Social egg freezing among Single Women in China: Policy Perceptions, Attitudes, and Influencing Factors

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Design: A cross-sectional study utilizing an online questionnaire. Participants: A total of 1,408 single women with valid responses, recruited from nine cities across China between March and May 2025, representing diverse sociodemographic profiles in terms of age, educational attainment, and income levels. Exposure Variables: Sociodemographic characteristics, awareness of SEF policies, cost tolerance, and perceptions of risks and societal value associated with SEF. Primary Outcome Measures: Attitudes toward SEF, determinants of willingness to undergo SEF, level of policy awareness, and support for regulatory reforms. Results: Favorable attitudes toward SEF were reported by 34.94% of participants. Significant predictors included older age (OR=1.725), higher educational attainment (OR=1.356), increased income (OR=1.091), greater cost tolerance (OR=1.407), and heightened policy awareness (OR=3.305). Additionally, 68.89% of participants supported policy revisions, 89.42% advocated for government subsidies, and 78.62% endorsed the inclusion of SEF in medical insurance coverage. Conclusion: Demographic and socioeconomic factors significantly influence attitudes toward SEF. There is a critical need for policy reforms that balance reproductive autonomy with regulatory oversight, alongside the implementation of robust social support mechanisms. Social egg freezing Single women China Policy perception Reproductive autonomy Fertility preservation Figures Figure 1 Introduction In modern society, the phenomenon of delayed childbearing among women, driven by career advancement, educational pursuits, and shifting marital ideologies, has become increasingly prevalent. China's total fertility rate has exhibited a consistent decline, decreasing from 1.22 in 2000 to 1.07 in 2022[1]. Concurrently, the proportion of first-time mothers aged 35 and above has risen significantly, from 8.65% in 2004 to 17.04% in 2014[2]. This trend of postponed childbearing presents a conflict with women's aspirations for reproductive autonomy. SEF, as a method of fertility preservation, offers a theoretical solution to mitigate age-related fertility decline; however, its implementation remains constrained by policy restrictions in China[3]. In 2013, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) jointly issued updated guidelines, classifying oocyte vitrification as a non-experimental clinical procedure based on substantial evidence of its efficacy. This reclassification was supported by data demonstrating comparable pregnancy rates between vitrified oocytes and fresh oocytes in in vitro fertilization (IVF), with no significant increase in chromosomal abnormalities or congenital anomalies, a position further endorsed by the American College of Obstetricians and Gynecologists (ACOG). Currently, this technology is clinically indicated for women at risk of infertility due to medical interventions such as oncological surgery, radiotherapy, or chemotherapy. However, for healthy women considering SEF solely to mitigate age-related fertility decline, the available medical evidence remains insufficient to justify its routine use. Consequently, in clinical practice, healthcare providers are obligated to comprehensively inform patients about the therapeutic uncertainties, potential risks, financial implications, and alternative options associated with SEF[4–7]. While SEF is increasingly viewed as a potential strategy to reconcile reproductive autonomy with societal roles, its broader implementation continues to encounter significant ethical, legal, and sociocultural challenges[8]. Globally, substantial variations exist in the legal and policy frameworks governing SEF for single women across different jurisdictions. In the United States, SEF is permitted for single women, though it lacks comprehensive federal legislation. The ASRM has endorsed its ethical acceptability, with most clinical institutions recommending the procedure be performed prior to the age of 38[9]。In the United Kingdom, SEF is regulated by the Human Fertilisation and Embryology Authority (HFEA), which imposes a maximum storage duration of 10 years for cryopreserved oocytes, mandating their disposal if unused beyond this period[10]。Notably, the Singaporean government has recently implemented a policy, effective from 2023, permitting women aged 21 to 35, irrespective of marital status, to undergo oocyte cryopreservation[11]. In China, the reproductive rights of single women and policy frameworks surrounding SEF remain in a developmental stage, with existing regulations imposing explicit restrictions on single women's access to cryopreservation services. The Chinese Ministry of Health, through Document No. 176 issued in 2003, explicitly prohibits medical institutions from providing assisted reproductive technology (ART) to unmarried women, a policy that was subsequently reaffirmed by the National Health Commission in its 2021 official response. Nevertheless, acknowledging the growing societal interest in SEF, the NHC has indicated its commitment to advancing the legislative framework for ART management, enhancing regulatory oversight, monitoring advancements in fertility preservation technologies, and cautiously promoting their clinical application to safeguard the health rights of women and their offspring. Within this policy context, high-profile cases such as the "Xu Zaozao egg freezing case" have highlighted the tension between regulatory constraints and individual reproductive autonomy, underscoring the institutional barriers single women face in accessing fertility preservation. Furthermore, these cases reveal a significant disparity between public perceptions, attitudes, and the policy support required for SEF technology[3]. The academic community has yet to systematically evaluate the cognitive characteristics, attitude formation mechanisms, and policy support needs of this demographic. This knowledge gap not only risks exacerbating the unregulated application of such technologies but also hinders the development of an evidence-based foundation for policy reform[12]. While international research on the ethical and technical dimensions of SEF has advanced, systematic investigations focusing on single women in China remain scarce. At the policy level, China restricts egg freezing to married women for medical indications, such as cancer treatment, creating a significant disparity between regulatory frameworks and societal demands. This discrepancy not only impedes single women's access to fertility preservation but also underscores the public's limited understanding of the safety, efficacy, and policy landscape surrounding egg freezing technology. Empirical research is urgently needed to inform evidence-based policy development and public education initiatives[3]. Existing studies predominantly focus on the egg freezing needs of individuals with medical conditions, such as cancer patients, while lacking robust quantitative analyses of SEF willingness, policy awareness, and influencing factors among single women[13]. Furthermore, there is no consensus on evaluating the potential societal impacts of egg freezing technology on labor markets, marriage dynamics, and population structures[14]. "Policy adjustments require the integration of multi-dimensional evidence, including attitudinal data, technical feasibility, resource allocation, and long-term impacts. This cross-sectional study focuses on 'demand-side attitudes,' providing a baseline of social acceptance for policy reform. However, it should be combined with other evidence chains such as medical resource supply, cost-effectiveness, and international experiences to collectively support reform directions, including potential supporting measures like age-stratified regulation and medical insurance coverage mentioned in this study. This study aims to address these research gaps by investigating the policy awareness, attitudes, and needs of single women in China regarding SEF through a large-scale questionnaire survey. Specifically, it seeks to address three key questions: (1) What factors drive the willingness to pursue egg freezing? (2) How does policy awareness influence risk perception? (3) What constitutes the optimal pathway for social support system optimization? The findings will provide an empirical foundation for refining China's SEF policy framework and enhancing public education efforts, while offering novel insights into the socio-psychological mechanisms underlying modern women's reproductive decision-making [15]. By integrating technical feasibility, societal needs, and policy considerations into a multidimensional analysis, this study aims to reconcile reproductive autonomy with societal norms, thereby contributing to academic discourse and policy formulation in this field. Materials and methods The study employed a targeted recruitment strategy utilizing the Wenjuanxing platform (https://www.wjx.cn/), which provides access to a sample library service comprising over 6.2 million real-name registered members. Data collection was conducted through self-administered online questionnaires distributed between March 18 and May 19, 2025. The platform facilitated sample matching based on predefined criteria, including gender (female), marital status (single), and geographic location. The study population was stratified based on geographic location, specifically targeting unmarried female residents from three distinct city classifications: first-tier cities (Beijing, Guangzhou, Shenzhen), emerging first-tier cities (Nanjing, Hangzhou, Chongqing, Changsha), and second-tier cities (Shenyang).To enhance participant recruitment, particularly targeting individuals from Shanghai as a first-tier city, the questionnaire was disseminated through multiple platforms. These included the official WeChat public account of Shanghai Tenth People's Hospital, WeChat groups associated with the hospital's Reproductive Medicine Center, the researcher's personal Weibo account, and WeChat groups for students enrolled in the School of Transnational Law at Peking University Shenzhen Graduate School between 2019 and 2022.Participants independently completed a 30-item anonymous questionnaire without any direct involvement from the research team. Questionnaire Design and Content Framework The questionnaire was developed specifically for this study based on the framework of the Shanghai Health Law Research Project (Project No.: 2024WF07), which systematically evaluates three key dimensions: ethical considerations, legal frameworks, and social impact. It has not been published elsewhere.The English version of the questionnaire is available as Supplementary File 1. Initial item generation was facilitated using the "Doubao" and "DeepSeek" systems, followed by a rigorous manual screening process to ensure alignment with the research objectives, during which 21 irrelevant items were eliminated. The original pool of 35 items was subsequently refined to 30 items. Content validity was assessed by a panel of experts specializing in reproductive medicine, legal affairs, and health management. Based on their evaluations of item relevance (average score: 4.2/5) and clarity (average score: 3.8/5), two items were revised to enhance their precision and alignment with the study's aims. The final questionnaire encompasses four core dimensions: 1. Socio-demographic Variables: This section includes seven items assessing city of residence, gender, age, marital status, occupation, educational attainment, and annual income level. 2. Policy Awareness and Attitudes: This domain consists of ten items evaluating perspectives on egg freezing as a strategy to mitigate spouse selection pressure, considerations related to egg freezing, policy comprehension, legal awareness, and concerns regarding safety, potential risks, social value, service prioritization, cost tolerance, and cost-sharing entities for egg freezing technology. 3. Policy Implementation and Oversight: This section includes six items exploring support for revising egg freezing regulations, stakeholder interests to be considered during policy amendments, optimal regulatory frameworks, and the potential effects of egg freezing legalization on the labor market, delayed marriage and childbearing, and population structure. 4. Social Impact and Recommendations: This final domain comprises seven items addressing concerns about egg freezing for single women, regulatory priorities post-legalization, anticipated positive societal changes, the interplay between egg freezing technology dissemination and IVF, perspectives on medical insurance payment models, opinions on the trend of single women utilizing egg freezing for childbirth, and specific recommendations for policy improvement. The survey instrument comprised 30 multiple-choice questions, including 22 single-response items utilizing a 4-5 point Likert-type scale (e.g., the "policy awareness" domain was operationalized through four distinct categories: "very familiar", "basically familiar", "heard but unclear", and "uncertain", which directly informed the categorical variable analysis yielding "policy awareness OR=3.305" in the results section). The remaining 8 multiple-response questions incorporated 5-6 response options per item (e.g., the "social value of oocyte cryopreservation technology" dimension included response choices such as "ensuring reproductive autonomy" and "alleviating career-family conflicts"). Quantitative data, including the finding that "80.26% of respondents believe it can alleviate career-family conflicts", were derived from frequency analyses of these response patterns. The survey design, incorporating both graded response scales for single-answer items and multi-dimensional options for multiple-response items, was methodologically aligned with the percentage-based data presentation and categorical variable processing in the results section, thereby facilitating robust analysis of participants' attitudinal orientations. Questionnaire Implementation and Data Quality Control The questionnaire was developed and administered using the Wenjuanxing platform, which incorporated a pre-screening mechanism through its "Sample Library Service" to restrict participation exclusively to single women. All data were processed with strict confidentiality, and no personally identifiable information was collectedThe survey was strategically distributed across eight major cities: Beijing, Guangzhou, Shenzhen, Nanjing, Hangzhou, Chongqing, Changsha, and Shenyang. The platform was programmed to collect 1,200 valid responses, with 224 responses targeted from each of Beijing, Guangzhou, and Shenzhen, and 103 responses from each of the remaining five cities. To optimize the response rate, the questionnaire was disseminated through multiple channels, including the paid sample library service of Wenjuanxing, the official WeChat public account of Shanghai Tenth People's Hospital, the WeChat group of the hospital's Reproductive Medicine Center, the WeChat group for faculty and students of the School of International Law at Peking University Shenzhen Graduate School, and the author's personal Weibo account. To ensure the integrity and quality of the collected data, several rigorous quality control measures were implemented: (1) The "anti-repeated filling" function of Wenjuanxing was activated to prevent multiple submissions from the same IP address, device, or account; (2) A mandatory completion rule was enforced to ensure that all questions were answered before submission;The mandatory completion rule is implemented to maintain the logical coherence of the three-dimensional framework encompassing "ethical, legal, and social effects" (e.g., the policy cognition variable serves as a fundamental component in the analysis of social effects). This rule is designed to prevent the omission of critical variables that could compromise the validity of the multiple regression model.