Egg freezing for non-medical reasons, known as social freezing, has received considerable attention in recent years, prompting discussions about ethical issues involved. This review aims to summarize the ethical issues of social freezing using the four fundamental principles of autonomy, nonmaleficence, beneficence and justice as a framework.

A systematic literature review was conducted by searching the databases PubMed, CINAHL and Google scholar from November 2023 to February 2024. Qualitative, quantitative and mixed-methods studies published within the last 25 years addressing ethical issues of social freezing were included.

Following a multi-stage screening and selection process, a total of 33 studies were included in the review. The analysis identified a diverse range of ethical arguments concerning social egg freezing, structured according to the four principles of biomedical ethics: autonomy, nonmaleficence, beneficence, and justice.

Autonomy emerged as a central ethical consideration, with elective oocyte cryopreservation framed as a means of enhancing reproductive self-determination by enabling women to temporally dissociate fertility from biological aging. However, this autonomy is often situated within broader sociocultural and structural constraints, including employer-driven incentives, prevailing gender norms, and restrictive legal frameworks, which may subtly compromise the voluntariness of reproductive decision-making. Nonmaleficence-related concerns centered on the physical and psychological risks associated with the procedure, particularly in the context of advanced maternal age, repeated ovarian stimulation, and fertility preservation in transgender adolescents. These risks include medical complications, emotional distress, and the potential for regret or false expectations regarding reproductive success. Under the principle of beneficence, the literature highlights potential psychological benefits, including reduced anxiety and increased perceived reproductive agency, particularly among highly educated women and those lacking a suitable partner. Nonetheless, these benefits are not equitably experienced across all populations. Justice-related considerations revealed significant disparities in access to social egg freezing, primarily driven by prohibitive costs, lack of insurance coverage, and sociocultural exclusion. These factors contribute to structural reproductive inequities, disproportionately affecting socioeconomically disadvantaged individuals and members of the transgender community.

Collectively, the findings underscore the ethically ambivalent nature of social egg freezing—simultaneously expanding reproductive possibilities for some while reinforcing existing social and economic inequities for others. The practice presents a multifaceted ethical landscape, characterized by the tension between promoting reproductive autonomy—closely intertwined with gender equality—and perpetuating structural disparities due to financial and systemic barriers. These dynamics highlight the imperative for regulatory frameworks that not only facilitate equitable access through financial support mechanisms but also mandate the provision of comprehensive, balanced, and evidence-based information to support truly informed reproductive decision-making.