Introduction

1.1. Socio-cultural Context

The last 40 years have seen a persistent shift towards later childbearing in many Western countries including the United Kingdom (Kreyenfeld, 2010; Ní Bhrolcháin & Toulemon, 2005). During the 1970s, women in England and Wales were on average 26 years of age at the birth of their first child; however, by 2016 this had increased to 28.8 years (ONS, 2018). As Graph 1.1 indicates, the number of women having children at a younger age (under 20, 20–24 and 25–29) has significantly declined since the 1970s, and in the same period the number of women having children at an older age (30–34, 35–39 and 40 and over) has increased. Indeed, prior to 2003 more babies were born to women aged 25–29 than any other age group; however, women aged 30–34 now have the highest rate of fertility (ONS, 2015).

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Graph 1.1:

Age-specific Fertility Rates (England and Wales, 1938–2017).

When the total fertility rate fell in the United Kingdom for a fifth consecutive year in 2017, decreased fertility rates were observed across every age group except for women aged 40 and over where the rate increased by 1.3%, reaching the highest level since 1949. This increase is part of a general trend which has seen the fertility rate of women aged 40 and over more than treble since 1991 ² (ONS, 2014). Whilst this trend towards later motherhood has been most significantly observed in Western societies, a shift towards delayed and older motherhood has also been identified in new and developing economies such as India, China and Latin America (Allahbadia, 2016; Sobotka & Beaujouan, 2018).

Delayed motherhood and the shift to later childbearing have been attributed to a wide range of social, economic, personal and relational factors. These include the increased reliability of methods of contraception; changing social norms related to the timing of parenthood; women’s increased participation in higher education and the labour force; the normalisation of multiple partnerships prior to marriage; difficulties in finding a partner with whom to pursue parenting; perceptions of personal readiness; rising costs of living and childcare; as well as economic instability and market uncertainty (Chabé-Ferret & Gobbi, 2018; Daly, 2011; Daniluk & Koert, 2017; Mills, Rindfuss, McDonald, te Velde, & ESHRE Reproduction, & Society Task Force, 2011). Indeed, improvements in population health, advances in medical technology, and access to contraception and abortion have meant that many women and men in the global north now have an unprecedented level of control over their fertility. Furthermore, should they wish to have children, they can exert significant influence over the timing of parenthood (Lemoine & Ravitsky, 2015; Lowe, 2016). However, when the time comes to try and create their families, many women, men and couples find they have experienced only the illusion of reproductive control and are unable to conceive without medical intervention (Earle & Letherby, 2007).

Around one in six couples in the United Kingdom have difficulties in conceiving, and for many this is a highly stressful, emotionally difficult, isolating as well as stigmatising experience with the potential for long-term effects even if they do eventually become parents (Cox, Glazebrook, Sheard, Ndukwe, & Oates, 2006; Wirtberg, Möller, Hogström, Tronstad, & Lalos, 2006). Prior to the advent of assisted reproductive technologies the experience of infertility was something the sufferer was forced to live with which, whilst was disappointing for many, was ultimately unchangeable (Earle & Letherby, 2002). However, following the development of in vitro fertilisation (IVF) by UK scientists Robert Edwards, Patrick Steptoe and Jean Purdy, and the birth of the first IVF baby Louise Brown in 1978, there was a shift from the social problem of involuntary childlessness to the medical problem of infertility (Becker & Nachtigall, 1992). This shift, and the way that medicalised fertility treatment has become increasingly normalised and routinised, not only in the clinic but also among wider publics, reflects how the social and private lives of social actors have become increasingly dominated by biomedicine (Clarke, 2010).

