Patient-centered elective egg freezing: a binational qualitative study of best practices for women’s quality of care

  • Marcia C. InhornEmail author
  • Daphna Birenbaum-Carmeli
  • Lynn M. Westphal
  • Joseph Doyle
  • Norbert Gleicher
  • Dror Meirow
  • Martha Dirnfeld
  • Daniel Seidman
  • Arik Kahane
  • Pasquale Patrizio
Assisted Reproduction Technologies



How can elective egg freezing (EEF) be made patient centered? This study asked women to reflect on their experiences of EEF, which included their insights and recommendations on the optimal delivery of patient-centered care.


In this binational, qualitative study, 150 women (114 in the USA, 36 in Israel) who had completed at least one cycle of EEF were recruited from four American IVF clinics (two academic, two private) and three in Israel (one academic, two private) over a two-year period (June 2014–August 2016). Women who volunteered for the study were interviewed by two medical anthropologists. Interviews were audio recorded, transcribed, and entered into a qualitative data management program (Dedoose) for analysis.


The majority (85%) of women were without partners at the time of EEF, and thus were undertaking EEF alone in mostly couples-oriented IVF clinics. Following the conceptual framework known as “patient-centered infertility care,” we identified two broad categories and eleven specific dimensions of patient-centered EEF care, including (1) system factors: information, competence of clinic and staff, coordination and integration, accessibility, physical comfort, continuity and transition, and cost and (2) human factors: attitude and relationship with staff, communication, patient involvement and privacy, and emotional support. Cost was a unique factor of importance in both countries, despite their different healthcare delivery systems.


Single women who are pursuing EEF alone in the mostly couples-oriented world of IVF have distinct and multifaceted needs. IVF clinics should strive to make best practices for patient-centered EEF care a high priority.


Fertility preservation Elective egg freezing Patient-centered care United States Israel 



The authors would like to thank Jennifer DeChello, Jeannine Estrada, Sandee Murray, Tasha Newsome, Mira Vale, and Ruoxi Yu for various forms of editorial, research, study recruitment, and transcription assistance.

