Journal of Assisted Reproduction and Genetics

, Volume 34, Issue 8, pp 1035–1041 | Cite as

Is employer coverage of elective egg freezing coercive?: a survey of medical students’ knowledge, intentions, and attitudes towards elective egg freezing and employer coverage

  • Deborah E. Ikhena-Abel
  • Rafael Confino
  • Nirali J. Shah
  • Angela K. Lawson
  • Susan C. Klock
  • Jared C. Robins
  • Mary Ellen PavoneEmail author
Assisted Reproduction Technologies



The purpose of this study was to understand medical students’ knowledge, intentions, and attitudes towards oocyte cryopreservation and employer coverage of such treatment.


This cross-sectional study was performed via an online cross-sectional survey distributed to 280 female medical students from March through August 2016. Demographics, attitudes towards employer coverage, and factors influencing decision-making were assessed via a self-reported multiple-choice questionnaire. The relationship between respondents’ attitudes towards employer coverage and other parameters was analyzed.


A total of 99 responses were obtained out of 280 female medical students. Most respondents (71%) would consider oocyte cryopreservation (potential freezers), although 8% would not consider the procedure and 21% were unsure. Seventy-six percent of respondents felt pressure to delay childbearing. Potential freezers were more likely to be single (p = 0.001), to report feeling pressure to delay childbearing (p = 0.016), and to consider egg freezing if offered by an employer (p < 0.001). Importantly, 71% percent did not view employer coverage as coercive and 77% of respondents would not delay childbearing due to employer coverage. Factors influencing decision-making in potential freezers were absence of a suitable partner (83%), likelihood of success (95%), and health of offspring (94%), among others. Knowledge about the low chance of pregnancy per oocyte (6–10%) would influence decision-making in 42% of potential freezers.


Oocyte freezing is an acceptable strategy for the majority of young women surveyed. Pressure to delay childbearing was related to openness to freeze eggs. The majority of respondents did not find employer coverage for egg freezing coercive although further research is needed with larger, representative samples to ascertain the relationship between pressure to delay childbearing due to work demands and employer coverage for egg freezing.


Fertility preservation Employer coverage Elective oocyte cryopreservation 


Compliance with ethical standards

This study was approved by the Institutional Review Board at Northwestern University, and all surveys were completed anonymously.

Authors’ roles

All authors were involved in study data analysis, and interpretation, drafting, and revising the manuscript critically for important intellectual content, final approval of the manuscript to be published, and agreement to be accountable for all aspects of the work.