It is estimated that over eight million babies have been born worldwide from IVF technologies. In the United Kingdom the National Institute for Health and Care Excellence (NICE) suggests that women should be offered up to three cycles of IVF funded by the National Health Service (NHS), subject to certain criteria. However, in England, Wales and Northern Ireland, access to NHS-funded fertility treatment is overseen by local clinical commissioning groups (CCGs), and as few as 12% of CCGs follow this national guidance with many offering patients only one cycle of IVF or in some cases none at all (Fertility Fairness, 2017). This approach to the rationing of IVF treatment means that depending on where a person lives, access to IVF and the conditions of this access varies considerably. In 2016, 41% of IVF treatment cycles were funded by the NHS, leaving the remaining 59% of treatments to be privately funded. The cost of a cycle of IVF varies across the country and by the needs of individual patients and couples but may cost upwards of £5,000 per cycle. Thus, medicalised fertility treatment is beyond the reach of many (Bell, 2009).

Despite the high financial as well as emotional costs of medicalised fertility treatment, almost three-quarters of IVF cycles do not result in a live birth (HFEA, 2016). The birth rate per embryo transfer (PET) for all fresh cycles of IVF in the United Kingdom in 2016 was 21%. However, when broken down by age, birth rates vary considerably, with women under 35 having the highest birth rate PET (29%) and women over the age of 44 having the lowest (below 15%) (HFEA, 2016). As such, it is worth noting that even in younger patients, IVF has only a modest success rate which sees less than one in three couples with a ‘take-home baby’ after one round of treatment. Nevertheless, stories of miracle IVF babies and IVF success continue to abound in all quarters of the media, leading many to overestimate the efficacy of the technology (Chan, Chan, Peterson, Lampic, & Tam, 2015; Lucas, Rosario, & Shelling, 2015). Furthermore, despite its seemingly ubiquitous nature, fertility treatment is not risk free (Kamphuis, Bhattacharya, Van Der Veen, Mol, & Templeton, 2014); yet there remains an expectation that individuals and couples who struggle to conceive will want, and will draw upon, new reproductive technologies in order to build their families (Bell, 2017; Sandelowski, 1991).

Since the birth of the first IVF baby over 40 years ago, the number of technologies, treatments and procedures to assist in the process of creating healthy human life has expanded significantly and the UK fertility industry is now estimated to be worth £320 million (Risebrow, 2018). This expansion of the fertility industry has not only enabled many heterosexual couples to overcome barriers to parenthood but, through technologies of reproductive donation as well as surrogacy, has seen the emergence and increased visibility of alternative family forms such as lesbian mother families, gay father families and families headed by single mothers by choice (Nordqvist & Smart, 2014; Norton, Hudson, & Culley, 2013; Zadeh, Ilioi, Jadva, & Golombok, 2018). Furthermore, new developments in genetic screening and mitochondrial donation have also enabled people with serious inherited diseases in their family to have children of their own, safe in the knowledge that they will not be passing on the disease to their offspring (Dimond & Stephens, 2018; Herbrand, 2017). Technologies of egg donation have also enabled some women of advanced maternal age, who have reached the end of their reproductive lives, to experience pregnancy, birth and motherhood (Osazee & Omozuwa, 2018). However, the age of a woman at the time of trying to conceive, either naturally or via medicalised fertility treatment, is universally recognised as one of the best predictors of a future live birth (Balasch, 2010; Dunson, Colombo, & Baird, 2002).

1.2. Age and Fertility

A female foetus at 20 weeks has between 6 and 7 million eggs; however, at the time of birth her egg reserve will have already decreased by several million and she will continue to ‘lose’ eggs throughout her life. This loss occurs not only via ovulation and menstruation but also through the process of atresia, which sees the degeneration of ovarian follicles that do not ovulate during the menstrual cycle. This means that by puberty a girl has 300,000–500,000 eggs remaining, dropping to 25,000 at age 37, and by the time she enters menopause she may have as few as 1,000 eggs left, the majority of which will be of very low quality. This process of fertility decline is believed to occur throughout a woman’s lifetime with a slight increase of the rate of decline beginning after she is 32, with a further pronounced and more accelerated loss of eggs occurring after 37 years (American College of Obstetricians & Gynecologists, 2014). As a woman ages, the quality and quantity of her eggs decline, which together has a significant effect on her ability to spontaneously conceive and carry a healthy pregnancy to full term (Utting & Bewley, 2011). Indeed, research has shown that as a woman gets older the chance of getting pregnant declines and the likelihood of a pregnancy ending in a miscarriage increases (Balasch & Gratacos, 2012; Heffner, 2004; Nybo Andersen, Wohlfahrt, Christens, Olsen, & Melbye, 2000) (see Graph 1.2), and by the time a woman is 40, some evidence has suggested that the risk of experiencing a miscarriage may overtake the chance of a live birth.

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Graph 1.2:

Fertility and Miscarriage with Advancing Maternal Age.

Women who are pregnant at the age of 35 and older are routinely described in medical literature as ‘older mothers’ and are believed to be at an increased risk of many other complications throughout pregnancy and birth (see Tables 1.1 and 1.2), including gestational diabetes (Hemminki, 1996; Jolly, Sebire, Harris, Robinson, & Regan, 2000; Joseph et al., 2005), placenta praevia (Williams & Mittendorf, 1993), placenta abruption (Utting & Bewley, 2011), emergency caesarean section (Rosenthal & Paterson-Brown, 1998; Tough et al., 2002), chronic hypertension (Gosden & Rutherford, 1995), pre-eclampsia (Ziadeh & Yahaya, 2001) and post-partum haemorrhage (Jolly et al., 2000). Additional risks to children born from older mothers include an elevated risk of birth defects or genetic/chromosomal abnormalities (see Table 1.1), including trisomy 21, which results in Down’s syndrome. By comparison, whilst some research has shown a link between advanced paternal age and negative health outcomes seen in children, these risks are less pronounced and occur at a much older age (Balasch, 2010; Bray, Gunnell, & Davey Smith, 2006; Hook, 1981; Toriello, Meck, & Professional Practice, & Guidelines Committee, 2008).

The causes of infertility in women and men are multiple and largely known (see NICE, 2013 for further discussion); however, in up to 25% of cases no reason for infertility can be ascertained and the term ‘unexplained infertility’ is used (NICE, 2013). Although younger women can experience ‘unexplained infertility’, research has linked this to the age of women at the time of trying to conceive (Maheshwari, Porter, Shetty, & Bhattacharya, 2008). Whilst IVF technologies can help some women and couples experiencing unexplained infertility to conceive much wanted children, the success rates of IVF in older women remain low (see Table 1.3). Therefore, if a woman is unable to conceive via IVF using her own eggs due to problems with egg quality or quantity, she may be counselled to consider egg donation. This would see her attempt conception using eggs donated by another, sometimes younger woman.

The use of donor eggs in IVF has been shown to increase the chance of a live birth in older women as the capacity to conceive and carry a pregnancy to term has been shown to be affected primarily by the age of a woman’s eggs, not the age of her womb (Navot et al., 1994).

1.3. Cryopreservation of Reproductive Tissue

Practices of cryopreservation have historically been deployed within the biosciences in the storage and transportation of non-human organic materials not only to assist in the process of animal breeding (Clarke, 2007) but also to support the preservation of animal and seed biodiversity (Kroløkke, 2018; Loring, 2016; Radin, 2015). Routine practices of human tissue cryopreservation include the freezing and storing of stem cells from cord blood banking, as well as the freezing of reproductive material such as embryos, eggs, sperm and even ovarian tissue (Donnez & Dolmans, 2015; Machin, Brown, & McLeod, 2012). The process of cryopreservation allows various kinds of tissue and cellular material to be frozen, stored, thawed and then used without any apparent loss of vitality. By arresting biological processes and development, reproductive materials such as gametes can be held in ‘suspended animation’ and taken out of chronological time, allowing storage and transit not only across geographical borders but also across temporal space for redeployment at the time of a person’s choosing.

