Book Review: Egg Freezing in the 21st Century – A global perspective

Egg Freezing in the 21st Century: A Global Perspective
Edited by Dr Gillian Lockwood
Published by World Scientific Publishing
ISBN-10: 9811253005, ISBN-13: 978-9811253003
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As advancements in reproductive technology reshape the possibilities of parenthood, egg freezing has emerged as a significant, yet in some circumstances controversial, tool. It has the potential to enhance the reproductive autonomy of women in the global north, yet also, increasingly, in the global south.

In the past five years a number of research monographs dedicated to exploring this technology have emerged from scholars in gender studies, sociology, anthropology, science and technology studies to examine the application of egg freezing in a diversity of settings (Baldwin, 2019; Inhorn, 2023; Krolokke et al 2019; Van De Weil, 2020; and Waldby, 2019).

However, until recently there remained a notable gap: the absence of an edited collection that brought together contributions from a variety of authors across these and other disciplines.

In seeking to fill this gap, consultant fertility specialist, Dr Gillian Lockwood, has brought together clinicians, reproductive medicine specialists, social scientists and bioethicists to examine the topic of egg freezing in a new edited collection published by World Scientific: 'Egg Freezing in the 21st Century: A Global Perspective'. The volume offers a balanced mix of chapters, with some focusing, predominantly, on social science and related perspectives on egg freezing (broadly chapters 1, 6, 10-13), and others exploring the technological, clinical and medical dimensions of the practice (2-5, 7-9).

While it was valuable to have these, often distinct, disciplines represented in one volume, I nonetheless notice multiple collisions between these two perspectives which on occasion saw some authors overlook, and sometimes radically oversimplify, the nuances underpinning the use and experience of these technologies.

Furthermore, in places the book perpetuated outdated and inaccurate tropes, such as portraying 'career women' as using egg freezing purely to strategically delay motherhood. It also simplistically attributed declining fertility rates to the notion that women are choosing not to have children in favour of other pursuits, framing the issue in terms of personal choice rather than examining broader societal, economic, or structural factors that influence reproductive decisions.

It perhaps would have been more interesting to frame the issue of declining birth rates (which was situated as a problem across multiple chapters) as part of the global fertility gap which is seeing women and couples having fewer children than they hoped or anticipated worldwide.

While other chapters discussed the imperfect context in which women, men and couples (though the book often framed this as a woman's issue) made decisions about reproduction, too often the vast amount of literature from within, but also beyond, the social sciences went undiscussed or uncited. This exceptional 'light touch' with citations extended into the more clinically-oriented chapters, leaving the reader somewhat ungrounded. Repeatedly, various authors (though not all) would use phrases such as 'there are studies suggesting' or 'research suggests' without providing specific citations to substantiate these claims, making it difficult to verify or engage critically with the evidence being referenced.

Given the book's title, I was anticipating an exploration of the medical, ethical, and social dimensions of egg freezing, with a focus on global trends, diverse cultural contexts, and multidisciplinary perspectives from a range of international voices. While the book does very well to collate a diversity of authors, working on egg freezing in a variety of countries, I felt as a whole the book overlooks the practice and use of egg freezing in diverse context and particularly outside the global north.

Some chapters engaged with the global element of the book's premise more centrally than others, and looked at their particular aspect of egg freezing through a global lens, however this was largely limited to briefly reviewing international trends in egg freezing data or demographic change. Though in some places this was actually over-laboured and honestly not very interesting to follow, such as in the opening chapter or through a discussion of research undertaken in a variety of international settings (which I thought was better captured in chapter 13).

As a whole, I felt that the book missed opportunities to engage in more exciting international debates and examine the implications of egg freezing in a global context such as exploring the growth in and demand for egg freezing in developing economies such as India or Brazil, where access to reproductive technologies is expanding alongside economic development.

It might also have addressed the controversies surrounding prohibitions of egg freezing in China and cultural resistance to the technology in Japan and South Korea. Additionally, it could have examined how the use of vitrification has led to changes in patterns of egg donation enabling the procurement of eggs from providers in the global south and eastern European countries for use in wealthier nations (predominantly) in the west.

Finally, while a strong and thoughtful chapter, I was surprised to see that the book ended at chapter 13 following the inclusion of Professor Allan Pacey's discussion on men and male attitudes to fertility and fertility preservation. I would have very much liked to have seen a synthesis of the key themes and issues explored within the book more clearly drawn out and discussed in a concluding chapter.

Indeed, such a chapter could have had the scope to explore the new challenges and opportunities facing the field of fertility preservation more broadly. Given the multiple disciplines included in the book, it could have also offered insights into new directions for research, including both discipline-specific inquiries and opportunities for cross-disciplinary or multidisciplinary collaboration.

Such a concluding chapter could have united the diverse disciplinary insights, offering a roadmap for future research which would have significantly enhanced the book's contribution to the study of egg freezing.

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