Freezing fertility or freezing false hope? A content analysis of social egg freezing in U.S. print media

Reconciling moral discourses on choice, risk and pronatalism: the politics of elective egg freezing in Singapore

This article examines the framing of choice, risk and pronatalism in Singapore's debate on elective egg freezing, beginning from the government's review of the ban in 2012 and ending in 2023 when the procedure was legalised. It demonstrates the possibility of reconciling liberal discourses on reproductive choice with technocritical discourses on egg freezing as a risky and oppressive pronatalist technology. While medical complications, false hope and commercial abuse were longstanding concerns in Singapore, these risks were perceived as reconcilable with choice through an age limit, mandatory counselling and comparative frames from the national and international regulatory context. Additionally, low fertility rates and efforts to advance gender equality enabled the reconciliation of choice and pronatalism as policy justifications, while the construction of female candidates' heteronormative reproductive desire framed pronatalism in women-centric ways. Such reconciliation was facilitated by Singapore's strong interventionist culture which normalises paternalism and pronatalism. Within this context and through actors' articulation of policy ideas, elective egg freezing was reinterpreted as a technology with manageable risks, and a hope technology for women and nation. A moral Singapore State which permits elective egg freezing while supporting the interests of women and society was thus co-produced by politicians, journalists and doctors.

Mapping ethical, legal, and social implications (ELSI) of fertility preservation

RESEARCH QUESTION

The study examines the ethical, legal, and social implications of fertility preservation, highlighting its importance across oncofertility, elective egg freezing, and posthumous assisted reproduction, as well as its impact on transgender individuals undergoing gender-affirming surgeries.

DESIGN

A comprehensive analysis of 600 articles, focusing on a diverse range of disciplines, including bioethics, psychology, and sociology, to explore public and healthcare professionals' knowledge, patient experiences, and regulatory constraints.

RESULTS

The body of literature is growing, indicating increasing recognition of FP's significance. Key themes included the centrality of counseling and informed decision-making, especially in oncofertility and EEF, and ethical debates surrounding informed consent and the autonomy of involved individuals. The analysis underscored a western-centric bias in current research, emphasizing the need for more inclusive and culturally sensitive studies.

CONCLUSIONS

The study calls for a nuanced understanding of FP, advocating for policies that consider ethical, cultural, and social dimensions. It suggests the necessity for interdisciplinary research to address identified gaps, particularly in understanding non-Western perspectives and ensuring equitable access to FP services globally. Moreover, the review emphasizes the importance of integrating patient-centric approaches and ethical frameworks to guide FP practices and policies, ensuring they respect diverse values and meet individuals' needs.

Awareness, Attitude, and Fertility Desire in Elective Oocyte Cryopreservation of Adults in Four Areas of China

Purpose

Controversy exists on whether or not elective oocyte cryopreservation (eOC) can be conducted in public hospitals in China. Policymakers should take into account the benefits and risks in the Chinese population. This study explored basic data concerning the awareness, attitudes of eOC, and fertility desire of eOC in China to offer evidence for policy making.

Methods

A total of 442 people in four areas of China responded to a survey. The questionnaire was divided into three parts: awareness, attitude, and fertility desire of eOC. Descriptive analysis and multivariable regression analysis were used in the study.

Results

Generally, the respondents had a positive or neutral attitude towards eOC. However, about 90% of respondents did not know the cost of eOC. In general, a more positive attitude was found towards eOC among participants who had heard of the procedure compared with those who had not. Most women did not desire to reproduce by eOC. After adjusting for access to information, we found that female, older age groups, and singles were more likely to have increased awareness than their counterparts. The awareness of participants who accessed information from any source had a higher relative probability of having good awareness levels compared to participants who had not accessed the information. Undergraduates exhibited significantly higher levels of cognitive understanding, as indicated by their increased familiarity and comprehension, compared to high school students (relative risk ratio = 1.44, confidence interval = 0.48,4.29).

Conclusion

Continued discussion is needed regarding the ethical, legal, and social aspects of performing eOC in public hospitals. Furthermore, policies are needed to regulate eOC to protect the reproductive freedom of healthy women.