(3) Logical verification trap questions were embedded to identify and exclude perfunctory or malicious responses; (4) A minimum response time of 3 minutes was set to discourage hasty or insincere participation; (5) Data were systematically reviewed for rationality, with abnormal responses (e.g., students reporting an annual income exceeding 300,000 yuan or unmarried students over 55 years old) being excluded; (6) Responses exhibiting patterns of regularity (e.g., consistently selecting option A in single-choice questions) were flagged and invalidated; (7) Responses from regions not meeting the specified criteria were disqualified. The survey was distributed to a cohort of 12,788 registered users through the "Sample Library Service," generating 1,744 completed responses, corresponding to an initial response rate of 9.60%. Following the exclusion of 506 invalid responses, 1,238 valid questionnaires were retained, resulting in an effective response rate of 71.00%. Additionally, 458 questionnaires were collected via supplementary channels, of which 288 were excluded as invalid, yielding 170 valid responses with an effective response rate of 37.12%. The comprehensive inclusion and exclusion process is depicted in Fig. 1. Statistical analyses This study employed quantitative statistical methodologies for data analysis. Initial data processing and quality control measures were implemented, wherein valid samples were selected through the application of anti-duplication mechanisms, logical verification protocols, and a 3-minute response time threshold on the Wenjuanxing platform. Variables were subsequently categorized, grouped, and encoded for analysis. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were utilized to characterize sample attributes and attitude distributions. Binary logistic regression was conducted to examine factors influencing the willingness to undergo oocyte cryopreservation, with the decision to consider egg freezing serving as the dependent variable, and variables such as urban classification, age, and occupation as independent predictors. Regression coefficients, odds ratios, and 95% confidence intervals were calculated, with statistical significance defined at P 0.1, and the P-value of the Hosmer and Lemeshow Test goodness-of-fit test greater than 0.1.Statistical analysis was performed using IBM SPSS Statistics 26.0. Results Sociodemographic characteristics Table 1 summarizes the demographic profile of the study cohort (n=1,408). The majority of participants resided in first-tier cities (Beijing, Shanghai, Guangzhou, Shenzhen), comprising 56.89% (n=801) of the sample, followed by new first-tier cities (24.64%, n=347) and second-tier or lower-tier cities (18.47%, n=260). Age distribution analysis revealed that the 18–28-year-old cohort constituted the largest proportion (72.30%, n=1,018), while the 29–35-year-old and ≥36-year-old groups accounted for 22.51% (n=317) and 5.18% (n=73), respectively. Occupational distribution indicated that non-managerial employees in sectors such as manufacturing, services, and internet industries represented the highest proportion (38.64%, n=544), followed by students (25.78%, n=363), other professionals (19.89%, n=280), and enterprise managers (15.70%, n=221). Educational attainment was notably high, with 83.88% (n=1,181) of participants holding a bachelor’s degree or higher, 12.50% (n=176) possessing a junior college diploma, and 3.62% (n=51) having a high school education or less. Annual income distribution showed that 45.74% (n=644) of participants earned less than 80,000 CNY, 30.05% (n=423) earned between 80,000 and 150,000 CNY, and 18.04% (n=254) exceeded 150,000 CNY, while 6.18% (n=87) declined to disclose their income. The sample structure reflects a predominance of first-tier city residents, younger individuals, highly educated backgrounds, and non-managerial corporate employees. The income distribution, characterized by a high proportion of lower-income individuals, aligns with the substantial representation of students and early-career professionals in the sample (combined >80%). Perception and attitudes Factors influencing egg freezing decisions Among the 1,408 respondents, 34.94% (n=492) reported having considered oocyte cryopreservation, while 40.41% (n=569) explicitly stated they had not considered it, and 24.64% (n=347) expressed uncertainty. A multivariate logistic regression model was constructed incorporating key variables, including geographic location, age, occupation, educational attainment, annual income, awareness of China's current oocyte cryopreservation policies, and psychological cost tolerance thresholds, as detailed in Table 2. The analysis revealed several statistically significant predictors of oocyte cryopreservation consideration: advancing age (OR=1.725, 95%CI 1.397-2.129, P<0.001), higher educational attainment (OR=1.356, 95%CI 1.102-1.669, P=0.004), increased annual income (OR=1.091, 95%CI 1.028-1.158, P=0.004), awareness of current oocyte cryopreservation policies (OR=3.305, 95%CI 2.601-4.200, P<0.001), and greater psychological cost tolerance (OR=1.407, 95%CI 1.16-1.707, P=0.001) were all positively associated with the likelihood of considering oocyte cryopreservation. Technical cognition and perception of fertility pressure Quantitative analysis revealed that 78.48% (n=1119/1408) of participants perceived oocyte cryopreservation as a potential intervention for alleviating short-term marital selection pressure among unmarried women. Within this cohort, 36.51% (n=514/1408) evaluated the technology's efficacy as "substantially effective," while 42.97% (n=605/1408) characterized its impact as "moderately effective." Policy cognition and legal attitude A substantial majority of respondents (70.81%, 997/1408) reported familiarity with the egg freezing policy but lacked detailed understanding, while only 2.84% (40/1408) demonstrated comprehensive knowledge. A moderate proportion (16.69%, 235/1408) indicated a basic understanding, and 9.66% (136/1408) expressed uncertainty, highlighting a significant gap in public awareness of the policy. In terms of legal attitudes, 60.3% (849/1408) supported the implementation of specific eligibility criteria (e.g., age and health status) for single women seeking egg freezing, whereas 32.6% (459/1408) advocated for unrestricted access. A minority (2.63%, 37/1408) opposed the policy, arguing that it should be limited to married couples, and 4.47% (63/1408) remained undecided. Technical Risk and Social Value Cognition The survey revealed that 87.86% (1237/1408) of respondents expressed concerns regarding the potential health risks associated with egg freezing procedures, particularly ovarian hyperstimulation syndrome. Moreover, 79.19% (1115/1408) demonstrated awareness of the long-term implications of cryopreservation on oocyte quality, while 70.38% (991/1408) indicated apprehension about the efficacy of the freezing and thawing processes. In contrast, 86.51% (1218/1408) perceived the primary societal benefit of egg freezing as safeguarding female reproductive autonomy. Additionally, 80.26% (1130/1408) viewed the procedure as a potential solution to mitigate the conflict between professional aspirations and childbearing, 40.34% (568/1408) considered it a means to advance gender equality, and 52.56% (740/1408) believed it could facilitate the establishment of non-traditional family structures in reproductive contexts. Cost tolerance and policy support needs The survey revealed distinct patterns in cost tolerance for egg freezing, with 55.04% (775/1408) of participants reporting a psychological threshold below 50,000 yuan, while 36.79% (518/1408) expressed acceptance for costs ranging between 50,000 and 100,000 yuan. A smaller proportion, 7.03% (99/1408), indicated willingness to pay between 100,000 and 150,000 yuan, and only 1.14% (16/1408) were prepared to exceed 150,000 yuan. Regarding cost-sharing mechanisms, the majority of respondents (89.42%; 1259/1408) advocated for government financial subsidies, 78.62% (1107/1408) supported inclusion in medical insurance coverage, and 30.68% (432/1408) anticipated corporate benefits to cover the expenses. Policy Revision and Regulatory Suggestions A substantial majority of respondents (68.89%, 970/1408) expressed support for revising existing regulations to permit single women to undergo oocyte cryopreservation. Among these, 24.29% (342/1408) demonstrated full endorsement, while 44.60% (628/1408) advocated for standardized implementation. A neutral position was maintained by 27.91% (393/1408), whereas 2.63% (37/1408) expressed opposition, 0.36% (5/1408) were strongly opposed, and 0.21% (3/1408) remained undecided. Concerning regulatory frameworks, 78.98% (1112/1408) favored a government-led oversight mechanism for oocyte cryopreservation technology, with 87.14% (1227/1408) emphasizing the necessity of rigorous qualification assessments for medical institutions. Additionally, 86.22% (1214/1408) raised concerns regarding potential misuse and inadequate supervision, particularly highlighting risks associated with profit-driven commercial entities and illicit transactions. In terms of policy revision priorities, 84.38% (1188/1408) identified the fertility preservation needs of older single women as a critical focus, 79.55% (1120/1408) emphasized the need to address the career-childbearing balance for professional women, and 68.25% (961/1408) underscored the importance of addressing medical indications, such as conditions that compromise fertility. Awareness of social and demographic impacts The survey revealed that 84.38% (1188/1408) of respondents perceived the legalization of oocyte cryopreservation as a means to safeguard women's reproductive autonomy, while 82.32% (1159/1408) considered it a potential solution to mitigate the conflict between professional development and childbearing. Furthermore, 78.48% (1105/1408) believed this technology could enhance female labor force participation. However, 65.41% (921/1408) anticipated that oocyte cryopreservation might lead to delayed childbearing age and a consequent short-term decline in birth rates, with 46.24% (651/1408) agreeing that it could contribute to the trend of late marriage and childbearing. Additionally, 60.44% (851/1408) expressed concerns that the rising proportion of advanced maternal age primiparas might accelerate population aging, while 54.47% (767/1408) were apprehensive about the potential for gender ratio imbalance resulting from the combination of oocyte cryopreservation and gender selection technologies. Notably, 64.49% (908/1408) believed that single women utilizing oocyte cryopreservation for childbearing could lead to an increase in single-parent families and non-traditional family structures. Attitudes towards childbearing by single women through egg freezing The survey revealed that 52.63% (741/1408) of respondents endorsed the use of egg freezing technology by single women to conceive, perceiving it as a manifestation of reproductive autonomy. A substantial proportion, 41.76% (588/1408), adopted a neutral position while emphasizing the importance of the children's developmental environment. Conversely, 4.62% (65/1408) expressed reservations, 0.78% (11/1408) opposed the practice, and 0.21% (3/1408) held alternative perspectives. Key Policy and Technology Correlation Analysis Medical Insurance Payment Preferences: The survey revealed that 85.51% (1204/1408) of respondents favored proportional reimbursement, while 62.71% (883/1408) expressed support for implementing special subsidies targeting the working population. Regulatory Priorities: Analysis of respondent feedback identified four key regulatory focus areas: 87.14% (1227/1408) emphasized the necessity of rigorous qualification assessments for medical institutions, 86.36% (1216/1408) highlighted the importance of compliance in oocyte disposal protocols, 86.01% (1211/1408) prioritized the prevention of technological misuse, particularly in cases of gender selection, and 78.98% (1112/1408) stressed the need for transparent cost disclosure in oocyte cryopreservation procedures. Policy Recommendations: Regarding policy development, 90.2% (1270/1408) of participants supported the implementation of a standardized national technical framework, while 78.41% (1104/1408) proposed the establishment of an independent ethical review committee to oversee related practices. Discussion Main research findings and academic dialogue This study investigates the multifaceted determinants influencing decisions regarding SEF and the current state of policy awareness among single women in China, utilizing data from a survey of 1,408 participants. The results demonstrate that advanced age (OR=1.725), higher educational attainment (OR=1.356), and increased annual income (OR=1.091) are significantly correlated with a greater propensity to pursue egg freezing. These findings are consistent with international research indicating that professional women often consider egg freezing as a strategy to reconcile reproductive aspirations with career progression[12, 15].Notably, women with a comprehensive understanding of the existing egg freezing policy exhibited a significantly higher likelihood of considering the procedure (OR=3.305). However, 70.81% of respondents reported having "heard of the policy but lacked detailed knowledge," highlighting a substantial disparity between policy dissemination and public comprehension[8]. This discrepancy may stem from the restrictive provisions for single women outlined in China's 2003 "Human ART Specifications," which appear misaligned with contemporary societal demands. These findings present a cross-cultural divergence from research conducted in France, where approximately 89.4% of women perceive inadequate public awareness regarding SEF, and 72.2% of those opting for SEF are single, primarily motivated by the absence of suitable partners[16]. "Notably, the high public support for