Egg freezing has become a trend among single women as a special ‘fertility insurance’. The procedure has garnered increasing support amid falling birth rates, and sparked wide discussions on the boundaries of assisted reproduction technology. Li Bingcun reports from Hong Kong.
Living in a more diverse and inclusive society, women keep striving for greater freedom in all aspects of life, particularly fertility — one of the most significant steps they will take.
But antiquated disquiet and laws have kept them at bay, prompting growing calls for the shackles to be removed.
Given the potential consequences of opening egg-freezing services to a wider group of women, more specific and targeted policies should be formulated to plug the loopholes instead of closing the door to most people.
Liu Bing, a professor with the School of Social Sciences at Tsinghua University
Sitting at home every night, Neva Li would pinch her belly, jab a needle into it just below her navel, and watch the medicine being driven slowly into her body.
The injections were to stimulate her ovulation and accelerate egg maturation. Instead of getting it done in a hospital, she preferred doing it herself as it was more convenient. After 10 consecutive days of injections, 15 eggs were retrieved from her body through surgery, and 11 of them were then frozen.
The frozen eggs were to be used for conceiving children with the person of her choice, although Li didn’t have a clue then as to whom that person might be. “It would be terrible if, eventually, I found that person, only to find my fertility is gone due to my age.”
Egg freezing — once perceived as daunting and unattainable — is becoming popular among single women eager to preserve their fertility freedom. It’s now not only a form of medical treatment for infertile women — it also serves as a valuable tool for ordinary women to turn back their biological clocks.
Li is the first among her friends to resort to egg freezing. In 2019, at the age of 32, she completed the process at Hong Kong Sanatorium & Hospital — one of the city’s top private medical institutions — an operation that set her back HK$140,000 ($17,900).
Born on the Chinese mainland, Li has been in the Hong Kong Special Administrative Region for 14 years. As an insurance agent, she’s accustomed to preparing for the worst. After attending a lecture enlightening her that a woman’s fertility would plummet after the age of 35, she took to egg freezing as a special “fertility insurance” for herself. As a single, making up her mind as to where to receive the procedure called for careful consideration concerning policies and cost-effectiveness.
The procedure costs an average of $15,000 and $20,000 per cycle in the United States, which has the best technology and is basically free of restrictions on egg freezing. On the Chinese mainland, egg freezing costs more than 20,000 yuan ($2,790) per cycle, but is not allowed for unmarried women with no fertility problems. To Li, Hong Kong seemed to be the most convenient choice. It allows unmarried women to freeze their eggs, but they can be used only after the woman gets married, and the storage period is limited to 10 years.
Li ultimately chose Hong Kong, hoping to find a suitable partner within the 10-year period. If that doesn’t happen, she would have to consider transporting the eggs to the US despite extra costs and potential damage to them during transportation.
Egg freezing usually takes about two weeks per cycle, including stimulation of follicle growth, egg retrieval and having them frozen. It’s believed that the optimal age for a woman to choose egg freezing is 30 to 35 years. After the eggs are frozen, women can still pursue natural pregnancy or thaw the eggs and get pregnant using in vitro fertilization technology.
The number of eggs stored by licensed medical facilities in Hong Kong had increased from about 5,000 in 2019 to more than 14,000 last year. The age of women seeking such services range from younger than 25 years to over 50.
Easing curbs important
In a 2023 research report on China’s assisted reproduction industry conducted by the YuWa Population Research think tank, over 60 percent of the respondents, mostly aged 30 to 34 and with higher education levels, said they would like to preserve their fertility through egg freezing.
As the mainland forbids single women from undergoing egg freezing for nonmedical reasons, many women have gone overseas for such services. Their destinations include not only technologically advanced areas like the US, the United Kingdom, Japan, Singapore, Hong Kong and Taiwan, but also Thailand, Malaysia and Cambodia.
With the COVID-19 pandemic having disrupted many people’s plans to raise a family, the global egg-freezing and embryo-banking market reached $3.9 billion in 2022, and is expected to grow at a compound annual growth rate of 16.8 percent from 2023 to 2030, according to international consulting company Grand View Research.
In contrast to the freedom enjoyed by men in sperm freezing, women’s egg freezing is subject to varying degrees of restrictions in many regions around the world. There is growing demand to relax some of the curbs to empower women with greater reproductive freedom.
Hong Kong legislators have proposed extending the storage period for frozen eggs from 10 years to 30 or 55 years, and offering a HK$50,000 subsidy for people undergoing egg freezing or sperm freezing.
During this year’s two sessions — the annual meeting of China’s top legislative body and its political advisory body — some of the nation’s policy advisers were also in favor of opening egg-freezing services for single women on a limited basis.
From 2023, Singapore has allowed healthy women from 21 to 37 years old to choose egg freezing, but like Hong Kong, the usage is restricted to after marriage.
