‘I feel that injustice is being done to me’: a qualitative study of women’s viewpoints on the (lack of) reimbursement for social egg freezing

Abstract

\n Background\n\nDuring the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium.\nMethods\n\nTo understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis.\nResults\n\nWe identify three themes: (1) From ongoing concern to non-issue; (2) Negotiating the reimbursement for social egg freezing; (3) From fully out-of-pocket to (partial) free good. In the first theme, we found that some women were concerned about the cost of social egg freezing and the lack of clear information about it. Furthermore, they reported moral sentiments of injustice which they attributed to their lack of acknowledgement for their struggles and needs. Other women perceived the reimbursement controversy of social egg freezing as something far removed from their lived experience. The second theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment unbefitting reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free.\nConclusions\n\nThis research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. Based on our results, it seems an oversimplification to portray social egg freezers as merely affluent women who are not concerned about the coverage of egg freezing costs. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them express a preference or a need for reimbursement.