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. 2018 Jul 23;16(1):70.
doi: 10.1186/s12958-018-0389-z.

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

M C Inhorn  1 , D Birenbaum-Carmeli  2 , J Birger  3 , L M Westphal  4 , J Doyle  5 , N Gleicher  6 , D Meirow  7 , M Dirnfeld  8 , D Seidman  7 , A Kahane  9 , P Patrizio  10
Affiliations

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

M C Inhorn et al. Reprod Biol Endocrinol. .

Abstract

Background: What 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.

Methods: A 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.

Results: Women 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.

Discussion: The "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.

Conclusion: Among 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.

Keywords: Education; Fertility preservation; Gender; Israel; Men as partners; Oocyte cryopreservation; Reproductive epidemiology; Single women; Socio-demography; United States.

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Conflict of interest statement

Authors’ information

MCI of Yale University and DB-C of University of Haifa are professors of medical anthropology who specialize in qualitative research with assisted reproduction patients. They are personally responsible for the in-depth interviews that form the core dataset of this paper. As the corresponding author of this paper, further information on MCI’s research can be found at www.marciainhorn.com.

Ethics approval and consent to participate

The research protocol, including study design, study recruitment, interview schedule, and qualitative data analysis and management plan, was approved by the Human Subjects Committees and Institutional Review Boards at Yale University and the University of Haifa, as well as by ethics committees of all 7 participating IVF clinic study sites. In the US, these included the Center for Human Reproduction, New York City; Shady Grove Fertility, Rockville, MD; and the Stanford Fertility and Reproductive Medicine Center. In Israel, these included Carmel Medical Center, Haifa; Sheba Medical Center, Ramat Gan; Assuta Medical Center, Tel Aviv; and Assuta Medical Center, Rishon Lezion. All women participating in this study in these various centers signed written informed consent forms, agreeing to their participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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