Funding information

This study was funded by a grant from the US National Science Foundation, BCS-1356136, to PI Marcia C. Inhorn and Co-PI Pasquale Patrizio.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, et al. Ten pathways to elective egg freezing: a binational analysis. J Assist Reprod Genet. 2018;35:2003–11.CrossRefGoogle Scholar
  2. 2.
    Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, et al. Elective egg freezing and its underlying socio-demography: a binational analysis with global implications. Reprod Biol Endocrinol. 2018;16:70.CrossRefGoogle Scholar
  3. 3.
    Allahbadia GN. Social egg freezing: developing countries are not exempt. J Obstet Gynaecol India. 2016;66:213–7.CrossRefGoogle Scholar
  4. 4.
    Santo EVE, Dieamant F, Petersen CG, Mauri AL, Vagnini LD, Renzi A, et al. Social oocyte cryopreservation: a portrayal of Brazilian women. JBRA Assist Reprod. 2017;21:101–4.CrossRefGoogle Scholar
  5. 5.
    Hammarberg K. Fertility preservation in women for social reasons. Encyclopedia Reprod. 2018;5:259–62.CrossRefGoogle Scholar
  6. 6.
    Lewis EI, Missmer SA, Farland LV, Ginsburg ES. Public support in the United States for elective oocyte cryopreservation. Fertil Steril. 2016;106:1182–9.CrossRefGoogle Scholar
  7. 7.
    Lallemant C, Vassard D, Andersen AN, Schmidt L, Macklon N. Medical and social egg freezing: internet-based survey of knowledge and attitudes among women in Denmark and the UK. Acta Obstet Gynecol Scand. 2016;95:1402–10.CrossRefGoogle Scholar
  8. 8.
    Milman LW, Senapati S, Sammel MD, Cameron KD, Gracia C. Assessing reproductive choices of women and the likelihood of oocyte cryopreservation in the era of elective oocyte freezing. Fertil Steril. 2017;107:1214–22.CrossRefGoogle Scholar
  9. 9.
    Cobo A, Garcia-Velasco JA. Why all women should freeze their eggs. Clin Obstet Gynecol. 2016;28:206–10.Google Scholar
  10. 10.
    Donnez J, Dolmans M-M. Fertility preservation in women. N Engl J Med. 2017;377:1657–65.CrossRefGoogle Scholar
  11. 11.
    Gunnala V, Schattman G. Oocyte vitrification for elective fertility preservation: the past, present, and future. Clin Obstet Gynecol. 2017;29:59–63.Google Scholar
  12. 12.
    Goldman KN, Grifo JA. Elective oocyte cryopreservation for deferred childbearing. Clin Obstet Gynecol. 2016;23:458–64.Google Scholar
  13. 13.
    Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What to reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril. 2014;100:1343–9.CrossRefGoogle Scholar
  14. 14.
    Stoop D, Maes E, Polyzos NP, Verheyen G, Tournaye H, Nekkebroeck J. Does oocyte banking for anticipated gamete exhaustion influence future relational and reproductive choices? A follow-up of bankers and non-bankers. Hum Reprod. 2015;30:338–44.CrossRefGoogle Scholar
  15. 15.
    Hammarberg K, Kirkman M, Pritchard N, Hickey M, Peate M, McBain J, et al. Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Hum Reprod. 2017;32:575–81.CrossRefGoogle Scholar
  16. 16.
    Pritchard N, Kirkman M, Hammarberg K, McBain J, Agresta F, Bayly C, et al. Characteristics and circumstances of women in Australia who cryopreserved their oocytes for non-medical indications. J Reprod Infant Psychol. 2017;35:108–18.CrossRefGoogle Scholar
  17. 17.
    Gurtin ZB, Shah T, Wang J, Ahuja K. Reconceiving egg freezing: insights from an analysis of 5 years of data from a UK clinic. Reprod BioMed Online. 2019;38:272–82.CrossRefGoogle Scholar
  18. 18.
    Greenwood EA, Pasch LA, Hastie J, Cedars MI, Huddleston HG. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation. Fertil Steril. 2018;109:1097–104.CrossRefGoogle Scholar
  19. 19.
    Brown E, Patrick M. Time, anticipation, and the life course: egg freezing as temporarily disentangling romance and reproduction. Am Sociol Rev. 2018:1–24.Google Scholar
  20. 20.
    Baldwin K, Culley L, Hudson N, Mitchell H, Lavery S. Oocyte cryopreservation for social reasons: demographic profile and disposal intentions of UK users. Reprod BioMed Online. 2015;31:239–45.CrossRefGoogle Scholar
  21. 21.
    Baldwin K. “I suppose I think to myself, that’s the best way to be a mother”: how ideologies of parenthood shape women’s use for social egg freezing technology. Sociol Res Online. 2017;22:2–15.CrossRefGoogle Scholar
  22. 22.
    Baldwin K. Conceptualising women’s motivations for social egg freezing and experience of reproductive delay. Sociol Health Illn. 2018;40:859–73.CrossRefGoogle Scholar
  23. 23.
    Baldwin K, Culley LA, Hudson N, Mitchell HL. Running out of time: exploring women’s motivations for social egg freezing. J Psychosom Obstet Gynecol. 2018:1–8.
  24. 24.