'False hope' in assisted reproduction: the normative significance of the external outlook and moral negotiation

Despite the frequent invocation of 'false hope' and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of 'false hope' only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate.

Main topics in assisted reproductive market: A scoping review

BACKGROUND

Infertility affects around 12% of couples, and this proportion has been gradually increasing. In this context, the global assisted reproductive technologies (ART) market shows significant expansion, hovering around USD 26 billion in 2019 and is expected to reach USD 45 billion by 2025.

OBJECTIVES

We realized a scoping review of the ART market from academic publications, market reports, and specialized media news, to identify the main terms and characterize them into the main topics in the area.

DESIGN

We apply an LDA topic modeling process to identify the main terms, and clustered them into semantic synonymous topics. We extracted the patterns and information to these topics and purposed a factor/consequence correlation to them.

RESULTS

We found 2,232 academic papers and selected 632 to include in the automatic term detection. We also included 34 market reports and seven notices produced by specialized enterprises. Were identified 121 most relevant cited terms covering 7,806 citations. These terms were manually aggregated into 10 topics based on semantic similarity: neutral terms (37.2%), economic aspects (17.6%), in vitro fertilization (IVF) commodities & cross-border reproductive care (CBRC) (10.6%), geographic distribution (9.5%), social aspects (7%), regulation (6%), trends & concerns (3.9%), accessibility (3.4%), internet influence (2.9%), and fertility preservation for non-medical reasons (2%).

DISCUSSION

The analysis indicates a market with expressive complexity. Most terms were associated with more than one topic, indicating the synergism of this market's behavior. Only seven terms related to economic aspects, surrogacy and donation represent around 50% of the citations. Except for the topic formed by generic terms, the topic of the economic aspects was the most represented, reflecting macro perspectives such as a-la-carte standard of treatments, many clinics operating on a small/medium scale, and the recent formation of conglomerates. The IVF commodities & CBRC topic brings an overview of gametes pricing and transnational surrogacy, and its regulation. The topic of geographic distribution indicates that that the Asia-Pacific (APAC) market has the most significant growth potential in all fields. Despite the increase in supply and demand for infertility treatments and technological advances in recent decades, the success rate of IVF cycles remains at around 30%. Terms referring to research and development or technical improvement were not identified in a significant way in this review.

CONCLUSIONS

The formation of topics by semantic similarity proved to be an initial path for the elaboration of in-depth studies on the dynamics between several factors, for this, we present the panel classifying main terms into factors (demand, pent-up demand, or distributive) or ART market consequences. Through this approach, it was possible to observe that most of the works addresses economic aspects, regulation and geographic aspects and that topics related to research and improvement have not been addressed. In this way, we highlight the need to deepen the analysis of market elements that may be related to increased efficiency of IVF in the technical field.

The first nationwide website survey of the availability and costs of medical and non-medical oocyte cryopreservation in Japan

Research question

How does the cost-related oocyte cryopreservation (OoC) vary by the facility in Japan, and what data is provided on the websites about OoC procedures?

Design

Website survey. The websites of all 621 facilities that provide assistive reproductive technology registered in Japan were surveyed in 2021. Data included the rates of explicit statements regarding the provision of OoC for only medical reasons (medical only group) or non-medical reasons (non-medical group). Based on whether or not facilities that perform OoC clearly stated the cost on their websites, we compared the costs of OoC and annual storage cost between medical only and non-medical groups. Furthermore, we examined the stated number of OoC procedures performed and their clinical outcomes.

Results

Of the 621 facilities, 146 (23.5%) clearly stated that they offer OoC on their websites. Of the 88 medical only groups and 58 non-medical groups, 24 (27.3%) and 42 (72.4%) clearly stated the OoC cost, and 27 (30.7%) and 44 (75.9%) clearly states the annual oocyte storage cost, respectively. The OoC costs were significantly higher for the non-medical group than in the medical group. In the medical only group, the annual storage cost remained almost the same regardless of the number of oocytes, while in the non-medical group, the annual storage cost was 2-3 times higher than in the medical only group. Only 16 facilities (16/146, 11.0%) had mentioned the number of OoC procedures, and five facilities (3.4%) provided information on the clinical outcomes after OoC.

