Egg freezing policy in Turkey: A critical analysis in comparative perspective

Yıl 2023, Cilt: 47 Sayı: 1, 71 - 94, 08.07.2023

Azer Kılıç

Öz

Egg freezing for non-medical reasons has emerged as an effective and increasingly common procedure thanks to recent advances in cryotechnologies. This procedure aims to enable women to get pregnant in the future by having their eggs frozen as a measure against age-related decline in fertility. In Turkey, egg freezing was only allowed for medical reasons such as chemotherapy treatment and fertility-threatening operations until 2014. Women now also can have their eggs frozen in case of diminishing ovarian reserves, family history of premature menopause and the risk of age-related decline in fertility. While single women can have their eggs frozen, only the married ones can use their frozen eggs via in vitro fertilization. It is important to note that gamete donation is not legally allowed in Turkey. How should we then explain the egg freezing policy in Turkey given such limitations? At first look, the 2014 policy change might seem like an expansion of women’s reproductive rights. However, it looks more problematic when we consider it in comparison to policy approaches from other countries and in relation to women’s experiences of egg freezing and preferences concerning the use of reproductive technologies.

The article first provides an overview of the egg freezing literature, with a focus on the binary of the medical and the non-medical. It then points at the diversity of policy approaches across the world. This is followed by an elaboration on the egg freezing policy in Turkey and how it does not seem conducive to the profile of women who have their eggs frozen according to the extant studies. Accordingly, the 2014 policy change is linked to anxieties stemming from the government’s pronatalist and culturally conservative agendas. Egg freezing is not allowed for women who are young and healthy with plenty eggs, because of, it is argued, the concerns about the postponement of marriage and childbearing. Hence, egg freezing is allowed as a last resort only for a small group of women under certain circumstances. Otherwise, this group of women could have no chances of pregnancy, a scenario which would not be desirable from the perspective of pronatalism and social norms. In other words, the current egg freezing policy provides extra time for women who, to date, have not conformed to social norms in their life courses to conform. Finally, the article points at institutional issues concerning egg freezing as a matter of feminist policy advocacy.

Anahtar Kelimeler

egg freezing, assisted reproductive technologies, reproductive health policies, pronatalism, gender

Türkiye’de Yumurta Dondurma Politikası: Karşılaştırmalı Perspektiften Eleştirel Bir Değerlendirme

Öz

Medikal teknolojilerdeki gelişmeler sayesinde tıbbi olmayan nedenlerle yumurta dondurma son on yılda dünya genelinde etkin ve yaygın bir yöntem olarak belirmeye başladı. Böylelikle doğurganlıkta yaşa bağlı azalma durumuna karşı bir kadının önceden yumurtalarını dondurması ve ileride tüp bebek yöntemiyle hamile kalabilmesi amaçlanıyor. Türkiye’de ise 2014 yılında yapılan mevzuat değişikliğiyle yumurta dondurmaya izin verilen tıbbi zorunluluk halleri daha geniş tanımlandı. Daha önceden kemoterapi gibi üreme hücrelerine zarar verebilen tedaviler ve yumurtalıkların alınması gibi üreme fonksiyonlarının kaybedilmesine yol açabilecek operasyonlar öncesinde yumurta dondurmaya izin veriliyordu. Mevzuattaki değişiklikle ve klinik uygulamaya göre, yumurta rezervleri azalmış, ailesinde erken menopoz öyküsü olan ve/veya belirli bir yaşın üstünde olan, dolayısıyla doğurganlıkta yaşa bağlı azalma riskiyle karşı karşıya olan kadınlar da artık yumurta dondurabiliyor. Ancak mevzuata göre bekarken yumurta dondurabilen bu kadınların, dondurulmuş yumurtalarını tüp bebek yoluyla kullanmak istediklerinde evli olmaları gerekiyor. Diğer yandan, ülkemizde sperm ve yumurta donasyonunun mümkün olmadığını hatırlamakta fayda var. Bu kısıtlamalar dikkate alındığında, mevcut yumurta dondurma politikası nasıl değerlendirilmeli? 2014’teki mevzuat değişikliği ilk bakışta kadınların üreme haklarının genişlemesi olarak görülebilir, ama gerek başka ülkelerdeki politika yaklaşımları ile karşılaştırmalı düşünüldüğünde gerekse ülkemizde yumurtalarını donduran kadınların deneyimleri ve tercihleri düşünüldüğünde sorunlu olduğu görülmektedir.