    Kilic A, Gocmen I. Fate, morals and rational calculations: freezing eggs for non-medical reasons in Turkey. Soc Sci Med. 2018;203:19–27.CrossRefGoogle Scholar
  25. 25.
    Gocmen I, Kilic A. Egg freezing experiences of women in Turkey: from the social context to the narratives of reproductive ageing and empowerment. Eur J Wom Stud. 2018;25:168–82.CrossRefGoogle Scholar
  26. 26.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: Institute of Medicine; 2001.Google Scholar
  27. 27.
    Van Empel IWH, Dancet EAF, Koolman XHE, Nelen WLDM, Stolk EA, Sermeus W, et al. Physicians underestimate the importance of patient-centeredness to patients: a discrete choice experiment in fertility care. Hum Reprod. 2011;26:584–93.CrossRefGoogle Scholar
  28. 28.
    Dancet EAF, D’Hooghe TM, Sermeus W, Van Empel I, Strohmer H, Wyns C, et al. Patients from across Europe have similar views on patient-centered care: an international multilingual qualitative study in infertility care. Hum Reprod. 2012;27:1702–11.CrossRefGoogle Scholar
  29. 29.
    Dancet EAF, Van Empel IWH, Rober P, Nelen WLDM, Kremer JAM, D’Hooghe TM. Patient-centered infertility care: a qualitative study to listen to the patient’s voice. Hum Reprod. 2011;26:827–33.CrossRefGoogle Scholar
  30. 30.
    Aarts JWM, Huppelschoten AG, van Empel IWH, Boivin J, Verhaak CM, Kremer JAM, et al. How patient-centered care relates to patients’ quality of life and distress in a study in 427 women experiencing infertility. Hum Reprod. 2012;27:488–95.CrossRefGoogle Scholar
  31. 31.
    Huppelschoten AG, Aarts JWM, van Empel IWH, Cohlen BJ, Kremer JAM, Nelen WLDM. Feedback to professionals on patient-centered fertility care is insufficient for improvement: a mixed-method study. Fertil Steril. 2013;99:1419–27.CrossRefGoogle Scholar
  32. 32.
    Mourad SM, Nelen WLDM, Akkermans RP, Vollebergh JHA, Grol RPTM, Hermens RPMG, et al. Determinants of patients’ experiences and satisfaction with fertility care. Fertil Steril. 2010;94:1254–60.CrossRefGoogle Scholar
  33. 33.
    Van Empel IWH, Aarts JNM, Cohlen BJ, Huppelschoten DA, Laven JSE, Nelen WLDM, et al. Measuring patient-centeredness, the neglected outcome in fertility care: a random multicenter validation study. Hum Reprod. 2010;25:2516–26.CrossRefGoogle Scholar
  34. 34.
    Van Empel IWH, Hermens RPMG, Akkermans RP, Hollander KWP, Nelen WLDM, Kremer JAM. Organizational determinants of patient-centered fertility care: a multilevel analysis. Fertil Steril. 2011;95:513–9.CrossRefGoogle Scholar
  35. 35.
    Inhorn MC, Birenbaum-Carmeli C, Westphal LM, Doyle J, Gleicher N, Meirow D, et al. Medical egg freezing: the importance of a patient-centered approach to fertility preservation. J Assist Reprod Genet. 2018;35:49–59.CrossRefGoogle Scholar
  36. 36.
    Hollan D. The psychology of person-centered ethnography. In: Moore CC, Mathews HF, editors. The psychology of cultural experience. Cambridge: Cambridge University Press; 2001. p. 48–67.Google Scholar
  37. 37.
    Hertz R. Single by chance, mothers by choice: how women are choosing parenthood without marriage and creating the new American family. Oxford: Oxford University Press; 2008.CrossRefGoogle Scholar
  38. 38.
    Mamo L. Queering reproduction: achieving pregnancy in the age of technoscience. Durham: Duke University Press; 2007.CrossRefGoogle Scholar
  39. 39.
    Almeling R. Sex cells: the medical market for eggs and sperm. Berkeley: University of California Press; 2011.Google Scholar
  40. 40.
    Inhorn MC. Cosmopolitan conceptions: IVF sojourns in global Dubai. Durham: Duke University Press; 2015.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Marcia C. Inhorn
    • 1
    Email author
  • Daphna Birenbaum-Carmeli
    • 2
  • Lynn M. Westphal
    • 3
  • Joseph Doyle
    • 4
  • Norbert Gleicher
    • 5
  • Dror Meirow
    • 6
  • Martha Dirnfeld
    • 7
  • Daniel Seidman
    • 8
  • Arik Kahane
    • 9
  • Pasquale Patrizio
    • 10
  1. 1.Department of AnthropologyYale UniversityNew HavenUSA
  2. 2.Department of NursingUniversity of HaifaHaifaIsrael
  3. 3.Stanford Fertility and Reproductive Medicine CenterStanford UniversitySunnyvaleUSA
  4. 4.Shady Grove FertilityRockvilleUSA
  5. 5.Center for Human ReproductionNew YorkUSA
  6. 6.Division Reproductive Endocrinology-IVF, Department of Obstetrics & Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of MedicineTechnionHaifaIsrael
  7. 7.Clinical Center for Fertility Preservation and Fertility Preservation Research Laboratory, Department of Obstetrics and GynecologySheba Medical CenterRamat GanIsrael
  8. 8.Department of Obstetrics and GynecologySheba Medical CenterRamat GanIsrael
  9. 9.Assuta Medical CenterRishoon LezionIsrael
  10. 10.Yale Fertility CenterYale UniversityNew HavenUSA

Personalised recommendations