Conclusion

Costs related to OoC are higher for the non-medical group in Japan. In addition, the websites contain scant information on the costs and clinical outcomes of OoC.

Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information

PURPOSE

Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information.

METHODS

An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method.

RESULTS

Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53).

CONCLUSION

Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.

Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol

BACKGROUND

Uptake of elective egg freezing has increased globally. The decision to freeze eggs is complex, and detailed, unbiased information is needed. To address this, we developed an online Decision Aid for women considering elective egg freezing. Decision Aids are the standard of care to support complex health decisions.

OBJECTIVES

This study will measure the impact of the Decision Aid on decision-making (e.g. decisional conflict, engagement in decision-making, distress, and decision delay) and decision quality (e.g. knowledge, level of informed choice, and regret).

METHODS AND ANALYSIS

A single-blinded two-arm parallel-group randomized controlled trial. Women considering elective egg freezing will be recruited using social media, newsletters, and fertility clinics. Data will be collected at baseline (recruitment), 6-month, and 12-month post-randomization. The primary hypothesis is that the intervention (Decision Aid plus Victorian Assisted Reproductive Technology Authority website) will reduce decisional conflict (measured using the Decisional Conflict Scale) at 12 months more than control (Victorian Assisted Reproductive Technology Authority website only). Secondary outcomes include engagement in decision-making (Perceived Involvement in Care Scale), distress (Depression, Anxiety, and Stress Scale), decision delay, knowledge, informed choice (Multi-dimensional Measure of Informed Choice), and decisional regret (Decisional Regret Scale).

ETHICS

The study was approved by the University of Melbourne Human Research Ethics Committee (Ethics ID: 2056457). Informed consent will be obtained from all participants prior to enrolment.

DISCUSSION

This is the first international randomized controlled trial that aims to investigate the effect of an elective egg freezing Decision Aid on decision-related outcomes (e.g. decisional conflict, informed choice, and regret). It is anticipated that participants who receive the Decision Aid will have better decision and health outcomes.

REGISTRATION DETAILS

ACTRN12620001032943: Comparing different information resources on the process and quality of decision-making in women considering elective egg freezing.

'I feel that injustice is being done to me': a qualitative study of women's viewpoints on the (lack of) reimbursement for social egg freezing

Background

During the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered to uptake at least one social egg freezing cycle in Belgium.

Methods

To understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis.

Results

We identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free.

Conclusions

This research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00774-z.

Disrupting the biological clock: Fertility benefits, egg freezing and proactive fertility management

In the last decade, the in-vitro fertilization (IVF) sector has witnessed a shift from so-called 'reactive IVF' to a new model of proactive fertility care. Whereas IVF was traditionally developed to treat people who found they were unable to conceive, the indication for IVF has broadened significantly to include a much wider group of potential patients through a new focus on proactive treatment of future (in)fertilities. This shift combines a number of new trends pertaining to preservation, prediction, private equity and platformization, all of which have gained influence in contemporary assisted reproduction. This article focuses on the emergence of company-sponsored fertility benefits, which combines each of these trends. Whereas fertility benefits - especially egg freezing insurance - have primarily been discussed in terms of women's empowerment or disenfranchisement, this article instead calls attention to the discursive, clinical and infrastructural shifts in contemporary assisted reproduction that have emerged with the rising popularity of these benefits. The analysis addresses these underdiscussed aspects of fertility benefits by focusing on the dynamics of demand; the shifts in the rationalization of intensified treatment pathways in the face of new reimbursement practices; and the online, platform-based infrastructures that are built to provide these treatments. In doing so, it analyses how this remaking of fertility towards an ethos of proactive fertility management reflects broader capitalist tailwinds.

