Women embark on motherhood much later in life than a few decades ago. This leads to increased pressure on women because they sense that they have to accomplish many important life goals between the ages of 30 and 40. For instance, they need to finish their studies, find a suitable job, and also launch their career. They have to find the right partner, be fertile, have two genetically related children, and still look young and vital while performing all that.
Elective egg freezing can alleviate the pressure of the search for the right partner, to immediately have children, and prevent women from making impulsive decisions, ending up in an unhappy marriage, single parenthood, or unwanted childlessness. It allows women to spend more time building a career or to simply find out whether there is a desire for a child. Elective egg freezing can bridge the gap between reproductive prime and readiness of women to have children.
The simple fact of taking action, having tried everything by taking advantage of all possible reproductive opportunities to preserve their fertility is for many women very rewarding. Afterwards, women experience a greater peace of mind since they have the feeling there is a plan B in case the right partner turns up and infertility has seriously declined. A study published in Fertility and Sterility in 2013 showed many women find it an empowering experience that has improved their reproductive future and feel more in control over family planning.
It is so far noted that the patient return rates and use rates of the frozen eggs is quite low (see BioNews 1196). The reasons for not returning to use the frozen eggs can be manifold. Perhaps women became pregnant spontaneously or are still waiting for the right partner, and are reluctant to become a single mother or choose to remain childless. Studies investigating these return and use rates however have short follow-up periods after vitrification (two to five years) when women are still relatively young and still have a good fertility potential. When looking back much further in time to women who froze eggs at least ten years ago, it was noted in research I presented at the European Society of Human Reproduction and Embryology conference in June 2023 that half of the women returned and upon return, nearly all used the frozen eggs.
Unfortunately, after having found a solution to alleviate the pressures, society again puts pressure, for instance in the UK and Belgium, by legally setting the limits for cryopreservation and use of frozen eggs for a period of ten years for non-medical egg freezing. The UK lifted these limits in 2021 (see BioNews 1111).
For women freezing eggs in their late thirties a ten-year cryopreservation period might be enough because, after ten years of cryopreservation, they run up to the maximum age limit in many countries of 50 years to become pregnant using fertility treatment.
However, some women freeze eggs at an earlier age, preferably before the age of 35. These women might be in their early forties when the storage period of their eggs expires, which might be exactly when they want to use them. In a study in the UK half of the women did not agree with a ten-year storage limit. Some felt there should be an indefinite storage period others defined a reproductive age of 50 years as a proper storage limit.
In short, women freezing at a younger age and women returning later than expected to use the eggs (after ten years of freezing) made the standard legally ten-year storage period too tight.
It seems that on one hand, women's reproductive autonomy is strengthened by the possibility to freeze eggs, and at the same time, autonomy is limited by a ten-year storage period (and/or an age limit for fertility treatment). At the time this limit was legally set quite arbitrarily without prior knowledge of the population of women wanting to freeze eggs and without the possibility to consult this new population.
Ethicists also point to the fact that ideally in order for a woman to gain relational (and reproductive) autonomy we should change the oppressive conditions in her life and not try to make her better adapt to those conditions privately/individually by for instance freezing eggs. Simultaneously, efforts to promote change in social and political structures in order to eliminate discriminatory features of society should be made, so that women can safely engage in motherhood at a younger age without fear of missing opportunities in their careers and other areas.
Still little is known about the reproductive pathways of women who froze eggs in the past five or ten or more years, although there are more insights now than a decade ago when fertility clinics started offering this treatment. It is time that policymakers and fertility organisations meet again to review this ten-year limit for egg storage in jurisdictions where it is still in place.
In the meantime, elective egg freezing can be added to the list of possible preventive measures against future age-related infertility in women. Creating public awareness, offering individualised age-specific information, and comprehensive counselling to make sure that realistic expectations are being created and that well-informed decisions can be made, remains key.