Egg freezing has also emerged as a workplace benefit. According to Fertility IQ — a global leader in family-building education — 30 of the Fortune 500 companies offer egg freezing benefits, including tech giants Meta (formerly known as Facebook), Microsoft, and Uber. Chinese travel agency Ctrip also offers subsidy and annual leaves for senior female managers to pursue egg freezing and other fertility services.
Silvia You, who works for Envita Fertility Center — a US-based assisted reproductive medical facility — says that there’s a growing consensus among women to seek egg freezing before turning 35, which she perceives as a symbol of the growing awareness and empowerment among women.
From being exclusive to celebrities, egg freezing has become more accessible to ordinary women. On social media platforms, a significant number of women who are currently not in a position to have children say they’re willing to preserve the opportunity for motherhood in the future despite the costs in time and money, and even health risks.
However, egg freezing doesn’t guarantee a baby. Women under 35 who freeze 20 eggs have a 90 percent chance of a live birth. Yet, for a 44-year-old, freezing 100 eggs yields only a 50 percent chance of success, a study published in 2017 in Human Reproduction shows. To increase the success rate, some choose to undergo multiple cycles, which significantly increases the cost.
The process also comes with potential complications. Less than 1 percent of patients suffer from severe ovarian hyperstimulation syndrome — a serious side effect that can lead to intense abdominal pain, persistent nausea and vomiting. The egg retrieval procedure also carries risks like pelvic infection and ovarian bleeding.
Updating policies vital
Besides career considerations, another key reason for single women to freeze their eggs is that they have yet to find a suitable partner to start a family. Some married women who are not ready to become a mother also want to freeze their eggs.
You, from Envita Fertility Center, noticed that there’s an increasing number of single women advocating separating procreation from marriage, with more of them purchasing sperm for the purpose of having children. She also brought sperm from overseas regions and plan to freeze the fertilized eggs in the US next year.
One social media post echoed such advocacy: “Is marriage a shackle for procreation? Can society be more tolerant of those who currently do not wish to enter marriage, instead of forcing them to give up on having children simply because they cannot find a suitable partner?”
Liu Bing, a professor with the School of Social Sciences at Tsinghua University, says that amid a falling birth rate, the fertility policies of many regions around the world, including the mainland, have become supportive instead of restrictive. There’s a practical need to update the policy for women using egg freezing services, he says.
He says that the mainland’s restrictions have not only driven people to overseas markets, but also fueled the development of underground medical activities, especially during the pandemic. Easing some of the curbs conditionally would allow more people to enjoy standard and affordable services at home.
But Liu agrees that some of the concerns about restricting the service remain valid, including the potential physical harm from egg retrieval surgery, as well as the limited fertility rates from using frozen eggs. There are also hidden risks associated with the illegal trade of eggs and surrogacy. Furthermore, allowing more women to freeze their eggs may lead to delayed childbirth, which would have a long-term effect on society.
Enterprises’ support for women to freeze eggs is also an indirect encouragement for female employees to delay childbirth. Those who don’t choose the service may face invisible pressure or even discrimination, Liu warns, adding that overpromotion of medical institutions can also persuade consumers to blindly follow the trend, prompting them to make impulsive choices.
How to minimize the negative impact and prevent abuse of the technology is what policymakers need to prudently consider, Liu says. “It’s not the technology problem. The ultimate mission of medical technologies is to make people live better.”
Given the potential consequences of opening egg-freezing services to a wider group of women, more specific and targeted policies should be formulated to plug the loopholes instead of closing the door to most people, he says.
For example, the mainland can consider allowing unmarried women of a certain age and with a strong desire for childbirth to freeze their eggs, and requiring the process to be free from commercial or ethically questionable purposes.
“The fundamental principle is to respect women’s genuine intentions and do not let technologies dictate their choices,” Liu says.
Olivia Ngan Miu-yung, a research assistant professor with the Medical Ethics and Humanities Unit at the University of Hong Kong, says family relationships are now more diverse than before. Large groups of people choose not to marry, not to have children, and to have same-sex relationships. Based on some overseas cases, granting more respect to the rights of individuals is the trend of the future, she says.
Noting that Hong Kong’s Human Reproductive Technology Ordinance hasn’t been updated for many years, Ngan says regulations and laws often lag behind technological advancements. It’s crucial to review and update them regularly, based on the ongoing circumstances.
Ngan says all gatekeepers, policymakers and regulators need to carefully weigh the pros and cons, and have thorough discussions when extending the accessibility of technologies. They’re also obliged to help the general public sufficiently understand the risks and challenges associated with it.
Li, who froze her eggs, had feared it would take a long time for her to find a perfect match, but to her surprise, she tied the knot only two years after the procedure, and soon gave birth to a child through natural pregnancy.
She then made the hard decision to destroy her frozen eggs as she doesn’t intend to have more children. Despite the incurred costs, she has no regrets about resorting to freezing her eggs. She felt more assured about the situation at that stage, and was more prepared for the uncertainties ahead.
“It let life come to me instead of making me chase it all the time,” she says.
Wu Kunling contributed to this story.
Contact the writers at bingcun@chinadailyhk.com