Funding P50 HD076188

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Practice Committees of American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99(1):37–43. doi: 10.1016/j.fertnstert.2012.09.028.CrossRefGoogle Scholar
  2. 2.
    Doyle JO, Richter KS, Lim J, Stillman RJ, Graham JR, Tucker MJ. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril. 2016;105(2):459–66 e2. doi: 10.1016/j.fertnstert.2015.10.026.CrossRefPubMedGoogle Scholar
  3. 3.
    Cobo A, Meseguer M, Remohi J, Pellicer A. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod. 2010;25(9):2239–46. doi: 10.1093/humrep/deq146.CrossRefPubMedGoogle Scholar
  4. 4.
    Rienzi L, Romano S, Albricci L, Maggiulli R, Capalbo A, Baroni E, et al. Embryo development of fresh 'versus' vitrified metaphase II oocytes after ICSI: a prospective randomized sibling-oocyte study. Hum Reprod. 2010;25(1):66–73. doi: 10.1093/humrep/dep346.CrossRefPubMedGoogle Scholar
  5. 5.
    Parmegiani L, Cognigni GE, Bernardi S, Cuomo S, Ciampaglia W, Infante FE, et al. Efficiency of aseptic open vitrification and hermetical cryostorage of human oocytes. Reprod BioMed Online. 2011;23(4):505–12. doi: 10.1016/j.rbmo.2011.07.003.CrossRefPubMedGoogle Scholar
  6. 6.
    Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, et al. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012;27(5):1231–7. doi: 10.1093/humrep/des029.CrossRefPubMedGoogle Scholar
  7. 7.
    Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril. 2013;100(5):1343–9. doi: 10.1016/j.fertnstert.2013.07.201.CrossRefPubMedGoogle Scholar
  8. 8.
    Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep. 2015;64(12):1–64.Google Scholar
  9. 9.
    Zoll M, Mertes H, Gupta J. Corporate giants provide fertility benefits: have they got it wrong? Eur J Obstet Gynecol Reprod Biol. 2015;195:A1–2. doi: 10.1016/j.ejogrb.2015.10.018.CrossRefPubMedGoogle Scholar
  10. 10.
    Stoop D, Cobo A, Silber S. Fertility preservation for age-related fertility decline. Lancet. 2014;384(9950):1311–9. doi: 10.1016/S0140-6736(14)61261-7.CrossRefPubMedGoogle Scholar
  11. 11.
    Bennett J. Company-paid egg freezing will be the great equalizer. Time. 2014;15:2014.Google Scholar
  12. 12.
    Kime P. Military's new fertility benefit will let troops freeze their sperm and eggs. Military Times; 2016. Retrived from
  13. 13.
    Lampert N. New fertility for female soliders. The Atlantic 2016 February 29, 2016.Google Scholar
  14. 14.
    Lewis EI, Missmer SA, Farland LV, Ginsburg ES. Public support in the United States for elective oocyte cryopreservation. Fertil Steril. 2016;106(5):1183–9. doi: 10.1016/j.fertnstert.2016.07.004.CrossRefPubMedGoogle Scholar
  15. 15.
    Cobo A, Garcia-Velasco JA. Why all women should freeze their eggs. Curr Opin Obstet Gynecol. 2016;28(3):206–10. doi: 10.1097/GCO.0000000000000269.CrossRefPubMedGoogle Scholar
  16. 16.
    Mertes H. Does company-sponsored egg freezing promote or confine women's reproductive autonomy? J Assist Reprod Genet. 2015;32(8):1205–9. doi: 10.1007/s10815-015-0500-8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Mertes H, Pennings G. Elective oocyte cryopreservation: who should pay? Hum Reprod. 2012;27(1):9–13. doi: 10.1093/humrep/der364.CrossRefPubMedGoogle Scholar
  18. 18.
    Association of American Medical Colleges. Table A-1: U.S. Medical school applications and matriculants by school, state of legal residence, and sex, 2016–2017. Rerieved from
  19. 19.
    Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril. 2003;79(3):577–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod. 2003;18(9):1959–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Stoop D, Nekkebroeck J, Devroey P. A survey on the intentions and attitudes towards oocyte cryopreservation for non-medical reasons among women of reproductive age. Hum Reprod. 2011;26(3):655–61. doi: 10.1093/humrep/deq367.CrossRefPubMedGoogle Scholar
  22. 22.
    Tietze C. Reproductive span and rate of reproduction among Hutterite women. Fertil Steril. 1957;8(1):89–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Menken J, Trussell J, Larsen U. Age and infertility. Science. 1986;233(4771):1389–94.CrossRefPubMedGoogle Scholar
  24. 24.
    Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. Federation CECOS. N Engl J Med. 1982;306(7):404–6. doi: 10.1056/NEJM198202183060706.CrossRefPubMedGoogle Scholar
  25. 25.
    Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.Google Scholar
  26. 26.
    Mesen TB, Mersereau JE, Kane JB, Steiner AZ. Optimal timing for elective egg freezing. Fertil Steril. 2015;103(6):1551–6 e1-4. doi: 10.1016/j.fertnstert.2015.03.002.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Willett LL, Wellons MF, Hartig JR, Roenigk L, Panda M, Dearinger AT, et al. Do women residents delay childbearing due to perceived career threats? Acad Med. 2010;85(4):640–6. doi: 10.1097/ACM.0b013e3181d2cb5b.CrossRefPubMedGoogle Scholar
  28. 28.
    Tan SQ, Tan AW, Lau MS, Tan HH, Nadarajah S. Social oocyte freezing: a survey among Singaporean female medical students. J Obstet Gynaecol Res. 2014;40(5):1345–52. doi: 10.1111/jog.12347.CrossRefPubMedGoogle Scholar
  29. 29.
    Silber SJ, Kato K, Aoyama N, Yabuuchi A, Skaletsky H, Fan Y, et al. Intrinsic fertility of human oocytes. Fertil Steril. 2017;107(5):1232–7. doi: 10.1016/j.fertnstert.2017.03.014.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Deborah E. Ikhena-Abel
    • 1
  • Rafael Confino
    • 1
  • Nirali J. Shah
    • 1
  • Angela K. Lawson
    • 1
  • Susan C. Klock
    • 1
  • Jared C. Robins
    • 1
  • Mary Ellen Pavone
    • 1
    Email author
  1. 1.Department of Obstetrics and GynecologyPrentice Women’s Hospital, Northwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations