By Yael Hashiloni-Dolev and Nitzan Rimon-Zarfaty
In 2009, Israel was one of the first countries to authorize social egg freezing, before it was declared non-experimental.
Israel is a highly pronatalist familistic society with relatively high marriage rates, low divorce rates, and the highest birth rate among OECD countries. Israeli pronatalism frames the favorable Israeli approach to fertility medicine and preservation. Currently, egg freezing is used for both medical and social reasons, and for transgender men.
Israeli policy views social egg freezing as primarily enabling, based on liberal ideology, “individual autonomy.”
Indeed, on one hand, social egg freezing has been praised as a revolutionary solution for women’s age-related fertility decline, thus providing women with liberating opportunities. On the other hand, it has been criticized for as oriented toward women’s bodies rather than toward taking away social obstacles to their full participation in the labor market and society in general. Giant corporations such as Apple and Facebook have offered funding for social egg freezing to their female employees while provoking ongoing bioethical and public debates regarding their implications, including; medicalization, (dis)empowerment, “appropriate” motherhood, medical risks, and success rates. This post considers these debates with a focus on the Israeli context.
SEF in Israel – Social context and policy
Israel’s social egg freezing regulation (amended in 2022 to allow more eggs to be retrieved and more treatment cycles), allows the eggs of healthy women aged 30-41 to be frozen. To date, political attempts to lower the age limitation to under 30 have failed. The Israeli policy enables a maximum of 6 cycles, or 25 retrieved eggs, to be undertaken before the age of 35, and/or 35 eggs to be retrieved for women aged 36-41 (whichever comes first). In case the maximum number of eggs are retrieved in the first cycle, one additional cycle is allowed. Unfertilized eggs are frozen for 5 years, which can be extended, and used until the age of 54. The procedure is not publicly funded.
In a comparative study of egg freezing regulation in Israel, Germany, the Netherlands, and Austria, the Israeli framework was identified as the most comprehensive and detailed. The research focused on the “regulatory boundary-work” between medical and social egg freezing. While demonstrating the artificial distinction between those concepts, the comparison highlighted Israeli regulation as presenting a clear and wide spectrum of clinical diagnostic criteria as well as a relatively generous funding scheme for medically-indicated egg freezing. Those include not solely cancer patients, but also several other reasons such as; increased risk for early amenorrhea, preventive ovary resection surgery, and more. Under such conditions fertility preservation is considered medical and thus subsidized, with a specific treatment protocol and consequently different funding tracks. Whatever is not specified is excluded, and considered “social.”
While such a detailed regulatory framework provides transparency, it can also be viewed as inflexible in the sense that it limits the funding and therefore the accessibility of EF to specific diagnostic indications, thus not enabling “loopholes” for making decisions on a case-by-case basis.
However, it is important to note that Israel provides women with the opportunity to use their cryopreserved eggs (frozen for “social” or “medical” reasons), due to its generous public funding scheme of IVF.
Currently only one small Israeli public health maintenance organization (Meuhedet) partly subsidizes SEF. Recently, following public demands, members of parliament have fought (so far unsuccessfully) for public funding of SEF, arguing it is cost-effective, as it will save the state money it now spends on futile fertility treatments in older age.
In 2021, the parliament’s research and information centre reported an increasing freezing trend, but also the lack of sufficient data collection regarding the procedure. Media reports indicated the number of Israeli women utilizing SEF has grown by ten times in 6 years (2011-16), reaching almost 1000 per year in 2016. It is estimated that every year the growth is about 20-50%. Furthermore, it is assessed that during the COVID-19 pandemic, numbers increased and the average age of women using the service decreased.
Israeli Women’s Viewpoint(s)- Workplace equality and more
A study examining Danish and Israeli female students’ views of financing social egg freezing (e.g., should it be funded privately, by the state, or by an employer), has found that such financing was perceived as mostly a private matter (in both countries) and thought of as the woman’s responsibility. Interestingly all students employed a neoliberal language of rights, choice, and privacy, and viewed separating the private bodies of women from the state as essential to maintaining women’s freedom.
The vast majority of students did not view the employer as a source of financial support. While some related to it as a work benefit, others saw funding by an employer as pressuring and discriminating against women. In echoing the feminist scholarly debate, students were split between opposing viewpoints. Supporters of state/employer financing of social egg freezing celebrated free choice, whereas critics formulated their opinion in terms of avoiding social pressure and intrusion into the private sphere, claiming that choice and freedom go together with self-financing.
The study reveals how social egg freezing financed by corporations, can appear suspect to those who would be the intended beneficiaries. By contrast, the state as a potential funder emerges as the benevolent supporter of women’s reproductive futures, though women’s ‘right’ to have fully funded social egg freezing is questioned.
One might wonder, however, to what extent career considerations represent a motivation to use social egg freezing. A study examining the views and experiences of Israeli and German social egg freezing users found that, similar to other studies conducted around the world and in Israel, and unlike prominent media representations, most women opting for social egg freezing are educated, middle-class, single women, who use it mainly due to a lack of a partner, and not due to intentions to delay childbirth in order to pursue education and career.
Yet, looking at the larger social picture, many economically developed societies are undergoing changes in: young people’s transition to adulthood; relationships patterns, leading to difficulties in forming a committed partnership; and prominently, women’s career and educational patterns, as more women are taking part in the labor market. These changes lead to postponing of maternal age and thus to a notion of a gap between the so called “Biological Clock” and the social schedule. Social egg freezing therefore can be seen as a medical-technological solution for reconciling this gap.
The Israeli situation is a unique example of this overall trend. Israeli women represent a relatively high rate of labor force participation, (68.26% in 2023), while simultaneously having an exceptionally high number of children. Most Israeli social egg freezing users were shown to be single-women interested in having children within a heteronormative framework. The study also documented a unique group of Jewish-religious users who use this technology for family planning, due to its potential to enable not just becoming a mother, but having many children, even with a late start.
Several scholars have highlighted social egg freezing’s potential to promote equal employment opportunities for women, while others have raised concerns regarding the reinforcement of gender discrimination and oppression by highlighting a male-centered model of ideal participation in the labor force. While we acknowledge the benefit of social egg freezing for some women, especially those with particular life circumstances, we argue that social egg freezing cannot serve as a solution for gender inequality in the workplace. We believe balancing the medical achievements with changing social norms of parenthood (support for more responsibility and involvement of fathers’ in child raising) and gender equality in the labor-market (work-life balance strategies) is the appropriate way to prevent a technology aimed at liberating women from becoming constraining. Israeli policy has not moved in this direction, yet.
Yael Hashiloni-Dolev is a Professor in the Department of Sociology and Anthropology at Ben-Gurion University of the Negev, Israel.
Nitzan Rimon-Zarfaty is a former post-doctoral fellow in the Department of Medical Ethics and History of Medicine at the University Medical Center Göttingen, Germany and a Senior Lecturer in the Department of Human Resource Management Studies at Sapir Academic College, Israel.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska- Curie grant agreement No. 749889. The project also received funding from the Minerva Stiftung Post-Doctoral Fellowship of the Max Planck Society.