Until recent years, women who were facing premature infertility as a result of a medical condition or treatment were encouraged to ‘preserve’ their fertility by freezing embryos either with a partner’s or donor sperm. This is because, in contrast to eggs, embryos are better able to withstand the processes of freezing and thawing (Rienzi et al., 2017). Embryo freezing has become a major and routine part of IVF treatment. However, whilst embryo freezing is a reliable way to maintain future reproductive potential, it is not suitable for young women who do not have a partner or are not yet ready to commit to potential motherhood with such a partner. Furthermore, embryo freezing can be rejected on religious or moral grounds (Robertson, 2014). As such, the alternative possibilities offered by ovarian tissue and egg freezing provide much hope to these groups for whom embryo freezing is not a viable option.

When it was first developed in the late 1980s, egg freezing was primarily intended as a strategy to enable women to preserve a number of healthy unfertilised eggs when faced with the threat of infertility due to a medical condition or medical treatment. However, the process of freezing eggs presented a more complex problem than the freezing of sperm or embryos not only due to the size of human eggs (which are so large that they can be seen with the naked eye) but also due to their large surface volume and the fact that they predominantly consist of cytoplasm which can be disrupted during the process of freezing. As such, initial efforts at egg freezing were marked by technical difficulties, including damage to the egg caused by the formation of ice crystals during freezing (Aman & Parks, 1994; Baka et al., 1995; Rienzi et al., 2004; Stoop et al., 2015; Vincent, Pickering, & Johnson, 1990). Further difficulties were encountered when seeking to achieve fertilisation, as the process of freezing was found to harden the zona pellucida (the ‘shell’ of the egg), making it difficult for a sperm to penetrate (Carroll, Depypere, & Matthews, 1990; Fabbri et al., 2001; Matson, Graefling, Junk, Yovich, & Edirisinghe, 1997; Paynter, Cooper, Gregory, Fuller, & Shaw, 1999). The development of intracytoplasmic sperm injection (ICSI) in the early 1990s was able to circumvent zona pellucida hardening; however, the process of slowly cooling eggs down to a final storing temperature of −196º remained problematic and saw many eggs lost through the process of freezing and thawing. It was not until the introduction of the vitrification or ‘fast-freezing’ method in the early 2000s, which substantially reduced the amount of damage done to the egg during freezing, that the procedure became more successful (Iussig et al., 2019).

As the clinical techniques of egg freezing have developed, the application of this technology has become increasingly diversified to include use by patients receiving gonadotoxic therapies for cancer and other illnesses (Rodriguez-Wallberg & Oktay, 2012), individuals with genetic conditions or illnesses which may result in premature infertility (Elizur et al., 2009) and individuals who object to the cryopreservation of embryos or who are undergoing gender-confirmation surgery (Armuand, Dhejne, Olofsson, & Rodriguez-Wallberg, 2017; Mitu, 2016). The increased use of egg freezing has also enabled the storage of eggs for use in donor IVF cycles as well as for research purposes (Kawwass et al., 2013) and has also enabled women not yet ready for motherhood to freeze their eggs for potential future use (Lockwood & Johnson, 2015; Petropanagos, Cattapan, Baylis, & Leader, 2015).

1.4. Describing and Conceptualising ‘Social’ Egg Freezing

The most appropriate terminology to describe egg freezing in an attempt to defer motherhood has been the subject of much discussion and dispute and remains largely unsettled (Daar et al., 2018). A variety of terms have been employed: for example, as the practice of self, or autologous, egg donation (Rybak & Lieman, 2009), ‘planned egg freezing’ (Daar et al., 2018), egg freezing for ‘lifestyle’ (Savulescu & Goold, 2008), ‘elective’ (Inhorn et al., 2018), ‘non-medical’, and ‘social’ reasons (Mertes & Pennings, 2011) as well as egg freezing for ‘anticipated gamete exhaustion’ (Stoop, van der Veen, Deneyer, Nekkebroeck, & Tournaye, 2014).