financial subsidies (89.42%) and medical insurance coverage (78.62%) identified in this study aligns with China’s ongoing pilot programs integrating in vitro fertilization (IVF) into medical insurance in several provinces. This convergence suggests that extending similar coverage to SEF could leverage existing healthcare reform momentum, enhancing both social acceptance and institutional continuity—key indicators of policy feasibility. Furthermore, the strong emphasis on rigorous qualification assessments for medical institutions (87.14%) resonates with China’s current infrastructure: over 500 medical facilities are already licensed to provide assisted reproductive technologies. By adopting Singapore’s model of 'qualification certification plus technical standardization'[11], eligible institutions could be selected from this existing network to deliver SEF services, avoiding the need for building a new system from scratch and thus ensuring short-term operational feasibility." Empirical evidence from international contexts demonstrates that cross-sectional survey data on public attitudes can provide a valuable preliminary foundation for policy reform initiatives. A case in point is Singapore's approach to revising its social egg freezing policy for single women in 2023. Prior to implementing this policy change, the government initiated a comprehensive year-long program, the "Singapore Women's Development Dialogue," which engaged nearly 6,000 participants through more than 160 structured dialogue sessions. The systematic collection and analysis of participant feedback and insights during this initiative served as critical empirical evidence informing the subsequent policy formulation. While cross-sectional survey data alone may not be sufficient to determine specific policy directions, when integrated with complementary evidence sources, it can significantly contribute to evidence-based policy reform processes. Regarding technical cognition, 78.48% of participants perceived oocyte cryopreservation as a potential strategy to mitigate short-term partner selection pressure, while 87.86% expressed concerns regarding associated surgical health risks, aligning with the ongoing global debate surrounding the safety profile of this technology[8, 17]. Concurrently, 86.51% acknowledged the role of oocyte cryopreservation in safeguarding reproductive autonomy, with 68.89% endorsing policy reform, thereby underscoring the pressing demand for reproductive self-determination among unmarried women. These findings establish a cross-cultural parallel with a British study reporting that "91% of women expressed no regret regarding their decision to undergo oocyte cryopreservation," thereby emphasizing the psychological significance of this technology as a form of "reproductive insurance"[10] It is imperative to acknowledge the internationally recognized limitations regarding the efficacy of Social Egg Freezing (SEF) in enhancing fertility rates. Empirical evidence from European and American contexts, where SEF has been implemented, reveals that the utilization rate of cryopreserved oocytes remains as low as 12%[7, 18], suggesting that the majority of frozen eggs do not culminate in actual reproductive outcomes, thereby constraining their impact on macro-level fertility enhancement. While this investigation identified that 34.94% of unmarried women exhibit a favorable disposition towards SEF, with 78.48% perceiving it as a mechanism to mitigate short-term mate-selection pressures, these attitudinal metrics do not substantiate the assertion that "SEF effectively augments fertility rates." The decision to undergo oocyte cryopreservation is predominantly driven by the desire to preserve reproductive autonomy (e.g., 52.63% endorse single women utilizing SEF for childbearing) rather than an inevitable progression towards actualized fertility. Furthermore, 87.86% of participants expressed concerns regarding surgical risks, and 55.04% indicated a cost threshold below 50,000 yuan, factors that may further diminish the practical utilization of SEF. Consequently, the principal value of SEF is more plausibly situated in "ensuring individual reproductive autonomy" (e.g., 86.51% affirm its role in safeguarding women's reproductive rights) rather than serving as a primary strategy to counteract declining fertility rates. Policy adjustments should be grounded in this reality, emphasizing the "fulfillment of reasonable reproductive needs" rather than overestimating its direct influence on demographic structural improvement. Research Limitations and Future Directions The study's sample composition demonstrates significant demographic bias, primarily attributable to constrained research funding. Specifically, 72.30% of participants were aged between 18 and 28 years, while 56.89% resided in first-tier cities. This skewed distribution consequently led to inadequate representation of both older single women and populations from lower-tier cities, potentially limiting the generalizability of the findings.Recruitment through hospital WeChat groups and law school cohorts introduced selection bias, as participants from medical contexts exhibited heightened risk awareness (87.86% expressed concern about surgical risks), while law students disproportionately emphasized legal rights (60.3% supported conditional eligibility). The questionnaire design included leading questions (e.g., "relieves spousal pressure") and employed simplistic measurements (e.g., one-time cost tolerance below 50,000 CNY reported by 55.04% of respondents), which compromised data accuracy. Future research should prioritize stratified sampling based on age, occupation, and city tier to enhance representativeness, alongside the adoption of validated scales and Likert measures to capture nuanced attitudinal variations. Longitudinal studies are essential to monitor the policy's impact on fertility rates and family structures, while ethical analyses should focus on modeling age-stratified regulatory frameworks and insurance coverage, informed by international best practices. A mixed-method approach integrating quantitative surveys with qualitative interviews is recommended to provide deeper insights into the contextual factors influencing decision-making processes. The attitudinal data presented in this study constitute a necessary yet insufficient condition for informing policy changes. To establish a comprehensive evidence base, future research should integrate longitudinal cohort studies to track fertility behaviors following oocyte cryopreservation, conduct cost-effectiveness analyses to evaluate financial implications such as healthcare insurance burdens, and incorporate qualitative interviews with key stakeholders, including healthcare providers and policymakers. Such a multifaceted approach would yield a robust evidentiary framework to guide policy development. Policy suggestions and practical inspirations Drawing upon the empirical findings of this study and international best practices, the following policy and practice recommendations are proposed for SEF among single women in China, with the objective of harmonizing individual reproductive autonomy with societal public interests: Establish a regulatory mechanism with age stratification and qualification review The study demonstrates that age is a significant determinant of egg freezing intention (OR=1.725), with a marked decline in success rates for women over 35 years. Furthermore, 84.38% of respondents advocate prioritizing fertility preservation for older single women. Age-Stratified Licensing System: Informed by Singapore's 2022 policy[11], establish age-specific thresholds (e.g., 23–35 years) for SEF eligibility. Applicants exceeding 35 years should be required to provide ovarian reserve assessment reports (e.g., AMH and FSH levels), integrated with the AFA model (Anti-Müllerian Hormone-Follicle-Stimulating Hormone-Age assessment model) to quantify fertility potential[19], thereby mitigating excessive medicalization. Standardized Qualification Review: Building on Levi-Setti et al.'s study of complications in 23,827 oocyte retrieval procedures (a 0.76% complication rate significantly associated with operator experience)[13], mandate that medical institutions obtain vitrification technology certification. Operators must complete a minimum of 250 oocyte retrieval procedures prior to offering SEF services, and a nationally unified technical operation standard should be established. Development of a Multi-tiered Social Support System to Alleviate Economic and Medical Barriers The study reveals that 55.04% of respondents can only afford costs below 50,000 yuan, while 89.42% support government subsidies and 78.62% advocate for insurance coverage. Coordinated Fiscal and Medical Insurance Subsidies: Inspired by France's 2021 Bioethics Law, integrate egg freezing and retrieval costs into the medical insurance pool[20] (e.g., covering 60% of basic expenses). Provide additional fixed subsidies for low-income groups (annual income <80,000 yuan), and encourage enterprises to cover 30% of the costs as a benefit, aligning with 30.68% of respondents' expectations. Risk-sharing Mechanism: Develop insurance products tailored to egg freezing outcomes. Based on Crawford et al.'s 2013 study of U.S. egg freezing cycles (which found no significant difference in pregnancy rates between frozen and fresh eggs)[14], establish age-stratified compensation standards. For instance, women under 35 who fail to achieve pregnancy after freezing 20 oocytes would receive 70% compensation. Strengthening Technical Oversight and Ethical Governance to Mitigate Commercialization Risks A substantial majority of respondents (86.22%) expressed concerns regarding the potential misuse of reproductive technologies, while 68.89% advocated for policy reforms to standardize oocyte cryopreservation protocols. Implementation of Comprehensive Transparent Oversight: Drawing upon the 2020 UK Egg Freezing Guidelines[21], regulatory frameworks should mandate the disclosure of key performance metrics, including live birth rates per mature oocyte and complication rates such as the incidence of ovarian hyperstimulation syndrome. Furthermore, institutions must be prohibited from employing claims of "high success rates" for commercial promotion, consistent with Wilhoite et al.'s[7] findings on the risks of misleading patient consultations. Institutionalization of Routine Ethical Review Mechanisms: An interdisciplinary ethics committee should be established to evaluate the following critical aspects: The medical necessity of oocyte cryopreservation for single women, with particular attention to non-medical indications;Standardized protocols for the disposition of unused oocytes, requiring explicit consent for donation, research, or destruction;Enforcement of prohibitions on commercial transactions involving oocyte banks, in alignment with the anti-commercialization provisions outlined in the 2017 Global Egg Freezing Guidelines[22]。 Promoting Fertility Education and Workplace Support to Mitigate Structural Contradictions A significant proportion of respondents (70.81%) indicated limited understanding of egg freezing policies, reporting familiarity without detailed comprehension, while 78.48% perceived egg freezing as a potential strategy to mitigate mate selection pressures. These findings underscore critical gaps in societal awareness and persistent workplace fertility-related conflicts. Lifespan Fertility Education: Building on Hafezi et al.'s investigation into Iranian women's knowledge of egg freezing, which revealed that only 6.9% accurately identified the success rate of freezing at age 35[12], it is imperative to integrate "fertility awareness courses" into secondary and tertiary education curricula. Leveraging the AFA model[19], the development of online assessment tools is recommended to provide individuals with personalized insights into the correlations between age, egg count, and success rates。 Workplace Support Policy Coordination: Organizations should be encouraged to implement "flexible fertility leave" policies, offering women 10 days of paid recovery leave surrounding egg freezing procedures. Additionally, measures must be enacted to prohibit workplace discrimination against employees pursuing egg freezing, as highlighted by De Proost et al.'s critique of "individualized solutions that perpetuate workplace gender inequality" [20]。 Policy Innovation in Pilot Zones for Localized Experience Accumulation Implementation Strategies: Urban Pilot Initiative: The "Standardized Pilot Program for Oocyte Cryopreservation Services" will be implemented in major metropolitan areas, including Beijing, Shanghai, Guangzhou, and Shenzhen, to establish a comprehensive service framework encompassing "clinical assessment-cryopreservation-assisted reproduction" processes. Digital Monitoring Platform: A national oocyte cryopreservation information registry will be established to systematically document critical parameters, including donor age, ovarian reserve biomarkers, and utilization rates, thereby facilitating evidence-based policy optimization[22]. Interdisciplinary Coordination Framework: Adopting the UK's 2020 multidisciplinary guideline development paradigm, the National Health Commission will spearhead a collaborative effort involving the All-China Women's Federation, the Ministry of Human Resources and Social Security, and other relevant stakeholders to formulate the "Regulatory Guidelines for Oocyte Cryopreservation Services for Unmarried Women," ensuring an equilibrium between medical indications and reproductive autonomy[21] . Key Breakthrough Directions Evidence-Based Policy Translation: The empirical finding of 68.89% policy endorsement rate should be leveraged to facilitate local legislative initiatives. This process should incorporate evidence from Singapore's successful policy revision model, while maintaining a regulatory framework characterized by "limited accessibility with stringent oversight" to ensure policy specificity and effectiveness[11]. The empirical findings and practical considerations of this study suggest the implementation of a phased strategic framework for advancing policy reforms regarding social egg freezing (SEF) among single women: During the initial phase (1-3 years), implementation should prioritize the establishment of pilot programs in metropolitan areas with robust medical infrastructure (e.g., Beijing and Shanghai, which represented 56.89% of the study cohort). These initiatives should leverage existing assisted reproductive technology facilities to develop a comprehensive service framework, with particular emphasis on longitudinal monitoring of key metrics including SEF utilization rates, oocyte thawing success rates, and subsequent pregnancy outcomes. This approach will address the inherent limitations of cross-sectional study designs while generating empirical evidence to inform policy refinement. In the intermediate phase (3-5 years), resource allocation should be optimized based on pilot program data analysis. Considering the significant association between age and SEF receptivity (OR=1.725), an age-stratified service prioritization model focusing on women aged ≥35 years should be implemented. Concurrently, in light of the 89.42% endorsement rate for government subsidies observed in this study, a comprehensive fiscal impact analysis should be conducted to evaluate the sustainability of varying subsidy levels (30%-60%), thereby ensuring an equilibrium between societal demands and public expenditure. Risk Prevention Focus: Address the surgical risks of concern to 87.86% of respondents by mandating institutions to provide pre-operative complication disclosures (e.g., bleeding and infection rates) and offering 24-hour post-operative follow-up[13]. The proposed recommendations are empirically derived from the quantitative findings of this study, substantiated by international evidence, and designed to formulate a comprehensive egg-freezing policy framework that aligns with China's sociocultural context. This framework seeks to protect the reproductive autonomy of single women while addressing potential technological misuse and associated societal risks. Declarations a.Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of Shanghai Tenth People's Hospital (Approval Number: SHSY-IEC-6.0/25KY23/P01, approved on July 21, 2025). A waiver of informed consent was granted by the same board due to the anonymous nature of the survey and the low risk to participants. b.Consent for publication Not applicable. This study uses de-identified data, and no individual participant data is published. c.Availability of data and materials The data used in this study are available at the Dryad digital repository at https://doi.org/10.5061/dryad.wpzgmsc1t. Data Sharing Statement: Temporary link for review: http://datadryad.org/share/1LXclOR9CqmLo4kFUjX0huwi2QPe2-07GNMn1o01RSI. The questionnaire used in this study is available as Supplementary File 1. d.Competing interests All authors declare no financial or personal relationships with any for-profit or not-for-profit third parties that could influence the design, conduct, or reporting of this work. Specifically, there are no disclosures related to employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, or other funding (beyond the stated grant from the Shanghai Municipal Health Commission, Grant No.: 2024WF07) within the past 36 months. Disclosure for each author: "None". e.Funding The funding from the Shanghai Municipal Health Commission (Grant No.: 2024WF07) provided crucial financial support for the smooth progress of the research. It covered essential expenses such as data collection, sample analysis, labor costs for researchers, and academic exchanges. This ensured the orderly advancement of all tasks during the research process and laid a material foundation for the generation of research results. f.Authors' contributions All authors have fulfilled the authorship criteria established by the International Committee of Medical Journal Editors (ICMJE). Kunming Li (First Author): Conceptualized and designed the study; formulated the research protocol and questionnaire; oversaw data collection and analysis; drafted and revised the manuscript. Jinli Wang (Co-first Author): Contributed to the study design; coordinated data collection across multiple sites; conducted statistical analyses, including binary logistic regression; participated in manuscript preparation and critical revision. Fei Shi (Corresponding Author): Provided overarching supervision of the research project; secured funding; interpreted critical findings; rigorously revised the manuscript for intellectual content; finalized the submission and assumes responsibility for all aspects of the work. All authors have reviewed and approved the final manuscript, and collectively affirm their accountability for ensuring that any issues related to the accuracy or integrity of the work are thoroughly investigated and resolved. References Han Q, Dang J, Wu Y, Ye W: Childlessness and its associated factors among Chinese women: a nationwide population-based study . BMC Public Health 2025, 25 (1):638. Li H, Nawsherwan, Fan C, Mubarik S, Nabi G, Ping YX: The trend in delayed childbearing and its potential consequences on pregnancy outcomes: a single center 9-years retrospective cohort study in Hubei, China . BMC Pregnancy Childbirth 2022, 22 (1):514. Zhao Y, Fu H: Social Egg Freezing for Single Women in China: Legal and Ethical Controversies . Risk Manag Healthc Policy 2023, 16 :2379-2389. Mature oocyte cryopreservation: a guideline . Fertil Steril 2013, 99 (1):37-43. Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, Barri P, Diedrich K: Oocyte cryopreservation for age-related fertility loss . Hum Reprod 2012, 27 (5):1231-1237. ACOG: Committee Opinion No. 584: oocyte cryopreservation . Obstet Gynecol 2014, 123 (1):221-222. Wilhoite MN, Warwar RE, Starostanko AN, Sax MR: Analysis of the Literature and Patient Counseling Considerations for Planned Oocyte Cryopreservation . Obstet Gynecol 2022, 140 (1):102-105. Lahoti U, Pajai S, Shegekar T, Juganavar A: Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts . Cureus 2023, 15 (10):e47956. Cascante SD, Berkeley AS, Licciardi F, McCaffrey C, Grifo JA: Planned oocyte cryopreservation: the state of the ART . Reprod Biomed Online 2023, 47 (6):103367. Jones BP, Kasaven L, L'Heveder A, Jalmbrant M, Green J, Makki M, Odia R, Norris G, Bracewell Milnes T, Saso S et al : Perceptions, outcomes, and regret following social egg freezing in the UK; a cross-sectional survey . Acta Obstet Gynecol Scand 2020, 99 (3):324-332. Chin AHB: Singapore needs to update regulation of frozen egg donation after permitting social egg freezing . J Assist Reprod Genet 2022, 39 (7):1497-1500. Hafezi M, Zameni N, Nemati Aghamaleki SZ, Omani-Samani R, Vesali S: Awareness and attitude toward oocyte cryopreservation for non-medical reasons: a study on women candidates for social egg freezing . J Psychosom Obstet Gynaecol 2022, 43 (4):532-540. Levi-Setti PE, Cirillo F, Scolaro V, Morenghi E, Heilbron F, Girardello D, Zannoni E, Patrizio P: Appraisal of clinical complications after 23,827 oocyte retrievals in a large assisted reproductive technology program . Fertil Steril 2018, 109 (6):1038-1043.e1031. Crawford S, Boulet SL, Kawwass JF, Jamieson DJ, Kissin DM: Cryopreserved oocyte versus fresh oocyte assisted reproductive technology cycles, United States, 2013 . Fertil Steril 2017, 107 (1):110-118. De Proost M, Coene G, Nekkebroeck J, Provoost V: Beyond individualisation: towards a more contextualised understanding of women's social egg freezing experiences . J Med Ethics 2022, 48 (6):386-390. Chehimi M, Boursier A, Lefebvre-Khalil V, Decanter C, Keller L, Fournier V, Barbotin AL: Sociodemographic profile of women seeking elective egg freezing when financed by the public healthcare system . Reprod Biomed Online 2025, 50 (5):104705. Katsani D, Paraschou N, Panagouli E, Tsarna E, Sergentanis TN, Vlahos N, Tsitsika A: Social Egg Freezing-A Trend or Modern Reality? J Clin Med 2024, 13 (2). Mintziori G, Veneti S, Kolibianakis EM, Grimbizis GF, Goulis DG: Egg freezing and late motherhood . Maturitas 2019, 125 :1-4. Xu H, Shi L, Feng G, Xiao Z, Chen L, Li R, Qiao J: An Ovarian Reserve Assessment Model Based on Anti-Müllerian Hormone Levels, Follicle-Stimulating Hormone Levels, and Age: Retrospective Cohort Study . J Med Internet Res 2020, 22 (9):e19096. De Proost M, Johnston M: The revision of the French bioethics law and the questions it raises for the future of funding for egg freezing . Reprod Biomed Online 2022, 44 (4):591-593. Anderson RA, Davies MC, Lavery SA: Elective Egg Freezing for Non-Medical Reasons: Scientific Impact Paper No. 63 . Bjog 2020, 127 (9):e113-e121. Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, Vanderpoel S, Racowsky C: Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance . Hum Reprod Update 2017, 23 (2):139-155. Tables Table 1 Sociodemographic characteristics of the study population(n=1408) Geographical Distribution First-tier cities 801 56.89% New first-tier cities 347 24.64% Second-tier & other cities 260 18.47% Age Groups 18-28 years 1018 72.30% 29-35 years 317 22.51% 36 years and above 73 5.18% Occupational Categories Students 363 25.78% Ordinary enterprise employees 544 38.64% Enterprise managers 221 15.70% Other professions 280 19.88% Educational Attainment Bachelor's degree and above 1181 83.88% Junior college 176 12.50% High school and below 51 3.62% Annual Income Levels Below CNY 80,000 644 45.74% CNY 80,000-150,000 423 30.05% Above CNY 150,000 254 18.04% Not disclosed 87 6.18% Table 2. Multivariable Logistic Regression Analysis of Factors Associated with Egg Freezing Willingness (n=1408) Variable β SE OR 95% CI P-value Demographic factors City level† -0.01 0.082 0.99 0.844-1.162 0.905 Age‡ 0.545 0.108 1.725 1.397-2.129 <0.001 Occupation§ -1.042 0.714 0.353 0.087-1.429 0.144 Socioeconomic factors Educational attainment¶ 0.305 0.106 1.356 1.102-1.669 0.004 Annual income‖ 0.087 0.031 1.091 1.028-1.158 0.004 Policy and cost perceptions Awareness of egg freezing policy** 1.195 0.122 3.305 2.601-4.200 <0.001 Psychological tolerance of cost†† 0.342 0.099 1.407 1.160-1.707 0.001 Footnotes: β: regression coefficient; SE: standard error; OR: odds ratio; CI: confidence interval † City level: 1=Tier-1 cities, 2=New tier-1 cities, 3=Tier-2 cities, 4=Tier-3 and below ‡ Age groups: 1=18-22, 2=23-28, 3=29-35, 4=36-45, 5=46-55, 6=>55 years § Occupation: 1=Non-medical students, 2=Medical students, 3=Enterprise employees, 4=Managers, 5=Civil servants, 6=Healthcare workers, 7=Educators, 8=Legal professionals, 9=Freelancers, 10=Retirees, 11=Emerging professions, 12=Others ¶ Education: 1=Junior high, 2=High school, 3=College, 4=Bachelor, 5=Master, 6=PhD ‖ Annual income (CNY): 1=300k, 9=Undisclosed ** Policy awareness: 4=Very familiar, 3=Basically familiar, 2=Heard but unclear, 1=Uncertain †† Cost tolerance (CNY): 1=150k Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 Sep, 2025 Reviewers invited by journal 10 Sep, 2025 Editor assigned by journal 09 Sep, 2025 Editor invited by journal 20 Aug, 2025 Submission checks completed at journal 19 Aug, 2025 First submitted to journal 19 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":51782,"visible":true,"origin":"","legend":"\u003cp\u003eillustrates the participant enrollment process. The Wenjuanxing platform initially targeted 12,788 users, yielding 1,744 returned questionnaires. Following the exclusion of 506 ineligible responses, 1,238 valid questionnaires were retained. These were subsequently combined with 170 additional participants recruited through alternative sources, resulting in a final sample size of N=1,408.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7388275/v1/98900ff9e62187a215c1223b.png"},{"id":91827310,"identity":"cd3b3e2a-a441-48e2-a701-1810b2473cfe","added_by":"auto","created_at":"2025-09-22 08:46:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2051241,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7388275/v1/70f6885d-42ed-4ac6-a4da-9515f55dae48.pdf"},{"id":91827294,"identity":"f1c5a23f-d250-478c-b4dd-ee4612bbe385","added_by":"auto","created_at":"2025-09-22 08:46:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19825,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7388275/v1/cf7bb8762d6397ed5d8d47b4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social egg freezing among Single Women in China: Policy Perceptions, Attitudes, and Influencing Factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn modern society, the phenomenon of delayed childbearing among women, driven by career advancement, educational pursuits, and shifting marital ideologies, has become increasingly prevalent. China's total fertility rate has exhibited a consistent decline, decreasing from 1.22 in 2000 to 1.07 in 2022[1]. Concurrently, the proportion of first-time mothers aged 35 and above has risen significantly, from 8.65% in 2004 to 17.04% in 2014[2]. This trend of postponed childbearing presents a conflict with women's aspirations for reproductive autonomy. SEF, as a method of fertility preservation, offers a theoretical solution to mitigate age-related fertility decline; however, its implementation remains constrained by policy restrictions in China[3].\u003c/p\u003e\u003cp\u003e In 2013, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) jointly issued updated guidelines, classifying oocyte vitrification as a non-experimental clinical procedure based on substantial evidence of its efficacy. This reclassification was supported by data demonstrating comparable pregnancy rates between vitrified oocytes and fresh oocytes in in vitro fertilization (IVF), with no significant increase in chromosomal abnormalities or congenital anomalies, a position further endorsed by the American College of Obstetricians and Gynecologists (ACOG). Currently, this technology is clinically indicated for women at risk of infertility due to medical interventions such as oncological surgery, radiotherapy, or chemotherapy. However, for healthy women considering SEF solely to mitigate age-related fertility decline, the available medical evidence remains insufficient to justify its routine use. Consequently, in clinical practice, healthcare providers are obligated to comprehensively inform patients about the therapeutic uncertainties, potential risks, financial implications, and alternative options associated with SEF[4\u0026ndash;7]. While SEF is increasingly viewed as a potential strategy to reconcile reproductive autonomy with societal roles, its broader implementation continues to encounter significant ethical, legal, and sociocultural challenges[8]. Globally, substantial variations exist in the legal and policy frameworks governing SEF for single women across different jurisdictions. In the United States, SEF is permitted for single women, though it lacks comprehensive federal legislation. The ASRM has endorsed its ethical acceptability, with most clinical institutions recommending the procedure be performed prior to the age of 38[9]。In the United Kingdom, SEF is regulated by the Human Fertilisation and Embryology Authority (HFEA), which imposes a maximum storage duration of 10 years for cryopreserved oocytes, mandating their disposal if unused beyond this period[10]。Notably, the Singaporean government has recently implemented a policy, effective from 2023, permitting women aged 21 to 35, irrespective of marital status, to undergo oocyte cryopreservation[11]. In China, the reproductive rights of single women and policy frameworks surrounding SEF remain in a developmental stage, with existing regulations imposing explicit restrictions on single women's access to cryopreservation services.