“It’s Just Another Added Benefit”: Women’s Experiences with Employment-Based Egg Freezing Programs

Abstract

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.

Keywords:

• Egg freezing
• reproductive autonomy
• qualitative research
• undue influence
• ethics of workplace benefits
• elective cryopreservation

Acknowledgments

The authors would like to thank Saskia Hendricks and the two anonymous reviewers for their comments on this manuscript. The authors would also like to express thanks to the women who agreed to share their stories and participate in this research study.

Author contributions

Skye A. Miner-Interpretation of the data, drafting of manuscript, revising manuscript, final approval of manuscript

Wynter K. Miller-Study design, data collection, data interpretation, editing manuscript, final approval of manuscript

Christine Grady-Editing manuscript, final approval of manuscript

Benjamin E. Berkman-Study design, data interpretation, editing manuscript, final approval of manuscript

Conflicts of interest

The authors have no conflict of interest to declare.

Disclosure

The authors have no conflict of interest to declare. This work was supported in part by the Intramural Research Program of the NIH Clinical Center and Genome Institute.

Disclaimer

The opinions expressed are those of the authors and do not reflect the policies and positions of the National Institutes of Health or the U.S. Department of Health and Human Services.

Ethical approval

This study was approved by the institutional review board at the National Institutes of Health.

Notes

1 In this paper, we use the term social egg freezing (Bozzaro 2018) to distinguish egg freezing due to socioeconomic reasons from egg freezing due to medical indication. While others have used elective egg freezing (Devine et al. 2015) or egg freezing for anticipated gamete exhaustion (AGE) (Stoop et al. 2015), these terms do not capture the societal constraints that lead women to freeze their eggs. Although ASRM (2018) has suggested the use of the term “planned oocyte preservation” this term also incorporates less-immediate medically indicated uses of the technology (e.g., fertility loss due to transgender hormone use or surgery, fertility loss due to primary ovarian insufficiency) (Ethics Committee of the American Society for Reproduction 2018). Since this paper is concerned with the sociocultural reasons that women face in deciding whether or not to use this technology as provided by their employer, we use the term “social” egg freezing.

Additional information

Funding

This research was supported by the Intramural Research Program of the National Institutes of Health, including funding from the National Human Genome Research Institute and the NIH Clinical Center.