The term ‘social’ egg freezing has been criticised for minimising or trivialising the process of freezing eggs for potential future use (Pennings, 2013). Equally, the use of the phrase ‘elective’ egg freezing, or egg freezing for ‘lifestyle’ reasons, has been similarly critiqued for implying a deliberate desire on behalf of women to delay motherhood which may not wholly characterise the experiences of those using the technology. The process of egg freezing is also strictly speaking not ‘non-medical’ as it takes place in licenced medical clinics and is carried out by medical professionals. Whilst recognising how social changes have led to the postponement of motherhood, Stoop et al. (2014) have argued that it is the prevention of age-related infertility which motivates women to store gametes. As such, they advocate for the term ‘AGE banking’ or egg freezing for ‘Anticipated Gamete Exhaustion’. More recently, the American Society for Reproductive Medicine (ASRM) proposed the term ‘planned egg freezing’ which they suggested removed any value judgements associated with the technology (Daar et al., 2018). Such terminology as proposed by Stoop et al. (2014) and the ASRM are no doubt attempts at more neutral representations of this process. However, this technology is inherently bound up with a complex set of political, social, economic and relational conditions which are important to emphasise in any discussion of this technology. Thus, whilst the term ‘social’ egg freezing has been deployed in the past as a contraindication to egg freezing for medical reasons, I adopt this term in a slightly different way to insist on the socially constituted nature of this technology. As such, the precise nomenclature used throughout this book to describe the practice of egg freezing to support the deferment of motherhood will be that of ‘social egg freezing’. In describing women’s use of this technology in such a way I hope to draw attention to the social and political context within which this practice is situated and highlight how women’s reproductive choices, including their use of egg freezing, are inherently socially embedded. Furthermore, it is hoped that this phraseology will help challenge neoliberal discourse of individual choice which pervades much discussion of this technology and of women’s reproductive decisions more generally.

As well as being explicit about the ontological assumptions underpinning the phraseology that is adopted throughout this book, it is also important to consider and explain the way in which this book conceptualises and understands the practice of social egg freezing. In much medical as well as wider social discourse egg freezing has commonly been referred to as a ‘fertility preservation’ strategy, particularly when being used by individuals undergoing treatment for cancer or by those who have conditions which may result in premature menopause (Elizur et al., 2009; Rodriguez-Wallberg & Oktay, 2012). The term ‘fertility preservation’ has also been somewhat uncritically applied to the practice of social egg freezing, yet there has been little discussion about how useful such a descriptor is in adequately capturing the application of this technology in such a different context (Martin, 2010; Mayes, Williams, & Lipworth, 2018). I contend that describing social egg freezing as a form of fertility preservation misrepresents and poorly characterises the aims and potential effects of the technology. Instead, for reasons I will shortly outline, I argue that social egg freezing is better conceptualised and understood as a tool of ‘fertility extension’ and ‘genetic conservation’.

All women, whether they choose to freeze their eggs or not, will experience gradual fertility decline and eventually enter menopause with the associated physiological changes and effects. Therefore, whilst much of the advertising literature and discourses around social egg freezing draw on certain metaphors and tropes of ‘stopping’ or ‘rewinding’ the ‘biological clock’, of ‘putting fertility on ice’ or ‘stopping time’, the practice of social egg freezing does not in fact delay, stop or reverse the process of reproductive ageing. Indeed, it is likely that prior to turning to their frozen eggs in an attempt to have a child, heterosexual women will have tried to conceive naturally or by using assisted reproductive technologies such as inter uterine insemination and IVF with their remaining fresh eggs. Thus, at the point of drawing on their frozen reserve these women could be defined as no longer fertile as they are unable to conceive, carry and birth a child using their own genetic material. Whilst, as previously described, technologies of reproductive donation have long enabled women with a low ovarian reserve to experience pregnancy and birth, they have severed the genetic relationship between mother and child. However, egg freezing has the potential to enable users to maintain a genetic relationship with their future offspring by extending the amount of time it is possible to transmit genetic material along the maternal line, even going beyond that enabled by natural ovarian function (Martin, 2010; Mayes et al., 2018). As such, I argue that social egg freezing should be conceptualised and understood as a fertility extension technology which conserves genetic relatedness to potentially allow women to partake in the culturally valorised process of family building wherein the reproduction of genetic kinship relations is prioritised and maintained.