\u003c/p\u003e\u003cp\u003eThe Chinese Ministry of Health, through Document No. 176 issued in 2003, explicitly prohibits medical institutions from providing assisted reproductive technology (ART) to unmarried women, a policy that was subsequently reaffirmed by the National Health Commission in its 2021 official response. Nevertheless, acknowledging the growing societal interest in SEF, the NHC has indicated its commitment to advancing the legislative framework for ART management, enhancing regulatory oversight, monitoring advancements in fertility preservation technologies, and cautiously promoting their clinical application to safeguard the health rights of women and their offspring. Within this policy context, high-profile cases such as the \"Xu Zaozao egg freezing case\" have highlighted the tension between regulatory constraints and individual reproductive autonomy, underscoring the institutional barriers single women face in accessing fertility preservation. Furthermore, these cases reveal a significant disparity between public perceptions, attitudes, and the policy support required for SEF technology[3]. The academic community has yet to systematically evaluate the cognitive characteristics, attitude formation mechanisms, and policy support needs of this demographic. This knowledge gap not only risks exacerbating the unregulated application of such technologies but also hinders the development of an evidence-based foundation for policy reform[12].\u003c/p\u003e\u003cp\u003eWhile international research on the ethical and technical dimensions of SEF has advanced, systematic investigations focusing on single women in China remain scarce. At the policy level, China restricts egg freezing to married women for medical indications, such as cancer treatment, creating a significant disparity between regulatory frameworks and societal demands. This discrepancy not only impedes single women's access to fertility preservation but also underscores the public's limited understanding of the safety, efficacy, and policy landscape surrounding egg freezing technology. Empirical research is urgently needed to inform evidence-based policy development and public education initiatives[3]. Existing studies predominantly focus on the egg freezing needs of individuals with medical conditions, such as cancer patients, while lacking robust quantitative analyses of SEF willingness, policy awareness, and influencing factors among single women[13]. Furthermore, there is no consensus on evaluating the potential societal impacts of egg freezing technology on labor markets, marriage dynamics, and population structures[14].\u003c/p\u003e\u003cp\u003e\"Policy adjustments require the integration of multi-dimensional evidence, including attitudinal data, technical feasibility, resource allocation, and long-term impacts. This cross-sectional study focuses on 'demand-side attitudes,' providing a baseline of social acceptance for policy reform. However, it should be combined with other evidence chains such as medical resource supply, cost-effectiveness, and international experiences to collectively support reform directions, including potential supporting measures like age-stratified regulation and medical insurance coverage mentioned in this study.\u003c/p\u003e\u003cp\u003eThis study aims to address these research gaps by investigating the policy awareness, attitudes, and needs of single women in China regarding SEF through a large-scale questionnaire survey. Specifically, it seeks to address three key questions: (1) What factors drive the willingness to pursue egg freezing? (2) How does policy awareness influence risk perception? (3) What constitutes the optimal pathway for social support system optimization? The findings will provide an empirical foundation for refining China's SEF policy framework and enhancing public education efforts, while offering novel insights into the socio-psychological mechanisms underlying modern women's reproductive decision-making [15]. By integrating technical feasibility, societal needs, and policy considerations into a multidimensional analysis, this study aims to reconcile reproductive autonomy with societal norms, thereby contributing to academic discourse and policy formulation in this field.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe study employed a targeted recruitment strategy utilizing the Wenjuanxing platform (https://www.wjx.cn/), which provides access to a sample library service comprising over 6.2 million real-name registered members. Data collection was conducted through self-administered online questionnaires distributed between March 18 and May 19, 2025. The platform facilitated sample matching based on predefined criteria, including gender (female), marital status (single), and geographic location. The study population was stratified based on geographic location, specifically targeting unmarried female residents from three distinct city classifications: first-tier cities (Beijing, Guangzhou, Shenzhen), emerging first-tier cities (Nanjing, Hangzhou, Chongqing, Changsha), and second-tier cities (Shenyang).To enhance participant recruitment, particularly targeting individuals from Shanghai as a first-tier city, the questionnaire was disseminated through multiple platforms. These included the official WeChat public account of Shanghai Tenth People\u0026apos;s Hospital, WeChat groups associated with the hospital\u0026apos;s Reproductive Medicine Center, the researcher\u0026apos;s personal Weibo account, and WeChat groups for students enrolled in the School of Transnational Law at Peking University Shenzhen Graduate School between 2019 and 2022.Participants independently completed a 30-item anonymous questionnaire without any direct involvement from the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Design and Content Framework\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed specifically for this study based on the framework of the Shanghai Health Law Research Project (Project No.: 2024WF07), which systematically evaluates three key dimensions: ethical considerations, legal frameworks, and social impact. It has not been published elsewhere.The English version of the questionnaire is available as Supplementary File 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInitial item generation was facilitated using the \u0026quot;Doubao\u0026quot; and \u0026quot;DeepSeek\u0026quot; systems, followed by a rigorous manual screening process to ensure alignment with the research objectives, during which 21 irrelevant items were eliminated. The original pool of 35 items was subsequently refined to 30 items. Content validity was assessed by a panel of experts specializing in reproductive medicine, legal affairs, and health management. Based on their evaluations of item relevance (average score: 4.2/5) and clarity (average score: 3.8/5), two items were revised to enhance their precision and alignment with the study\u0026apos;s aims. The final questionnaire encompasses four core dimensions:\u003c/p\u003e\n\u003cp\u003e1. Socio-demographic Variables: This section includes seven items assessing city of residence, gender, age, marital status, occupation, educational attainment, and annual income level. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Policy Awareness and Attitudes: This domain consists of ten items evaluating perspectives on egg freezing as a strategy to mitigate spouse selection pressure, considerations related to egg freezing, policy comprehension, legal awareness, and concerns regarding safety, potential risks, social value, service prioritization, cost tolerance, and cost-sharing entities for egg freezing technology. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Policy Implementation and Oversight: This section includes six items exploring support for revising egg freezing regulations, stakeholder interests to be considered during policy amendments, optimal regulatory frameworks, and the potential effects of egg freezing legalization on the labor market, delayed marriage and childbearing, and population structure. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Social Impact and Recommendations: This final domain comprises seven items addressing concerns about egg freezing for single women, regulatory priorities post-legalization, anticipated positive societal changes, the interplay between egg freezing technology dissemination and IVF, perspectives on medical insurance payment models, opinions on the trend of single women utilizing egg freezing for childbirth, and specific recommendations for policy improvement.\u003c/p\u003e\n\u003cp\u003eThe survey instrument comprised 30 multiple-choice questions, including 22 single-response items utilizing a 4-5 point Likert-type scale (e.g., the \u0026quot;policy awareness\u0026quot; domain was operationalized through four distinct categories: \u0026quot;very familiar\u0026quot;, \u0026quot;basically familiar\u0026quot;, \u0026quot;heard but unclear\u0026quot;, and \u0026quot;uncertain\u0026quot;, which directly informed the categorical variable analysis yielding \u0026quot;policy awareness OR=3.305\u0026quot; in the results section). The remaining 8 multiple-response questions incorporated 5-6 response options per item (e.g., the \u0026quot;social value of oocyte cryopreservation technology\u0026quot; dimension included response choices such as \u0026quot;ensuring reproductive autonomy\u0026quot; and \u0026quot;alleviating career-family conflicts\u0026quot;). Quantitative data, including the finding that \u0026quot;80.26% of respondents believe it can alleviate career-family conflicts\u0026quot;, were derived from frequency analyses of these response patterns. The survey design, incorporating both graded response scales for single-answer items and multi-dimensional options for multiple-response items, was methodologically aligned with the percentage-based data presentation and categorical variable processing in the results section, thereby facilitating robust analysis of participants\u0026apos; attitudinal orientations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Implementation and Data Quality Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed and administered using the Wenjuanxing platform, which incorporated a pre-screening mechanism through its \u0026quot;Sample Library Service\u0026quot; to restrict participation exclusively to single women. All data were processed with strict confidentiality, and no personally identifiable information was collectedThe survey was strategically distributed across eight major cities: Beijing, Guangzhou, Shenzhen, Nanjing, Hangzhou, Chongqing, Changsha, and Shenyang. The platform was programmed to collect 1,200 valid responses, with 224 responses targeted from each of Beijing, Guangzhou, and Shenzhen, and 103 responses from each of the remaining five cities. To optimize the response rate, the questionnaire was disseminated through multiple channels, including the paid sample library service of Wenjuanxing, the official WeChat public account of Shanghai Tenth People\u0026apos;s Hospital, the WeChat group of the hospital\u0026apos;s Reproductive Medicine Center, the WeChat group for faculty and students of the School of International Law at Peking University Shenzhen Graduate School, and the author\u0026apos;s personal Weibo account.\u003c/p\u003e\n\u003cp\u003eTo ensure the integrity and quality of the collected data, several rigorous quality control measures were implemented: (1) The \u0026quot;anti-repeated filling\u0026quot; function of Wenjuanxing was activated to prevent multiple submissions from the same IP address, device, or account; (2) A mandatory completion rule was enforced to ensure that all questions were answered before submission;The mandatory completion rule is implemented to maintain the logical coherence of the three-dimensional framework encompassing \u0026quot;ethical, legal, and social effects\u0026quot; (e.g., the policy cognition variable serves as a fundamental component in the analysis of social effects). This rule is designed to prevent the omission of critical variables that could compromise the validity of the multiple regression model.(3) Logical verification trap questions were embedded to identify and exclude perfunctory or malicious responses; (4) A minimum response time of 3 minutes was set to discourage hasty or insincere participation; (5) Data were systematically reviewed for rationality, with abnormal responses (e.g., students reporting an annual income exceeding 300,000 yuan or unmarried students over 55 years old) being excluded; (6) Responses exhibiting patterns of regularity (e.g., consistently selecting option A in single-choice questions) were flagged and invalidated; (7) Responses from regions not meeting the specified criteria were disqualified.\u003c/p\u003e\n\u003cp\u003eThe survey was distributed to a cohort of 12,788 registered users through the \u0026quot;Sample Library Service,\u0026quot; generating 1,744 completed responses, corresponding to an initial response rate of 9.60%. Following the exclusion of 506 invalid responses, 1,238 valid questionnaires were retained, resulting in an effective response rate of 71.00%. Additionally, 458 questionnaires were collected via supplementary channels, of which 288 were excluded as invalid, yielding 170 valid responses with an effective response rate of 37.12%. The comprehensive inclusion and exclusion process is depicted in Fig. 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study employed quantitative statistical methodologies for data analysis. Initial data processing and quality control measures were implemented, wherein valid samples were selected through the application of anti-duplication mechanisms, logical verification protocols, and a 3-minute response time threshold on the Wenjuanxing platform. Variables were subsequently categorized, grouped, and encoded for analysis. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were utilized to characterize sample attributes and attitude distributions. Binary logistic regression was conducted to examine factors influencing the willingness to undergo oocyte cryopreservation, with the decision to consider egg freezing serving as the dependent variable, and variables such as urban classification, age, and occupation as independent predictors. Regression coefficients, odds ratios, and 95% confidence intervals were calculated, with statistical significance defined at P \u0026lt; 0.05. The model was constructed using the ENTER method, with Nagelkerke R Square \u0026gt; 0.1, and the P-value of the Hosmer and Lemeshow Test goodness-of-fit test greater than 0.1.Statistical analysis was performed using IBM SPSS Statistics 26.0. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the demographic profile of the study cohort (n=1,408). The majority of participants resided in first-tier cities (Beijing, Shanghai, Guangzhou, Shenzhen), comprising 56.89% (n=801) of the sample, followed by new first-tier cities (24.64%, n=347) and second-tier or lower-tier cities (18.47%, n=260). Age distribution analysis revealed that the 18\u0026ndash;28-year-old cohort constituted the largest proportion (72.30%, n=1,018), while the 29\u0026ndash;35-year-old and \u0026ge;36-year-old groups accounted for 22.51% (n=317) and 5.18% (n=73), respectively. Occupational distribution indicated that non-managerial employees in sectors such as manufacturing, services, and internet industries represented the highest proportion (38.64%, n=544), followed by students (25.78%, n=363), other professionals (19.89%, n=280), and enterprise managers (15.70%, n=221). Educational attainment was notably high, with 83.88% (n=1,181) of participants holding a bachelor\u0026rsquo;s degree or higher, 12.50% (n=176) possessing a junior college diploma, and 3.62% (n=51) having a high school education or less. Annual income distribution showed that 45.74% (n=644) of participants earned less than 80,000 CNY, 30.05% (n=423) earned between 80,000 and 150,000 CNY, and 18.04% (n=254) exceeded 150,000 CNY, while 6.18% (n=87) declined to disclose their income. The sample structure reflects a predominance of first-tier city residents, younger individuals, highly educated backgrounds, and non-managerial corporate employees. The income distribution, characterized by a high proportion of lower-income individuals, aligns with the substantial representation of students and early-career professionals in the sample (combined \u0026gt;80%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerception and attitudes \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors influencing egg freezing decisions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 1,408 respondents, 34.94% (n=492) reported having considered oocyte cryopreservation, while 40.41% (n=569) explicitly stated they had not considered it, and 24.64% (n=347) expressed uncertainty. A multivariate logistic regression model was constructed incorporating key variables, including geographic location, age, occupation, educational attainment, annual income, awareness of China\u0026apos;s current oocyte cryopreservation policies, and psychological cost tolerance thresholds, as detailed in Table 2. The analysis revealed several statistically significant predictors of oocyte cryopreservation consideration: advancing age (OR=1.725, 95%CI 1.397-2.129, P\u0026lt;0.001), higher educational attainment (OR=1.356, 95%CI 1.102-1.669, P=0.004), increased annual income (OR=1.091, 95%CI 1.028-1.158, P=0.004), awareness of current oocyte cryopreservation policies (OR=3.305, 95%CI 2.601-4.200, P\u0026lt;0.001), and greater psychological cost tolerance (OR=1.407, 95%CI 1.16-1.707, P=0.001) were all positively associated with the likelihood of considering oocyte cryopreservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTechnical cognition and perception of fertility pressure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative analysis revealed that 78.48% (n=1119/1408) of participants perceived oocyte cryopreservation as a potential intervention for alleviating short-term marital selection pressure among unmarried women. Within this cohort, 36.51% (n=514/1408) evaluated the technology\u0026apos;s efficacy as \u0026quot;substantially effective,\u0026quot; while 42.97% (n=605/1408) characterized its impact as \u0026quot;moderately effective.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy cognition and legal attitude \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA substantial majority of respondents (70.81%, 997/1408) reported familiarity with the egg freezing policy but lacked detailed understanding, while only 2.84% (40/1408) demonstrated comprehensive knowledge. A moderate proportion (16.69%, 235/1408) indicated a basic understanding, and 9.66% (136/1408) expressed uncertainty, highlighting a significant gap in public awareness of the policy. In terms of legal attitudes, 60.3% (849/1408) supported the implementation of specific eligibility criteria (e.g., age and health status) for single women seeking egg freezing, whereas 32.6% (459/1408) advocated for unrestricted access. A minority (2.63%, 37/1408) opposed the policy, arguing that it should be limited to married couples, and 4.47% (63/1408) remained undecided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTechnical Risk and Social Value Cognition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey revealed that 87.86% (1237/1408) of respondents expressed concerns regarding the potential health risks associated with egg freezing procedures, particularly ovarian hyperstimulation syndrome. Moreover, 79.19% (1115/1408) demonstrated awareness of the long-term implications of cryopreservation on oocyte quality, while 70.38% (991/1408) indicated apprehension about the efficacy of the freezing and thawing processes. In contrast, 86.51% (1218/1408) perceived the primary societal benefit of egg freezing as safeguarding female reproductive autonomy. Additionally, 80.26% (1130/1408) viewed the procedure as a potential solution to mitigate the conflict between professional aspirations and childbearing, 40.34% (568/1408) considered it a means to advance gender equality, and 52.56% (740/1408) believed it could facilitate the establishment of non-traditional family structures in reproductive contexts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCost tolerance and policy support needs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey revealed distinct patterns in cost tolerance for egg freezing, with 55.04% (775/1408) of participants reporting a psychological threshold below 50,000 yuan, while 36.79% (518/1408) expressed acceptance for costs ranging between 50,000 and 100,000 yuan. A smaller proportion, 7.03% (99/1408), indicated willingness to pay between 100,000 and 150,000 yuan, and only 1.14% (16/1408) were prepared to exceed 150,000 yuan. Regarding cost-sharing mechanisms, the majority of respondents (89.42%; 1259/1408) advocated for government financial subsidies, 78.62% (1107/1408) supported inclusion in medical insurance coverage, and 30.68% (432/1408) anticipated corporate benefits to cover the expenses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy Revision and Regulatory Suggestions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA substantial majority of respondents (68.89%, 970/1408) expressed support for revising existing regulations to permit single women to undergo oocyte cryopreservation. Among these, 24.29% (342/1408) demonstrated full endorsement, while 44.60% (628/1408) advocated for standardized implementation. A neutral position was maintained by 27.91% (393/1408), whereas 2.63% (37/1408) expressed opposition, 0.36% (5/1408) were strongly opposed, and 0.21% (3/1408) remained undecided. Concerning regulatory frameworks, 78.98% (1112/1408) favored a government-led oversight mechanism for oocyte cryopreservation technology, with 87.14% (1227/1408) emphasizing the necessity of rigorous qualification assessments for medical institutions. Additionally, 86.22% (1214/1408) raised concerns regarding potential misuse and inadequate supervision, particularly highlighting risks associated with profit-driven commercial entities and illicit transactions. In terms of policy revision priorities, 84.38% (1188/1408) identified the fertility preservation needs of older single women as a critical focus, 79.55% (1120/1408) emphasized the need to address the career-childbearing balance for professional women, and 68.25% (961/1408) underscored the importance of addressing medical indications, such as conditions that compromise fertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness of social and demographic impacts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey revealed that 84.38% (1188/1408) of respondents perceived the legalization of oocyte cryopreservation as a means to safeguard women\u0026apos;s reproductive autonomy, while 82.32% (1159/1408) considered it a potential solution to mitigate the conflict between professional development and childbearing. Furthermore, 78.48% (1105/1408) believed this technology could enhance female labor force participation. However, 65.41% (921/1408) anticipated that oocyte cryopreservation might lead to delayed childbearing age and a consequent short-term decline in birth rates, with 46.24% (651/1408) agreeing that it could contribute to the trend of late marriage and childbearing. Additionally, 60.44% (851/1408) expressed concerns that the rising proportion of advanced maternal age primiparas might accelerate population aging, while 54.47% (767/1408) were apprehensive about the potential for gender ratio imbalance resulting from the combination of oocyte cryopreservation and gender selection technologies. Notably, 64.49% (908/1408) believed that single women utilizing oocyte cryopreservation for childbearing could lead to an increase in single-parent families and non-traditional family structures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitudes towards childbearing by single women through egg freezing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey revealed that 52.63% (741/1408) of respondents endorsed the use of egg freezing technology by single women to conceive, perceiving it as a manifestation of reproductive autonomy. A substantial proportion, 41.76% (588/1408), adopted a neutral position while emphasizing the importance of the children\u0026apos;s developmental environment. Conversely, 4.62% (65/1408) expressed reservations, 0.78% (11/1408) opposed the practice, and 0.21% (3/1408) held alternative perspectives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Policy and Technology Correlation Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical Insurance Payment Preferences: The survey revealed that 85.51% (1204/1408) of respondents favored proportional reimbursement, while 62.71% (883/1408) expressed support for implementing special subsidies targeting the working population.\u003c/p\u003e\n\u003cp\u003eRegulatory Priorities: Analysis of respondent feedback identified four key regulatory focus areas: 87.14% (1227/1408) emphasized the necessity of rigorous qualification assessments for medical institutions, 86.36% (1216/1408) highlighted the importance of compliance in oocyte disposal protocols, 86.01% (1211/1408) prioritized the prevention of technological misuse, particularly in cases of gender selection, and 78.98% (1112/1408) stressed the need for transparent cost disclosure in oocyte cryopreservation procedures.\u003c/p\u003e\n\u003cp\u003ePolicy Recommendations: Regarding policy development, 90.2% (1270/1408) of participants supported the implementation of a standardized national technical framework, while 78.41% (1104/1408) proposed the establishment of an independent ethical review committee to oversee related practices.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eMain research findings and academic dialogue \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study investigates the multifaceted determinants influencing decisions regarding SEF and the current state of policy awareness among single women in China, utilizing data from a survey of 1,408 participants. The results demonstrate that advanced age (OR=1.725), higher educational attainment (OR=1.356), and increased annual income (OR=1.091) are significantly correlated with a greater propensity to pursue egg freezing. These findings are consistent with international research indicating that professional women often consider egg freezing as a strategy to reconcile reproductive aspirations with career progression[12, 15].Notably, women with a comprehensive understanding of the existing egg freezing policy exhibited a significantly higher likelihood of considering the procedure (OR=3.305). However, 70.81% of respondents reported having \u0026quot;heard of the policy but lacked detailed knowledge,\u0026quot; highlighting a substantial disparity between policy dissemination and public comprehension[8]. This discrepancy may stem from the restrictive provisions for single women outlined in China\u0026apos;s 2003 \u0026quot;Human ART Specifications,\u0026quot; which appear misaligned with contemporary societal demands. These findings present a cross-cultural divergence from research conducted in France, where approximately 89.4% of women perceive inadequate public awareness regarding SEF, and 72.2% of those opting for SEF are single, primarily motivated by the absence of suitable partners[16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026quot;Notably, the high public support for financial subsidies (89.42%) and medical insurance coverage (78.62%) identified in this study aligns with China\u0026rsquo;s ongoing pilot programs integrating in vitro fertilization (IVF) into medical insurance in several provinces. This convergence suggests that extending similar coverage to SEF could leverage existing healthcare reform momentum, enhancing both social acceptance and institutional continuity\u0026mdash;key indicators of policy feasibility.\u003c/p\u003e\n\u003cp\u003eFurthermore, the strong emphasis on rigorous qualification assessments for medical institutions (87.14%) resonates with China\u0026rsquo;s current infrastructure: over 500 medical facilities are already licensed to provide assisted reproductive technologies. By adopting Singapore\u0026rsquo;s model of \u0026apos;qualification certification plus technical standardization\u0026apos;[11], eligible institutions could be selected from this existing network to deliver SEF services, avoiding the need for building a new system from scratch and thus ensuring short-term operational feasibility.\u0026quot;\u003c/p\u003e\n\u003cp\u003eEmpirical evidence from international contexts demonstrates that cross-sectional survey data on public attitudes can provide a valuable preliminary foundation for policy reform initiatives. A case in point is Singapore\u0026apos;s approach to revising its social egg freezing policy for single women in 2023. Prior to implementing this policy change, the government initiated a comprehensive year-long program, the \u0026quot;Singapore Women\u0026apos;s Development Dialogue,\u0026quot; which engaged nearly 6,000 participants through more than 160 structured dialogue sessions. The systematic collection and analysis of participant feedback and insights during this initiative served as critical empirical evidence informing the subsequent policy formulation. While cross-sectional survey data alone may not be sufficient to determine specific policy directions, when integrated with complementary evidence sources, it can significantly contribute to evidence-based policy reform processes.