As she ends the book, Van de Wiel provokes us to think about the emerging social anxieties regarding the timing of reproduction. “Fertility planning” is what drives contemporary IVF practice and intervention. As Van de Wiel rightly suggests, “We are now at the cusp of a shift in ART practices from reproduction to fertility. And egg freezing is the first major technology to popularize IVF treatment for making fertilities, rather than primarily making babies” (219). This shift is neither organic nor tectonic, rather it’s part of emerging cultural imaginaries around labor, reproduction and aging that contemporary gendered experiences have given rise to.

Freezing Fertility is an important milestone in the thinking about reproduction and the experiences of age-related decline. The book occupies multiple disciplinary interests and brings to the fore the need to engage with the political and economic conversations around fertility globally. Each chapter is packed with information and analyses, sometimes becoming a hindrance to the flow and construction of ideas. Nonetheless, the value of Freezing Fertility for emerging research on fertility and aging cannot be discounted, as it positions itself firmly as a first amongst equals.