1.5. Key Issues in Social Egg Freezing

Egg freezing has been legal in the United Kingdom since 2000. However, the number of cycles performed in the United Kingdom has remained low until recent years. The HFEA, which registers the number of egg freezing treatment cycles undertaken each year, currently does not record the reasons given by women for accessing the technology. However, they have suggested that the recent increase in egg freezing cycles is likely to be due to larger numbers of women presenting for social reasons. As of 2016 around 62 fertility clinics across the United Kingdom offered egg freezing. However, data from HFEA show that most clinics are performing 10 or fewer egg freezing cycles a year with only 15% undertaking more than 20. Instead a large concentration of cycles are being undertaken by a small number of clinics, ³ with 78% of egg freezing cycles taking place in London. The last eight years has seen a significant increase in the number of egg freezing cycles performed not only in the United Kingdom but also in much of Western Europe, most notably in Spain but also in Belgium (ESHRE Working Group on Oocyte Cryopreservation in Europe et al., 2017) as well as in other high-income countries such as the USA, Australia and Israel (Daar et al., 2018; Inhorn et al., 2018; Pritchard et al., 2017; Waldby, 2015). There also appears to be an increased appetite and provision of social egg freezing in emerging and new economies as well as low- and middle-income countries (Allahbadia, 2016; Kılıç & Göçmen, 2018; Santo et al., 2017).

Research examining social egg freezing has suggested that the typical user of the technology is on average between 37 and 38 years of age at time of freezing (Groot et al., 2016; HFEA, 2018b; Waldby, 2015). This is noteworthy because, similar to IVF treatment more generally, the age of the woman at the time of undergoing egg freezing has been shown to have a significant effect on the likelihood of the procedure resulting in a live birth.

1.5.2. Access and Cost

Egg freezing for social reasons is not available in the United Kingdom via the NHS. A review of UK clinic websites performed in May 2018 (see Figure 1.1) showed the cost of one cycle of egg freezing to range from £2,720 to £3,929, with the median cost being £3,350 (HFEA, 2018a). However, these figures do not include the hormonal stimulation medication required, which can vary from £500 to several thousand pounds per cycle. Most clinics offer one or two years’ storage inclusive of the initial egg freezing fee; however, beyond this time, women need to pay between £125 and £350 a year to keep their eggs frozen. As a result, the total cost of egg freezing can be quite considerable, especially if women need to undergo the procedure multiple times to bank a sufficient number of eggs. Should a woman want to use her eggs to try and conceive, IVF treatment using ICSI is estimated to cost between £1,650 and £4,000, with the average median cost being around £2,500 (HFEA, 2018a). Thus, two rounds of egg freezing, including five years of storage and one round of ICSI, to achieve a pregnancy may cost in excess of £11,600. ⁶ However, it is likely that a woman may need to attempt more than one cycle of ICSI using their frozen eggs to secure a pregnancy with the associated cost and may also incur further treatment fees related to the use of donor sperm or other IVF add-ons. ⁷ In the USA the cost of egg freezing is similar if not slightly higher and sees women generally pay upwards of US $10,000 for each cycle in addition to storage fees of as much as US $1,000. It is therefore not surprising that the users of this technology are most often middle class, highly educated and in professional occupations (Baldwin, Culley, Hudson, Mitchell, & Lavery, 2015; Inhorn et al., 2018; Stoop et al., 2015).

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Figure 1.1:

Average Costs of Elements for a Typical Egg Freezing and Thaw Cycle.