\u003c/p\u003e\n\u003cp\u003eRegarding technical cognition, 78.48% of participants perceived oocyte cryopreservation as a potential strategy to mitigate short-term partner selection pressure, while 87.86% expressed concerns regarding associated surgical health risks, aligning with the ongoing global debate surrounding the safety profile of this technology[8, 17]. Concurrently, 86.51% acknowledged the role of oocyte cryopreservation in safeguarding reproductive autonomy, with 68.89% endorsing policy reform, thereby underscoring the pressing demand for reproductive self-determination among unmarried women. These findings establish a cross-cultural parallel with a British study reporting that \u0026quot;91% of women expressed no regret regarding their decision to undergo oocyte cryopreservation,\u0026quot; thereby emphasizing the psychological significance of this technology as a form of \u0026quot;reproductive insurance\u0026quot;[10]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is imperative to acknowledge the internationally recognized limitations regarding the efficacy of Social Egg Freezing (SEF) in enhancing fertility rates. Empirical evidence from European and American contexts, where SEF has been implemented, reveals that the utilization rate of cryopreserved oocytes remains as low as 12%[7, 18], suggesting that the majority of frozen eggs do not culminate in actual reproductive outcomes, thereby constraining their impact on macro-level fertility enhancement.\u003c/p\u003e\n\u003cp\u003eWhile this investigation identified that 34.94% of unmarried women exhibit a favorable disposition towards SEF, with 78.48% perceiving it as a mechanism to mitigate short-term mate-selection pressures, these attitudinal metrics do not substantiate the assertion that \u0026quot;SEF effectively augments fertility rates.\u0026quot; The decision to undergo oocyte cryopreservation is predominantly driven by the desire to preserve reproductive autonomy (e.g., 52.63% endorse single women utilizing SEF for childbearing) rather than an inevitable progression towards actualized fertility.\u003c/p\u003e\n\u003cp\u003eFurthermore, 87.86% of participants expressed concerns regarding surgical risks, and 55.04% indicated a cost threshold below 50,000 yuan, factors that may further diminish the practical utilization of SEF.\u003c/p\u003e\n\u003cp\u003eConsequently, the principal value of SEF is more plausibly situated in \u0026quot;ensuring individual reproductive autonomy\u0026quot; (e.g., 86.51% affirm its role in safeguarding women\u0026apos;s reproductive rights) rather than serving as a primary strategy to counteract declining fertility rates. Policy adjustments should be grounded in this reality, emphasizing the \u0026quot;fulfillment of reasonable reproductive needs\u0026quot; rather than overestimating its direct influence on demographic structural improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Limitations and Future Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026apos;s sample composition demonstrates significant demographic bias, primarily attributable to constrained research funding. Specifically, 72.30% of participants were aged between 18 and 28 years, while 56.89% resided in first-tier cities. This skewed distribution consequently led to inadequate representation of both older single women and populations from lower-tier cities, potentially limiting the generalizability of the findings.Recruitment through hospital WeChat groups and law school cohorts introduced selection bias, as participants from medical contexts exhibited heightened risk awareness (87.86% expressed concern about surgical risks), while law students disproportionately emphasized legal rights (60.3% supported conditional eligibility). The questionnaire design included leading questions (e.g., \u0026quot;relieves spousal pressure\u0026quot;) and employed simplistic measurements (e.g., one-time cost tolerance below 50,000 CNY reported by 55.04% of respondents), which compromised data accuracy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFuture research should prioritize stratified sampling based on age, occupation, and city tier to enhance representativeness, alongside the adoption of validated scales and Likert measures to capture nuanced attitudinal variations. Longitudinal studies are essential to monitor the policy\u0026apos;s impact on fertility rates and family structures, while ethical analyses should focus on modeling age-stratified regulatory frameworks and insurance coverage, informed by international best practices. A mixed-method approach integrating quantitative surveys with qualitative interviews is recommended to provide deeper insights into the contextual factors influencing decision-making processes.\u003c/p\u003e\n\u003cp\u003eThe attitudinal data presented in this study constitute a necessary yet insufficient condition for informing policy changes. To establish a comprehensive evidence base, future research should integrate longitudinal cohort studies to track fertility behaviors following oocyte cryopreservation, conduct cost-effectiveness analyses to evaluate financial implications such as healthcare insurance burdens, and incorporate qualitative interviews with key stakeholders, including healthcare providers and policymakers. Such a multifaceted approach would yield a robust evidentiary framework to guide policy development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy suggestions and practical inspirations \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrawing upon the empirical findings of this study and international best practices, the following policy and practice recommendations are proposed for SEF among single women in China, with the objective of harmonizing individual reproductive autonomy with societal public interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEstablish a regulatory mechanism with age stratification and qualification review \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study demonstrates that age is a significant determinant of egg freezing intention (OR=1.725), with a marked decline in success rates for women over 35 years. Furthermore, 84.38% of respondents advocate prioritizing fertility preservation for older single women.\u003c/p\u003e\n\u003cp\u003eAge-Stratified Licensing System: Informed by Singapore\u0026apos;s 2022 policy[11], establish age-specific thresholds (e.g., 23\u0026ndash;35 years) for SEF eligibility. Applicants exceeding 35 years should be required to provide ovarian reserve assessment reports (e.g., AMH and FSH levels), integrated with the AFA model (Anti-M\u0026uuml;llerian Hormone-Follicle-Stimulating Hormone-Age assessment model) to quantify fertility potential[19], thereby mitigating excessive medicalization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStandardized Qualification Review: Building on Levi-Setti et al.\u0026apos;s study of complications in 23,827 oocyte retrieval procedures (a 0.76% complication rate significantly associated with operator experience)[13], mandate that medical institutions obtain vitrification technology certification. Operators must complete a minimum of 250 oocyte retrieval procedures prior to offering SEF services, and a nationally unified technical operation standard should be established.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevelopment of a Multi-tiered Social Support System to Alleviate Economic and Medical Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study reveals that 55.04% of respondents can only afford costs below 50,000 yuan, while 89.42% support government subsidies and 78.62% advocate for insurance coverage.\u003c/p\u003e\n\u003cp\u003eCoordinated Fiscal and Medical Insurance Subsidies: Inspired by France\u0026apos;s 2021 Bioethics Law, integrate egg freezing and retrieval costs into the medical insurance pool[20] (e.g., covering 60% of basic expenses). Provide additional fixed subsidies for low-income groups (annual income \u0026lt;80,000 yuan), and encourage enterprises to cover 30% of the costs as a benefit, aligning with 30.68% of respondents\u0026apos; expectations.\u003c/p\u003e\n\u003cp\u003eRisk-sharing Mechanism: Develop insurance products tailored to egg freezing outcomes. Based on Crawford et al.\u0026apos;s 2013 study of U.S. egg freezing cycles (which found no significant difference in pregnancy rates between frozen and fresh eggs)[14], establish age-stratified compensation standards. For instance, women under 35 who fail to achieve pregnancy after freezing 20 oocytes would receive 70% compensation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengthening Technical Oversight and Ethical Governance to Mitigate Commercialization Risks\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA substantial majority of respondents (86.22%) expressed concerns regarding the potential misuse of reproductive technologies, while 68.89% advocated for policy reforms to standardize oocyte cryopreservation protocols.\u003c/p\u003e\n\u003cp\u003eImplementation of Comprehensive Transparent Oversight: Drawing upon the 2020 UK Egg Freezing Guidelines[21], regulatory frameworks should mandate the disclosure of key performance metrics, including live birth rates per mature oocyte and complication rates such as the incidence of ovarian hyperstimulation syndrome. Furthermore, institutions must be prohibited from employing claims of \u0026quot;high success rates\u0026quot; for commercial promotion, consistent with Wilhoite et al.\u0026apos;s[7] findings on the risks of misleading patient consultations. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInstitutionalization of Routine Ethical Review Mechanisms: An interdisciplinary ethics committee should be established to evaluate the following critical aspects: The medical necessity of oocyte cryopreservation for single women, with particular attention to non-medical indications;Standardized protocols for the disposition of unused oocytes, requiring explicit consent for donation, research, or destruction;Enforcement of prohibitions on commercial transactions involving oocyte banks, in alignment with the anti-commercialization provisions outlined in the 2017 Global Egg Freezing Guidelines[22]。\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePromoting Fertility Education and Workplace Support to Mitigate Structural Contradictions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant proportion of respondents (70.81%) indicated limited understanding of egg freezing policies, reporting familiarity without detailed comprehension, while 78.48% perceived egg freezing as a potential strategy to mitigate mate selection pressures. These findings underscore critical gaps in societal awareness and persistent workplace fertility-related conflicts.\u003c/p\u003e\n\u003cp\u003eLifespan Fertility Education: Building on Hafezi et al.\u0026apos;s investigation into Iranian women\u0026apos;s knowledge of egg freezing, which revealed that only 6.9% accurately identified the success rate of freezing at age 35[12], it is imperative to integrate \u0026quot;fertility awareness courses\u0026quot; into secondary and tertiary education curricula. Leveraging the AFA model[19], the development of online assessment tools is recommended to provide individuals with personalized insights into the correlations between age, egg count, and success rates。\u003c/p\u003e\n\u003cp\u003eWorkplace Support Policy Coordination: Organizations should be encouraged to implement \u0026quot;flexible fertility leave\u0026quot; policies, offering women 10 days of paid recovery leave surrounding egg freezing procedures. Additionally, measures must be enacted to prohibit workplace discrimination against employees pursuing egg freezing, as highlighted by De Proost et al.\u0026apos;s critique of \u0026quot;individualized solutions that perpetuate workplace gender inequality\u0026quot; [20]。\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy Innovation in Pilot Zones for Localized Experience Accumulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImplementation Strategies:\u003c/p\u003e\n\u003cp\u003eUrban Pilot Initiative: The \u0026quot;Standardized Pilot Program for Oocyte Cryopreservation Services\u0026quot; will be implemented in major metropolitan areas, including Beijing, Shanghai, Guangzhou, and Shenzhen, to establish a comprehensive service framework encompassing \u0026quot;clinical assessment-cryopreservation-assisted reproduction\u0026quot; processes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDigital Monitoring Platform: A national oocyte cryopreservation information registry will be established to systematically document critical parameters, including donor age, ovarian reserve biomarkers, and utilization rates, thereby facilitating evidence-based policy optimization[22]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterdisciplinary Coordination Framework: Adopting the UK\u0026apos;s 2020 multidisciplinary guideline development paradigm, the National Health Commission will spearhead a collaborative effort involving the All-China Women\u0026apos;s Federation, the Ministry of Human Resources and Social Security, and other relevant stakeholders to formulate the \u0026quot;Regulatory Guidelines for Oocyte Cryopreservation Services for Unmarried Women,\u0026quot; ensuring an equilibrium between medical indications and reproductive autonomy[21] .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Breakthrough Directions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvidence-Based Policy Translation: The empirical finding of 68.89% policy endorsement rate should be leveraged to facilitate local legislative initiatives. This process should incorporate evidence from Singapore\u0026apos;s successful policy revision model, while maintaining a regulatory framework characterized by \u0026quot;limited accessibility with stringent oversight\u0026quot; to ensure policy specificity and effectiveness[11].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe empirical findings and practical considerations of this study suggest the implementation of a phased strategic framework for advancing policy reforms regarding social egg freezing (SEF) among single women:\u003c/p\u003e\n\u003cp\u003eDuring the initial phase (1-3 years), implementation should prioritize the establishment of pilot programs in metropolitan areas with robust medical infrastructure (e.g., Beijing and Shanghai, which represented 56.89% of the study cohort). These initiatives should leverage existing assisted reproductive technology facilities to develop a comprehensive service framework, with particular emphasis on longitudinal monitoring of key metrics including SEF utilization rates, oocyte thawing success rates, and subsequent pregnancy outcomes. This approach will address the inherent limitations of cross-sectional study designs while generating empirical evidence to inform policy refinement.\u003c/p\u003e\n\u003cp\u003eIn the intermediate phase (3-5 years), resource allocation should be optimized based on pilot program data analysis. Considering the significant association between age and SEF receptivity (OR=1.725), an age-stratified service prioritization model focusing on women aged \u0026ge;35 years should be implemented. Concurrently, in light of the 89.42% endorsement rate for government subsidies observed in this study, a comprehensive fiscal impact analysis should be conducted to evaluate the sustainability of varying subsidy levels (30%-60%), thereby ensuring an equilibrium between societal demands and public expenditure.