Revisiting selected ethical aspects of current clinical in vitro fertilization (IVF) practice

Ethical considerations are central to all medicine though, likely, nowhere more essential than in the practice of reproductive endocrinology and infertility. Through in vitro fertilization (IVF), this is the only field in medicine involved in creating human life. IVF has, indeed, so far led to close to 10 million births worldwide. Yet, relating to substantial changes in clinical practice of IVF, the medical literature has remained surprisingly quiet over the last two decades. Major changes especially since 2010, however, call for an updated commentary. Three key changes deserve special notice: Starting out as a strictly medical service, IVF in recent years, in efforts to expand female reproductive lifespans in a process given the term “planned” oocyte cryopreservation, increasingly became more socially motivated. The IVF field also increasingly underwent industrialization and commoditization by outside financial interests. Finally, at least partially driven by industrialization and commoditization, so-called add-ons, the term describing mostly unvalidated tests and procedures added to IVF since 2010, have been held responsible for worldwide declines in fresh, non-donor live birthrates after IVF, to levels not seen since the mid-1990s. We here, therefore, do not offer a review of bioethical considerations regarding IVF as a fertility treatment, but attempt to point out ethical issues that arose because of major recent changes in clinical IVF practice.

Polygenic risk scoring of human embryos: a qualitative study of media coverage

BACKGROUND

Current preimplantation genetic testing (PGT) technologies enable embryo genotyping across the whole genome. This has led to the development of polygenic risk scoring of human embryos (PGT-P). Recent implementation of PGT-P, including screening for intelligence, has been extensively covered by media reports, raising major controversy. Considering the increasing demand for assisted reproduction, we evaluated how information about PGT-P is communicated in press media and explored the diversity of ethical themes present in the public debate.

METHODS

LexisNexis Academic database and Google News were searched to identify articles about polygenic embryo screening. This led to 535 news articles. 59 original articles met the inclusion criteria. Inductive content analysis was used to analyse these articles.

RESULTS

8.8% of articles gave embryo polygenic scoring a positive portrayal, while 36.8% expressed a negative attitude. 54.4% were neutral, mostly highlighting limited practical value of the technology in in vitro fertilization settings. We identified five main ethical themes that are also present in academic literature and the broader debate on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice and societal readiness.

CONCLUSIONS

Implementation of embryo polygenic profiling engenders a need for specific recommendations. Current media analysis discloses important ethical themes to consider when creating future guidelines for PGT-P.

Frozen eggs: national autologous oocyte thaw outcomes

OBJECTIVE

To characterize national outcomes of oocyte thaw (OT) cycles.

DESIGN

Retrospective descriptive study.

SETTING

All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2012 to 2018.

PATIENT(S)

All women undergoing OT cycles in the United States.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Absolute numbers of oocyte cryopreservation (OC) and OT cycles over time. Among OT cycles, patient and cycle characteristics, the ratio of the total number of oocytes thawed to the number of live births by maternal age at the time of cryopreservation (ATOC), and outcomes including pregnancy, miscarriage, live birth, and good perinatal outcome (GPO) by age ATOC.

RESULT(S)

From 2012 to 2018, 54,675 OC and 6,413 OT cycles were performed; the absolute numbers increased from 2,719 to 13,824 and from 348 to 1,810, respectively. The ratio of the total number of oocytes thawed to the number of live births increased significantly with increasing age ATOC, from 41.4 (age <35 years) to 122.4 (age >41 years). Among OT cycles resulting in embryo transfer, the live birth rate decreased with increasing age ATOC from 42.8% (age <35 years) to 10.8% (age >42 years). The live birth rate was higher when calculated per transfer (42.8% in women aged <35 years ATOC) rather than per thaw cycle (31.5% in women aged <35 years ATOC) because of the number of patients with no transfer. Among 1,124 cycles resulting in pregnancy, the chance of a GPO was highest among women aged <35 years ATOC (65.8%) and decreased as age at ATOC increased.

CONCLUSION(S)

Among reported OT cycles, the rates of pregnancy and live birth decreased as age ATOC increased. The number of oocytes thawed to achieve one live birth increased significantly with increasing age ATOC. In addition, among the resulting pregnancies, the rate of GPO decreased as age ATOC increased.