Whilst most women who freeze their eggs pay for the procedure themselves, a small number of women are able to access egg freezing through their employer, who ‘sponsors’ the procedure on their behalf. This issue of ‘employer-sponsored social egg freezing’ is explored in more detail in Chapter 2. A more common way, at least in the United Kingdom, in which women can access the technology free of charge is if they enter into an ‘egg sharing’ agreement (Blyth, 2002). The practice of egg sharing in ‘fresh’ IVF cycles has been the subject of much discussion with critics questioning the ethics and potential for exploitation for those involved in such schemes (Gürtin, Ahuja, & Golombok, 2012; Haimes, Taylor, & Turkmendag, 2012). Women who access egg freezing via a freeze share scheme can freeze their eggs for free if they donate or ‘share’ half of those eggs collected with another woman for use in fertility treatment. To undergo this process a woman most often needs to be 35 years of age or younger, as this is the maximum age at which women can donate eggs in the United Kingdom, and is required to have a certain hormone level indicating that she is likely to be able to produce a sufficient number of eggs for sharing. As the woman only keeps half of the eggs retrieved for herself, she may be counselled to undergo the procedure a number of times in order to collect a sufficient number for freezing (Donnez & Dolmans, 2013). Thus, unlike her fee-paying counterparts, she may need to undergo the process of ovarian stimulation and retrieval with the associated risks on two or more occasions. Furthermore, by entering into an egg sharing agreement the woman becomes an egg donor which has potentially significant long-term consequences, especially given that in the United Kingdom egg donors are identifiable to offspring when they reach the age of 18.

1.6. Overview of the Book

The phenomenon of social egg freezing has only recently emerged as a new social practice related to the timing of parenthood, and as such there remain many unanswered questions about women’s perceptions and use of this novel technology. This book is derived from an exploratory sociological research study which examined how 31 women, who were in many ways pioneering users of this technology, constructed, understood and experienced the phenomenon of social egg freezing in the context of debates surrounding reproductive choice and delayed motherhood. This research also explored how women made the decision to engage with social egg freezing, how they perceived the risks and benefits of the procedure, and how they experienced the ‘medical’ encounter in the clinic. As part of this investigation and analysis this research project also examined some of the broader sociological questions raised by this technology in relation to the (gendered) burden of appropriately timed parenthood, the medicalisation of women’s bodies in the reproductive domain, the further entrenchment of the geneticisation of society, and the way in which reproductive and parenting ideals, values and expectations can come into conflict with the biological and relational realities of women’s lives.

In drawing on this research and wider scholarship and investigation, this book joins a rich field of sociological research that applies qualitative methods to explore contemporary developments in assisted reproduction (Dimond & Stephens, 2018; Nash, 2014; Nordqvist & Smart, 2014; Wahlberg & Gammeltoft, 2018). This book aims to offer a nuanced, detailed and critical examination and analysis of social egg freezing by investigating the way in which users of this technology determine and negotiate their mothering desires which are mediated and constrained not only by wider socio-political and market contexts but also by their intimate encounters with (non)reproductive partners. It also aims to demonstrate the sometimes significant pressures and burdens new biomedical developments in reproductive technology can place upon women to draw upon and navigate these technologies in the pursuit of greater reproductive choice and control and in the process of family building. This text seeks to be the first of its kind to bring together rigorous academic research, detailed accounts from egg freezing users, and wider social science scholarship and theorising to explore the phenomenon of social egg freezing in qualitative depth. This book is therefore written not only for an academic audience but also for informed publics, users and potential users of social egg freezing, as well as those involved in the provision, delivery, management or regulation of assisted reproductive technologies. As such, I have sought for the tone and structure of this book to be sufficiently inclusive, accessible and engaging for specialist and non-specialist audiences alike.

Whilst remaining conscious of the way in which social egg freezing plays into and shapes broader debates and practices in a wider Western context, this research provides a uniquely British-American perspective on this technology.