Makalede, önce yumurta dondurma literatürüne ve “tıbbi – tıbbi olmayan” ayrımına değiniliyor. Ardından başka ülkelerde görülen politika yaklaşımlarının çeşitliliğine dikkat çekiliyor. Daha sonra ülkemizdeki uygulamalara eğilip, mevzuatın mevcut araştırmalarda beliren yumurta donduran kadın profiline uygunsuzluğuna işaret ediliyor. Bu doğrultuda, 2014 yılı mevzuat değişikliği iktidarın pronatalizm ve kültürel muhafazarlık kaynaklı kaygıları ile açıklanıyor: genç yaşta ve henüz yumurtalar sağlıklı ve bolken yumurta dondurmaya izin verilmemesinin ardında evliliğin ve anneliğin ötelenmesi konusundaki endişelerin yattığı iddia ediliyor. 2014 düzenlemeleri ancak sınırlı bir grup kadına belirli şartlar çerçevesinde bir nevi son çare olarak yumurta dondurmaya izin verilmesi olarak yorumlanıyor. Yoksa bu kadınların hamile kalma şanslarını büsbütün kaybedebilecekleri düşünülüyor olabilir ki bu da pronatalist gündem ve toplumsal normlar açısından arzu edilebilir bir ihtimal olarak görünmüyor. Dolayısıyla, hayat seyirleri açısından bu zamana kadar toplumsal normlara uygun yaşamamış kadınlara, mevcut yumurta dondurma politikası gecikmiş olarak da olsa normlara uyabilmek için bir fırsat sunuyor, ekstra zaman tanıyor denilebilir. Yazıda son olarak bir feminist politika konusu olarak yumurta dondurma konusunda dikkate alınması gereken kurumsal meselelere işaret ediliyor.

Anahtar Kelimeler

yumurta dondurma, üremeye yardımcı teknolojiler, üreme sağlığı politikası, pronatalizm, toplumsal cinsiyet

Kaynakça

• Akın, O. D., vd. (2019). Awareness of Fertility and Reproductive Aging in Women Seeking Oocyte Cryopreservation, Reproductive Aged Controls, and Female Health Care Professionals: A Comparative Study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 233, 146-150.
• Akkan, B. (2018). The Politics of Care in Turkey: Sacred Familialism in a Changing Political Context. Social Politics: International Studies in Gender, State & Society, 25(1), 72-91.
• ASRM (American Society for Reproductive Medicine) (2013). Mature Oocyte Cryopreservation: A Guideline. Fertility and Sterility, 99(1), 37–43.
• Baldwin, K. (2018). Conceptualising Women’s Motivations for Social Egg Freezing and Experience of Reproductive Delay. Sociology of Health & Illness, 40(5), 859–873.
• Baldwin, K. (2019). Egg Freezing, Fertility and Reproductive Choice: Negotiating Responsibility, Hope and Modern Motherhood. Emerald Publishing Limited.
• Baldwin, K. vd. (2019). Running out of time: exploring women’s motivations for social egg freezing. Journal of Psychosomatic Obstetrics & Gynecology, 40(2), 166–173.
• Bellani, D., Esping-Andersen, G. ve Nedoluzhko, L. (2017). Never partnered: A multilevel analysis of lifelong singlehood. Demographic Research, 37, 53–100.
• Birenbaum-Carmeli, D., Inhorn, M.C. ve Patrizio, P. (2020). Transgender Men’s Fertility Preservation: Experiences, Social Support, and the Quest for Genetic Parenthood. Culture, Health & Sexuality, 0(0), 1–16.
• Brown, E. ve Patrick, M. (2018). Time, Anticipation, and the Life Course: Egg Freezing as Temporarily Disentangling Romance and Reproduction. American Sociological Review, 83(5), 959–982.
• Buğra, A. (2014). Revisiting the Wollstonecraft Dilemma in the Context of Conservative Liberalism: The Case of Female Employment in Turkey. Social Politics, 21(1), 148-166.
• Calhaz-Jorge, C. vd. (2020). Survey on ART and IUI: Legislation, Regulation, Funding and Registries in European Countries: The European IVF-Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Human Reproduction Open, 1, 1–15.
• Carroll, K. ve Krolokke, C. (2018). Freezing for Love: Enacting `Responsible’ Reproductive Citizenship through Egg Freezing. Culture, Health & Sexuality, 20(9), 992–1005.
• Cattapan, A. vd. (2014). Breaking The Ice: Young Feminist Scholars of Reproductive Politics Reflect on Egg Freezing. IJFAB: International Journal of Feminist Approaches to Bioethics [Preprint].
• Cil, A.P. vd. (2019). A 5-year Analysis of Demographics, Cycle Characteristics and Reproductive Outcomes of 907 Egg Freezing Cycles in Patients with Diminished Ovarian Reserve and Age-Related Fertility Decline. Fertility and Sterility, 112(3), p. e108.
• CNN (2021). Beijing Wants Women to Have More Babies. So Why Isn’t It Loosening Rules on Egg Freezing? 21 Ağustos. Son erişim tarihi, 15/10/2022.
• Çarkoğlu, A. ve Kalaycıoğlu, E. (2012). Türkiye'de Aile, İş ve Toplumsal Cinsiyet. İstanbul: İstanbul Politika Merkezi.
• Daar, J. vd. (2018). Planned Oocyte Cryopreservation for Women Seeking to Preserve Future Reproductive Potential: An Ethics Committee Opinion. Fertility and Sterility, 110(6), 1022–1028.
• De Proost, M. ve Johnston, M. (2022). The Revision of The French Bioethics Law and The Questions It Raises For The Future Of Funding For Egg Freezing. Reproductive BioMedicine Online, 44(4), 591–593.
• Engin, C., Hürman, H. ve Harvey, K. (2020). Marriage and Family in Turkey: Trends and Attitudes, in Farris, D.N ve Threatt, E.H. (ed) International Handbook on the Demography of Marriage and the Family. Cham: Springer, 105–119.
• ESHRE (European Society for Human Reproduction and Embryology) (2012). Oocyte Cryopreservation for Age-Related Fertility Loss. Human Reproduction, 27(5), 1231–1237.
• Esping-Andersen, G. (2009). Incomplete Revolution: Adapting Welfare States to Women’s New Roles. Cambridge: Polity.
• Esping‐Andersen, G. ve Billari, F.C. (2015). Re-theorizing Family Demographics. Population and Development Review, 41(1), 1–31.