\u003c/p\u003e\n\u003cp\u003eRisk Prevention Focus: Address the surgical risks of concern to 87.86% of respondents by mandating institutions to provide pre-operative complication disclosures (e.g., bleeding and infection rates) and offering 24-hour post-operative follow-up[13]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe proposed recommendations are empirically derived from the quantitative findings of this study, substantiated by international evidence, and designed to formulate a comprehensive egg-freezing policy framework that aligns with China\u0026apos;s sociocultural context. This framework seeks to protect the reproductive autonomy of single women while addressing potential technological misuse and associated societal risks.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ea.Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of Shanghai Tenth People\u0026apos;s Hospital (Approval Number: SHSY-IEC-6.0/25KY23/P01, approved on July 21, 2025). A waiver of informed consent was granted by the same board due to the anonymous nature of the survey and the low risk to participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb.Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study uses de-identified data, and no individual participant data is published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec.Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are available at the Dryad digital repository at https://doi.org/10.5061/dryad.wpzgmsc1t. \u0026nbsp;Data Sharing Statement: Temporary link for review:\u003c/p\u003e\n\u003cp\u003ehttp://datadryad.org/share/1LXclOR9CqmLo4kFUjX0huwi2QPe2-07GNMn1o01RSI. The questionnaire used in this study is available as Supplementary File 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed.Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no financial or personal relationships with any for-profit or not-for-profit third parties that could influence the design, conduct, or reporting of this work. Specifically, there are no disclosures related to employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, or other funding (beyond the stated grant from the Shanghai Municipal Health Commission, Grant No.: 2024WF07) within the past 36 months. \u0026nbsp;Disclosure for each author: \u0026quot;None\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee.Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding from the Shanghai Municipal Health Commission (Grant No.: 2024WF07) provided crucial financial support for the smooth progress of the research. It covered essential expenses such as data collection, sample analysis, labor costs for researchers, and academic exchanges. This ensured the orderly advancement of all tasks during the research process and laid a material foundation for the generation of research results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ef.Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have fulfilled the authorship criteria established by the International Committee of Medical Journal Editors (ICMJE). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKunming Li (First Author): Conceptualized and designed the study; formulated the research protocol and questionnaire; oversaw data collection and analysis; drafted and revised the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJinli Wang (Co-first Author): Contributed to the study design; coordinated data collection across multiple sites; conducted statistical analyses, including binary logistic regression; participated in manuscript preparation and critical revision. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFei Shi (Corresponding Author): Provided overarching supervision of the research project; secured funding; interpreted critical findings; rigorously revised the manuscript for intellectual content; finalized the submission and assumes responsibility for all aspects of the work. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed and approved the final manuscript, and collectively affirm their accountability for ensuring that any issues related to the accuracy or integrity of the work are thoroughly investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHan Q, Dang J, Wu Y, Ye W: \u003cstrong\u003eChildlessness and its associated factors among Chinese women: a nationwide population-based study\u003c/strong\u003e. \u003cem\u003eBMC Public Health\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003e25\u003c/strong\u003e(1):638.\u003c/li\u003e\n \u003cli\u003eLi H, Nawsherwan, Fan C, Mubarik S, Nabi G, Ping YX: \u003cstrong\u003eThe trend 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\u003cstrong\u003e50\u003c/strong\u003e(5):104705.\u003c/li\u003e\n \u003cli\u003eKatsani D, Paraschou N, Panagouli E, Tsarna E, Sergentanis TN, Vlahos N, Tsitsika A: \u003cstrong\u003eSocial Egg Freezing-A Trend or Modern Reality?\u003c/strong\u003e \u003cem\u003eJ Clin Med\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e13\u003c/strong\u003e(2).\u003c/li\u003e\n \u003cli\u003eMintziori G, Veneti S, Kolibianakis EM, Grimbizis GF, Goulis DG: \u003cstrong\u003eEgg freezing and late motherhood\u003c/strong\u003e. \u003cem\u003eMaturitas\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e125\u003c/strong\u003e:1-4.\u003c/li\u003e\n \u003cli\u003eXu H, Shi L, Feng G, Xiao Z, Chen L, Li R, Qiao J: \u003cstrong\u003eAn Ovarian Reserve Assessment Model Based on Anti-M\u0026uuml;llerian Hormone Levels, Follicle-Stimulating Hormone Levels, and Age: Retrospective Cohort Study\u003c/strong\u003e. \u003cem\u003eJ Med Internet Res\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e22\u003c/strong\u003e(9):e19096.\u003c/li\u003e\n \u003cli\u003eDe Proost M, Johnston M: \u003cstrong\u003eThe revision of the French bioethics law and the questions it raises for the future of funding for egg freezing\u003c/strong\u003e. \u003cem\u003eReprod Biomed Online\u0026nbsp;\u003c/em\u003e2022, \u003cstrong\u003e44\u003c/strong\u003e(4):591-593.\u003c/li\u003e\n \u003cli\u003eAnderson RA, Davies MC, Lavery SA: \u003cstrong\u003eElective Egg Freezing for Non-Medical Reasons: Scientific Impact Paper No. 63\u003c/strong\u003e. \u003cem\u003eBjog\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e127\u003c/strong\u003e(9):e113-e121.\u003c/li\u003e\n \u003cli\u003eRienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, Vanderpoel S, Racowsky C: \u003cstrong\u003eOocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance\u003c/strong\u003e. \u003cem\u003eHum Reprod Update\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e23\u003c/strong\u003e(2):139-155.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Sociodemographic characteristics of the study population(n=1408)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"449\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGeographical Distribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;First-tier cities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e56.89%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;New first-tier cities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e24.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Second-tier \u0026amp; other cities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18.47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; 18-28 years \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e72.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; 29-35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e22.51%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; 36 years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e5.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational Categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e25.78%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Ordinary enterprise employees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e38.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Enterprise managers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e15.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Other professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e19.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Attainment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp;Bachelor\u0026apos;s degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e83.88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Junior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; High school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e3.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual Income Levels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Below CNY 80,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e45.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; CNY 80,000-150,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e30.05%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Above CNY 150,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18.04%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 345px;\"\u003e\n \u003cp\u003e\u0026nbsp; Not disclosed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Multivariable Logistic Regression Analysis of Factors Associated with Egg Freezing Willingness (n=1408)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eDemographic factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; City level\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.844-1.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Age\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1.397-2.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Occupation\u0026sect;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e-1.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.087-1.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eSocioeconomic factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Educational attainment\u0026para;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1.102-1.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Annual income‖\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1.028-1.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003ePolicy and cost perceptions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Awareness of egg freezing policy**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e1.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e3.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e2.601-4.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp; Psychological tolerance of cost\u0026dagger;\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e1.160-1.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFootnotes:\u003c/p\u003e\n\u003cp\u003e\u0026beta;: regression coefficient; SE: standard error; OR: odds ratio; CI: confidence interval\u003c/p\u003e\n\u003cp\u003e\u0026dagger; City level: 1=Tier-1 cities, 2=New tier-1 cities, 3=Tier-2 cities, 4=Tier-3 and below\u003c/p\u003e\n\u003cp\u003e\u0026Dagger; Age groups: 1=18-22, 2=23-28, 3=29-35, 4=36-45, 5=46-55, 6=\u0026gt;55 years\u003c/p\u003e\n\u003cp\u003e\u0026sect; Occupation: 1=Non-medical students, 2=Medical students, 3=Enterprise employees, 4=Managers, 5=Civil servants, 6=Healthcare workers, 7=Educators, 8=Legal professionals, 9=Freelancers, 10=Retirees, 11=Emerging professions, 12=Others\u003c/p\u003e\n\u003cp\u003e\u0026para; Education: 1=Junior high, 2=High school, 3=College, 4=Bachelor, 5=Master, 6=PhD\u003c/p\u003e\n\u003cp\u003e‖ Annual income (CNY): 1=\u0026lt;50k, 2=50-80k, 3=80-120k, 4=120-150k, 5=150-200k, 6=200-250k, 7=250-300k, 8=\u0026gt;300k, 9=Undisclosed\u003c/p\u003e\n\u003cp\u003e** Policy awareness: 4=Very familiar, 3=Basically familiar, 2=Heard but unclear, 1=Uncertain\u003c/p\u003e\n\u003cp\u003e\u0026dagger;\u0026dagger; Cost tolerance (CNY): 1=\u0026lt;50k, 2=50-100k, 3=100-150k, 4=\u0026gt;150k\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Social egg freezing, Single women, China, Policy perception, Reproductive autonomy, Fertility preservation","lastPublishedDoi":"10.21203/rs.3.rs-7388275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7388275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To examine the perceptions, attitudes, and influencing factors of single women in China regarding social egg freezing (SEF) and to identify optimal strategies for enhancing the social support system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign: \u003c/strong\u003eA cross-sectional study utilizing an online questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e A total of 1,408 single women with valid responses, recruited from nine cities across China between March and May 2025, representing diverse sociodemographic profiles in terms of age, educational attainment, and income levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExposure Variables: \u003c/strong\u003eSociodemographic characteristics, awareness of SEF policies, cost tolerance, and perceptions of risks and societal value associated with SEF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Outcome Measures: \u003c/strong\u003eAttitudes toward SEF, determinants of willingness to undergo SEF, level of policy awareness, and support for regulatory reforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFavorable attitudes toward SEF were reported by 34.94% of participants. Significant predictors included older age (OR=1.725), higher educational attainment (OR=1.356), increased income (OR=1.091), greater cost tolerance (OR=1.407), and heightened policy awareness (OR=3.305). Additionally, 68.89% of participants supported policy revisions, 89.42% advocated for government subsidies, and 78.62% endorsed the inclusion of SEF in medical insurance coverage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Demographic and socioeconomic factors significantly influence attitudes toward SEF. There is a critical need for policy reforms that balance reproductive autonomy with regulatory oversight, alongside the implementation of robust social support mechanisms.\u003c/p\u003e","manuscriptTitle":"Social egg freezing among Single Women in China: Policy Perceptions, Attitudes, and Influencing Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 08:38:20","doi":"10.21203/rs.3.rs-7388275/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"310682639478654320701349975500854739059","date":"2025-09-19T11:40:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T10:58:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T18:00:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-20T11:06:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-19T14:36:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-19T14:32:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19a358a5-4543-440f-bf83-68202401cb70","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T08:38:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 08:38:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7388275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7388275","identity":"rs-7388275","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}