Elective egg freezing and its underlying socio-demography: a binational analysis with global implications

Abstract

BackgroundWhat are the underlying socio-demographic factors that lead healthy women to preserve their fertility through elective egg freezing (EEF)? Many recent reviews suggest that women are intentionally postponing fertility through EEF to pursue careers and achieve reproductive autonomy. However, emerging empirical evidence suggests that women may be resorting to EEF for other reasons, primarily the lack of a partner with whom to pursue childbearing. The aim of this study is thus to understand what socio-demographic factors may underlie women’s use of EEF.MethodsA binational qualitative study was conducted from June 2014 to August 2016 to assess the socio-demographic characteristics and life circumstances of 150 healthy women who had undertaken at least one cycle of elective egg freezing (EEF) in the United States and Israel, two countries where EEF has been offered in IVF clinics over the past 7–8 years. One hundred fourteen American women who completed EEF were recruited from 4 IVF clinics in the US (2 academic, 2 private) and 36 women from 3 IVF clinics in Israel (1 academic, 2 private). In-depth, audio-recorded interviews lasting from 0.5 to 2 h were undertaken and later transcribed verbatim for qualitative data analysis.ResultsWomen in both countries were educated professionals (100%), and 85% undertook EEF because they lacked a partner. This “lack of a partner” problem was reflected in women’s own assessments of why they were single in their late 30s, despite their desires for marriage and childbearing. Women themselves assessed partnership problems from four perspectives: 1) women’s higher expectations; 2) men’s lower commitments; 3) skewed gender demography; and 4) self-blame.DiscussionThe “lack of a partner” problem reflects growing, but little discussed international socio-demographic disparities in educational achievement. University-educated women now significantly outnumber university-educated men in the US, Israel, and nearly 75 other societies around the globe, according to World Bank data. Thus, educated women increasingly face a deficit of educated men with whom to pursue childbearing.ConclusionAmong healthy women, EEF is a technological concession to gender-based socio-demographic disparities, which leave many highly educated women without partners during their prime childbearing years. This information is important for reproductive specialists who counsel single EEF patients, and for future research on EEF in diverse national settings.

For whom the egg thaws: insights from an analysis of 10 years of frozen egg thaw data from two UK clinics, 2008–2017

“…While the latter show no difference between their relationship status at time of freeze and time of thaw, with the great majority of those in the non-SEF category being in heterosexual relationships, the relationship status of women who froze their eggs for social reasons tells a completely different story. These women, as expected, are almost all single at the time of egg freezing, in line with findings from qualitative studies which report their main reasons for freezing as not being in a relationship, or not being in the right relationship and their motivations as a desire to Bbuy time^and to avoid Bpanic partnering^ [15,[18][19][20][21][22]. These women hope to meet partners before starting their families and are Banticipating coupledom^in the future [17].…”

“…Until recently, we have had only very limited demographic information about women who have frozen their own eggs [14,15], with our team conducting the first UK-based largescale quantitative analysis of the characteristics women who had frozen their eggs [16]. In that paper, we were able to give details of the number of women freezing their eggs each year, as well as their age at egg freeze, relationship status, average number of cycles undertaken, and average number of eggs frozen.…”

“…This refers to women who have chosen to freeze their eggs for so-called Bsocial reasons,^concerned primarily with age-related fertility decline and wishing to increase their chances of motherhood in the future. Although there are valuable debates regarding whether Bsocial^is the best or most appropriate terminology for this type of egg freezing [15,19], in this paper, we have decided to stay with it in order to differentiate between this and other forms of Belective^(i.e. non-medical) egg freezing.…”

Patient-centered elective egg freezing: a binational qualitative study of best practices for women’s quality of care

“…Elective oocyte cryopreservation via vitrification-or Belective egg freezing^(EEF), as women themselves prefer to call it [1,2]-for healthy women who are hoping to preserve their reproductive potential is gaining increasing international acceptance [3][4][5][6][7][8][9]. Although EEF has been considered a key way for reproductive-age women to defer or delay childbearing while pursuing their educations and careers [10][11][12], the emerging empirical evidence strongly suggests that the primary users of EEF are women reaching the end of their reproductive lifespans (i.e., late 30s to early 40s) who would like to pursue childbearing, but find themselves without a male partner.…”

Reproductive technologies are not the cure for social problems

“…But technomedical approaches generally do not solve social problems because they do not address the root of the issue, which is social in nature, not medical. Egg freezing is supposed to empower women to focus on their professional lives, yet empirical research shows that the reason most women are ‘delaying’ childbearing is not because of their career, but because they lack a partner 8. Egg freezing is not going to address the shortage of ‘suitable’ partners for professional women.…”