This chapter has situated the practice of egg freezing within its specific social, economic and technological context. It has drawn on wider demographic and medical literature to help understand the emergence of this technology and has identified and explored a number of complex issues relating to the ‘success rates’ being achieved with this technology and the risks the procedure poses to potential users. This chapter has also provided a discussion of and rationale for the precise nomenclature that is adopted throughout this book. Chapter 2 of this book draws on wider scholarship across the social sciences but also bioethics and law to provide a considered analysis and discussion of several contemporary debates in social egg freezing. This chapter explores how, via a process of medicalisation, age-related fertility decline has become reconstructed not as a natural and inevitable process of ageing but as something pathological and in need of a technological fix. It furthermore observes how this pathologising of ovarian ageing has given rise to new anxieties and responsibilities on behalf of women to anticipate their own infertility and consider drawing on new biomedical interventions. This chapter also examines how egg freezing technology has become highly commercialised not only as a tool of fertility extension but as a key mechanism in the wider ‘tissue economy’ by enabling the storage and transportation of eggs across geographic as well as temporal borders with greater frequency and ease. It then concludes by exploring the highly contentious issue of company-sponsored egg freezing and asks important questions about whose reproductive and mothering horizons are being broadened by social egg freezing and whose are being left on the sideline. Drawing critically on concepts and tools from lifecourse theory and wider social scientific research, as well as on the findings of interviews with users of social egg freezing, Chapter 3 explores the complex issue of reproductive timing. In this chapter the socio-cultural context of delayed parenthood is unpacked in greater detail, including the factors shaping the timing of motherhood and perceptions of the ‘right time’ to have a child. This chapter also explores perceptions and representation of older motherhood and problematises the way in which women are often presented as ‘choosing’ to delay pregnancy. Chapter 4 of this book draws on theories and concepts from the sociology of the family and parenting culture studies, alongside a discussion of the accounts of the research participants to explore how ideologies of parenthood can shape women’s perceptions of their readiness to parent. It explores how intentions to mother ‘intensively’ can produce anxieties about the performance of parenthood and how as a result some women in this research disclosed some ambivalence about becoming a mother in the future. This chapter also explores the other ways in which women considered going about performing parenthood beyond the ‘traditional’ two-parent family and examines their attitudes towards single motherhood via sperm donation. The fifth chapter of this book explores in detail the factors motivating women to undergo social egg freezing and presents the findings of this research in context with other quantitative and qualitative data on this topic which has emerged in recent years. This chapter demonstrates how women’s use of the technology was shaped by a fear of running out of time to find a suitable partner, a fear of engaging in panic partnering, as well as a fear of future regret and blame. This chapter also shows how concerns about career advancement did not play a significant role in women’s use of this technology but demonstrates how workplace issues related to maternity leave and fears of discrimination shaped the timing of motherhood and thus women’s use of egg freezing technology. In the absence of any other in-depth and nuanced account of the egg freezing process which presents the experiences of multiple users of this technology, Chapter 6 provides a thorough and detailed examination of the experience of social egg freezing from the perspective of the user. Organised chronologically, this chapter prioritises the participants’ voices and accounts and explores their initial thoughts and opinions of the technology, their experience of the egg freezing process, and their reflections on the procedure and future reproductive intentions. This chapter may be of particular interest to users and potential users of social egg freezing who are looking for detailed unbiased accounts of what it is like to freeze eggs for social reasons. Chapter 7 explores how women’s reproductive intentions and actions are intimately entangled with the procreative consciousness and impulses of potential and actual male partners. In exploring the sexual politics of social egg freezing, this chapter highlights the unequal power relations at play in the process of relationship formation and progression in large cities where many of the participants were based and shows how this works to disadvantage women as they age. This chapter also explores how the participants managed the disclosure of egg freezing and shows how some women mobilised their frozen reserve as a tool to communicate enduring reproductive capacities to potential partners and thereby increase their value in the marketplace of marriage. In the final chapter of this book I draw together some of the discussion which has spanned several chapters of this book and lay bare how the decision to undergo social egg freezing and women’s experience of reproductive delay were shaped by powerful factors beyond women’s control as individuals. I also consider the new opportunities presented by social egg freezing but also the highly gendered burdens and responsibilities this technology generates, and close with some reflections and considerations about future research directions.