Employer-Sponsored Egg Freezing: Carrot or Stick?

BACKGROUND

Since 2014, many companies have followed the lead of Apple and Facebook and now offer financial support to female employees to access egg freezing. Australian companies may soon make similar offers. Employer-sponsored egg freezing (ESEF) has raised concerns and there is academic debate about whether ESEF promotes reproductive autonomy or reinforces the 'career vs. family' dichotomy. Despite the growing availability of ESEF and significant academic debate, little is known about how ESEF is perceived by the public. The aim of this study was to explore women's attitudes toward ESEF.

METHODS

Women aged 18-60 years who resided in Victoria, Australia were invited to complete an online, cross-sectional survey investigating views toward egg freezing. Associations between participant demographics and their views about ESEF were assessed using multinominal logistic regression, adjusted for age and free text comments were analyzed using thematic analysis.

RESULTS

The survey was completed by 656 women, median age 28 years (range: 18-60 years). Opinions on the appropriateness of employers offering ESEF were divided (Appropriate: 278, 42%; Inappropriate: 177, 27%; Unsure: 201, 31%). There was significantly less support for ESEF among older participants and those employed part-time (p < 0.05). While some participants saw the potential for ESEF to increase women's reproductive and career options, others were concerned that ESEF could pressure women to delay childbearing and exacerbate existing inequities in access to ARTs.

CONCLUSIONS

Our analysis revealed that while some women identified risks with ESEF, for many women ESEF is not viewed as theoretically wrong, but rather it may be acceptable under certain conditions; such as with protections around reproductive freedoms and assurances that ESEF is offered alongside other benefits that promote career building and family. We suggest that there may be a role for the State in ensuring that these conditions are met.

Elective oocyte cryopreservation for age-related fertility decline

PURPOSE

Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation. This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counselling.

METHODS

A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives.

RESULTS

Clinician-led counselling regarding reproductive aging and fertility preservation is often overlooked. Elective oocyte cryopreservation is not a guarantee of live birth, and the answer regarding cost-effectiveness needs to be individualized. The existing studies on obstetric and perinatal outcomes following the use of egg freezing are, until now, reassuring. Constant monitoring of short-term and long-term outcomes, uniform regulation and evidence-based, individualized counselling is of paramount importance.

CONCLUSIONS

Elective oocyte cryopreservation is one of the most controversial aspects of the world of assisted reproduction, and a lot of questions remain unanswered. However, women today do have this option which was not available in the past. Elective oocyte cryopreservation for age-related fertility decline should be incorporated in women's reproductive options to ensure informed decisions and reproductive autonomy.

Legal and Ethical Analysis of Advertising for Elective Egg Freezing

This paper reviews common advertising claims by egg freezing companies and evaluates the medical evidence behind those claims. It then surveys legal standards for truth in advertising, including FTC and FDA regulations and the First Amendment right to free speech. Professional standards for medical advertising, such as guidelines published by the American Society for Reproductive Medicine (ASRM), the American College of Obstetricians and Gynecologists (ACOG), and the American Medical Association (AMA), are also summarized. A number of claims, many of which relate to the targeting of younger women for eOC, are found to breach legal and ethical standards for truth in advertising. The ethical implications of misleading advertising claims are also discussed, and the central narrative woven by OC ads - that egg freezing is empowering to women - is examined. The paper concludes that a more balanced approach to the risks and benefits of OC is necessary to truly respect women's autonomy. Moreover, justice requires us to look beyond a medical procedure accessible only to a minority of women in order to address inequities in the workplace.

The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects

BACKGROUND

There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.

OBJECTIVE AND RATIONALE

The present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA.

SEARCH METHODS

We used the scoping review methodology. Searches of interdisciplinary articles databases were performed with keywords pertaining to APA and its dimensions outside of biology and medicine. We included scientific articles, original research, essays, commentaries and editorials in the sample. The final sample of 177 documents was analysed with qualitative thematic analysis.