• Göknar, M.D. (2015) Achieving Procreation: Childlessness and IVF in Turkey. New York, Oxford: Berghahn Books.
• Greenwood, E.A. vd. (2018). To Freeze or Not To Freeze: Decision Regret And Satisfaction Following Elective Oocyte Cryopreservation. Fertility and Sterility, 109(6), 1097-1104.e1.
• Gürtin, Z.B. (2011). Banning Reproductive Travel: Turkey’s ART Legislation and Third-Party Assisted Reproduction. Reproductive BioMedicine Online, 23(5), 555–564.
• Gürtin, Z. (2017). Why are women freezing their eggs? Because of the lack of eligible men. The Guardian 7 Temmuz.
• Gürtin, Z.B. vd. (2019). Reconceiving Egg Freezing: Insights from An Analysis of 5 Years of Data from a UK Clinic. Reproductive BioMedicine Online, 38(2), 272–282.
• HÜNEE (Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü) (2019). 2018 Turkey Demographic and Health Survey. Ankara: Hacettepe Üniversitesi.
• IFFS (2022). Global Trends in Reproductive Policy and Practice. Global Reproductive Health, 7(e58).
• Inhorn, M.C. vd. (2018a). Elective Egg Freezing and Its Underlying Socio-Demography: A Binational Analysis with Global Implications. Reproductive Biology and Endocrinology, 16(1), 70.
• Inhorn, M.C. vd. (2018b). Ten pathways to elective egg freezing: a binational analysis. Journal of Assisted Reproduction and Genetics, 35(11), 2003–2011.
• Inhorn, M.C. vd. (2021). Egg Freezing at the End of Romance: A Technology of Hope, Despair, and Repair. Science, Technology, & Human Values, 0162243921995892.
• Martin, L.J. (2010). Anticipating Infertility: Egg Freezing, Genetic Preservation, and Risk. Gender & Society, 24(4), 526–545.
• Mutlu, B. (2018). Gizleyerek Aile Olmak: Yurtdışında Yasaklı Biyoteknolojilerle Çare Arayışları. Toplum ve Bilim, 144, 161–193.
• Pedersen, V.M.L. (2022). Freeze the Biological Clock: Discrimination, Disrespect, and Fertility Preservation via Social Freezing. Journal of Applied Philosophy, 39(3), 456–470.
• Pennings, G. (2021). Elective Egg Freezing and Women’s Emancipation. Reproductive Biomedicine Online, 42(6), 1053–1055.
• Rimon-Zarfaty, N. vd. (2021). Between “Medical” and “Social” Egg Freezing: A Comparative Analysis of Regulatory Frameworks in Austria, Germany, Israel, and the Netherlands. Journal of Bioethical Inquiry, 18(4), 683–699.
• Rose, N. (2004). Powers of Freedom: Reframing Political Thought. Cambridge: Cambridge University Press.
• Rottenberg, C., 2017. Neoliberal Feminism and the Future of Human Capital. Signs 42 (4), 329–348.
• Seyhan, A. vd. (2021). A Survey of Women Who Cryopreserved Oocytes for Non-Medical Indications (Social Fertility Preservation). Reproductive Sciences, 28(8), 2216–2222.
• Sussman, A.L. (2022). I Took an International Trip with My Frozen Eggs to Learn about the Fertility Industry. MIT Technology Review, 12 Eylül. Son erişim tarihi, 15/10/2022.
• Streeck, W. (2009). Flexible Employment, Flexible Families, and the Socialization of Reproduction. Cologne: Max Planck Institute for the Study of Societies.
• Ünal, R.A. (2020). Undoing Patrilineality: New Maternal Families and The Politics of Naming in Turkey. Hawwa, 1(aop), 182–205.
• van de Wiel, L. (2014). For Whom the Clock Ticks: Reproductive Ageing and Egg Freezing in Dutch and British News Media. Studies in the Maternal, 6(1), 1–28.
• van de Wiel, L. (2020). The Speculative Turn In IVF: Egg Freezing and The Financialization of Fertility. New Genetics and Society, 0(0), 1–21.
• Waldby, C. (2015). “Banking Time”: Egg Freezing and the Negotiation of Future Fertility. Culture, Health & Sexuality, 17(4), 470–482.
• Yakin, K., Urman, B. ve Balaban, B. (2022). Dynamic View of Assisted Reproduction in Turkey from 1996 to 2020. Reproductive BioMedicine Online, 44(4), 747–754.
• Yazar, 2008
• Yazar, 2010
• Yazar, 2017
• Yazar vd. 2018a
• Yazar vd. 2018b
• Yazar vd. 2021
• Zeno, E. (2020). Synchronizing the Biological Clock: Managing Professional and Romantic Risk through Company-Sponsored Egg Freezing. Social Problems [Preprint], (spaa031).