Most women feel empowered by elective procedures that enable them to bank eggs in case they can’t conceive naturally later in life, researchers at UC San Francisco have found. But one in six become regretful, for reasons that researchers do not yet fully understand.

The study surveyed women who underwent the procedure, known as elective oocyte cryopreservation, at UCSF between 2012 and 2016, and is the first comprehensive look at a medical procedure that has become increasingly popular in the last six or seven years, particularly in urban areas.

Women are using the approach to avoid age-related infertility, in the setting of a nationwide trend to delay the age of childbearing. And several technology companies in the San Francisco Bay Area now pay for the procedure for their employees. But the findings inject a note of caution as egg freezing becomes more widely available to women across the country.

“This technology is tremendous if it’s the only way of having a biological child and having a family,” said Heather Huddleston, MD, associate professor of obstetrics, gynecology and reproductive sciences at UCSF. “But it’s important that we progress thoughtfully, given all the implications this technology may have for women.”

Although 89 percent of women in the study said they believed they would be glad they froze their eggs, even if they never used them to conceive a child, 49 percent stopped short of a full endorsement of their decision. For reasons the researchers are still exploring, most had mild regret, while 16 percent had moderate to severe regret. The study only included women pursuing elective cryopreservation for nonmedical indications, and did not include women pursuing this treatment because, for example, they were about to undergo chemotherapy following a cancer diagnosis.

On average, women took the survey about two years after undergoing the procedure. Just six percent of the women surveyed had used their frozen eggs to try to conceive a child, so it was unlikely that those who expressed moderate to severe regret about the procedure did so because the technology had failed them.

“While most women expressed positive reactions of enhanced reproductive options after freezing eggs, we were surprised to discover that for a group of women it wasn’t so simple — some even frankly regretted their choice,” said Eleni Greenwood, MD, MSc, a clinical fellow in obstetrics, gynecology and reproductive sciences. “Although this study doesn’t reveal all the reasons behind regret, this is a critical finding, and we have follow-up studies underway to better understand what women are going through. What is clear is that egg freezing is more than just your standard insurance transaction for many women.”

The researchers found that women who retrieved fewer eggs in the procedure were more likely to regret having done it, possibly because they interpreted the low yield as an indication of low fertility, although retrieving fewer eggs is not in itself a reliable indicator of low fertility.

Although 80 percent of women said they had adequate information about the procedure, those who felt they did not have enough were more likely to express regret. Nearly 70 percent said they had enough emotional support, but those who did not feel this way were also more likely to express regret about the procedure, which requires significant time and expense. Over the course of the procedure, women undergo about 10 days of injections to stimulate the ovaries, and five or six ultrasound visits to monitor growth and development. When the eggs are mature, they are retrieved using a needle passed through the vaginal wall, under ultrasound guidance. The egg retrieval can be done in one day, but it requires sedation.

“As oocyte cryopreservation takes off, we wanted to take a step back to understand how this technology might impact the trajectory of women’s lives,” Greenwood said. “We see this work as just the start of that conversation. Our ultimate goal is to translate this research into creating an increasingly supportive system to help women, realistically, achieve their reproductive goals.”

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