OUTCOMES

We identified six themes highlighting the interdisciplinary nature of APA research. The 'terminological aspects' highlight the lack of consensus on the definition of APA and the strategies developed to offer alternatives. The 'social aspects' focus on the postponement transition towards reproducing later in life and its cultural dimensions. The 'public health aspects' refer to attempts to analyse APA as a problem with wider health and economic implications. The 'psychological aspects' focus on the consequences of APA and older fatherhood on psychological characteristics of the child. The 'ethical aspects' reflect on issues of APA emerging at the intersection of parental autonomy, children's welfare and social responsibility. The 'regulatory aspects' group different suggestions to collectively approach the implications of APA. Our results show that the field of APA is still in the making and that evidence is lacking to fully address the issues of APA. The review suggests promising avenues of research such as introducing the voice of fathers of advanced age into the research agenda.

WIDER IMPLICATIONS

The results of this review will be useful for developing policies and preconception health interventions that consider and include prospective fathers of advanced age.

"It's Just Another Added Benefit": Women's Experiences with Employment-Based Egg Freezing Programs

BACKGROUND

In 2014, companies began covering the costs of egg freezing for their employees. The adoption of this benefit was highly contentious. Some argued that it offered women more reproductive autonomy, buying time to succeed in their careers and postpone childbearing. Others suggested this benefit might place inappropriate pressure on women, unduly influencing them to freeze their eggs to prioritize their career over reproduction. Although ethical problems with this benefit have been explored, there has not been research analyzing the perspectives of women working for companies that offer employer-based egg freezing. Furthermore, existing empirical studies often focus on the experiences of egg freezers rather than the young women thinking about, but not yet using, this technology. Methods: Through in-depth semi-structured interviews, we explore the perceptions and attitudes of 25 women employees of companies with employer-based egg freezing. Results: These women describe delaying childbearing for a multitude of reasons, including not having a partner, and the desire to achieve social and career goals. Many women did not know that their employers covered egg freezing before the interview (44%; 11/24), suggesting this benefit is not essential to their career and family-building decisions. While women did not describe pressure to use this technology, they did describe how this benefit would not solve the difficulties of becoming a mother while excelling in their careers. Conclusion: Although women may not feel pressure to freeze their eggs and delay childbearing, they still feel constricted in their reproductive options. While employer programs may offer women the ability to delay childbearing, many saw this delay as postponing problems with work-life balance rather than solving them. We suggest that sociocultural shifts, such as workplace daycare, flexible workplace hours, and acceptability of non-biological parenthood, might allow women to feel more empowered about their reproduction choices.

Reproductive technologies are not the cure for social problems

Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women's inequality. While these advancements and technologies can benefit women, I argue medicine is not the best tool to 'cure' social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical.

Pathways to Parenthood in Social and Family Context: Decade in Review, 2020

OBJECTIVE

This article reviews research from the past decade on patterns, trends, and differentials in the pathway to parenthood.

BACKGROUND

Whether, and under what circumstances, people become parents has implications for individual identity, family relationships, the well-being of adults and children, and population growth and age structure. Understanding the factors that influence pathways to parenthood is central to the study of families and can inform policies aimed at changing childbearing behaviors.

METHOD

This review summarizes recent trends in fertility as well as research on the predictors and correlates of childbearing, with a focus on the United States and on research most relevant to family scholars. We document fertility differentials and prevailing explanations for variation across sub-groups and discuss alternative pathways to parenthood, such as adoption. The article suggests avenues for future research, outlines emerging theoretical developments, and concludes with a discussion of fertility policy.

RESULTS

U.S. fertility has declined in recent years; whether fertility rates will increase is unclear. Elements of the broader social context such as the Great Recession and increasing economic inequality have impacted pathways to parenthood, and there is growing divergence in behaviors across social class. Scholars of childbearing have developed theories to better understand how childbearing is shaped by life course processes and social context.

CONCLUSION

Future research on the pathways to parenthood should continue to study group differentials, refine measurement and theories, and better integrate men and couples. Childbearing research is relevant for social policy, but ideological factors impact the application of research to policy.