Exploring the Fertility Needs of Women Before and After Oocyte Freezing for Medical and Non-Medical Reasons: A Scoping Review.

The postponement of childbearing among women is an issue that has been raised with increasing frequency 1 . According to the latest census in Iran, the highest age-specific fertility rate was observed among urban women in the 35–39 age group. 2 In high-income countries, the number of women postponing motherhood has increased in recent decades. 3 Several factors contribute to women delaying their first pregnancy. 4 The global decline in fertility rates is primarily due to increasing levels of social affluence, increasing female literacy, and the decoupling of the meaning of life from reproduction. 5 Numerous demographic and epidemiologic studies have shown a decline in female fertility beginning in the mid-thirties. 6–8 It is important to acknowledge that certain aspects of women’s reproductive health, particularly those related to their reproductive capabilities, especially among unmarried women, have not received sufficient attention and may have been neglected in discussions. 9 On the other hand, advances in fertility preservation techniques, such as egg freezing, now offer people the opportunity to have genetic offspring by preserving their gametes. 10 Women encounter various challenges when using reproductive technologies. Clinical outcomes indicate that approximately 15–20 mature oocytes are required to achieve one live birth, highlighting the importance of counseling women about realistic expectations. 11 Evidence shows that success rates are highest when oocytes are frozen before the age of 35, with live birth rates directly associated with both the age at freezing and the number of mature oocytes obtained. 12 While the procedure is generally safe, risks such as ovarian hyperstimulation syndrome remain considerations. 13 Preserving fertility in cancer patients is also a challenge. Knowledge gaps and poor referral practices are common, although the importance of fertility preservation (FP) is generally understood by oncologists. 14 The American Society of Reproductive Medicine (ASRM) considers planned oocyte cryopreservation as a means of promoting women’s independence and social equality. 15 In many cases, women face barriers such as restrictive laws, stigma, and discrimination that make it difficult to access reproductive health services. 16 Although the need for fertility awareness and infertility prevention is emphasized, fertility awareness is currently missing from reproductive health guidelines. 17 Reproductive life management is a simple concept that can be quite complex in practice. 18 In the context of ongoing sociological change in contemporary societies, women’s fertility needs have changed considerably. As a result, oocyte cryopreservation has become a globally relevant practice, encompassing not only epidemiological trends but also psychosocial considerations and continuing unmet clinical needs. 19 This raises the question of what factors should be considered to meet the fertility needs of women before and after oocyte freezing. This review aimed to conduct a comprehensive literature review to analyze the reproductive needs of women who have undergone medical and non-medical oocyte freezing for fertility preservation.

This review addresses gaps in the literature and identifies the fertility needs of women before and after oocyte freezing to provide optimal care in women’s fertility management at the time of oocyte freezing. This scoping review is guided by the following research question: What are the fertility requirements for individuals seeking oocyte freezing? How should service providers manage the fertility needs of women before and after oocyte freezing?

This review was registered at PROSPERO with Registration ID: CRD42021223906. We conducted a scoping review using the framework proposed by Arksey and O’Malley 20 which consists of the following steps: 1) clarifying and linking the purpose and research question, 2) identifying relevant studies, 3) study selection, 4) charting the data, and 5) collating, summarizing, and reporting results. Using the Arksey and O’Malley framework enabled us to systematically explore peer-reviewed literature and clinical guidelines to achieve the study’s objectives. Collecting data to identify the needs of egg freezing applicants and analyzing them was instrumental for optimal planning and care management. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) [1] checklist for reporting. To maximize information, we utilized all available databases, including PubMed, Embase, Scopus, the Cochrane Library, Google Scholar, WHO, and ESHRE from 2004 to December 2024. Google Scholar and Google were searched to access conferences and clinical guidelines as grey literature. Related articles were uploaded into the Mendeley software. Search terms were created using the PCC (population, concept, and context) framework. The study population comprised women who underwent egg freezing. Concept focused on autonomy, motivation, and ethical considerations in fertility preservation, within the context of availability and decision-making aids. The study included the following keywords: Human fertility, social egg freezing, fertility preservation, Oocyte cryopreservation, and fertility awareness. Articles in both English and non-English languages were collected using MeSH and non-MeSH search engines. Cultural differences in the reproductive needs of egg freezing applicants were not considered in the search for articles. The search strategy was established ( Table 1 ). Table 1 Search Strategy in PubMed PCC Search Query Population and Context, and Concept (“Oocyte Retrieval”[MeSH Terms] OR “Oocyte Cryopreservation”[MeSH Terms] OR “egg freezing” OR “oocyte freezing” OR “oocyte preservation” OR “fertility preservation”[MeSH Terms] OR “cryopreservation”[MeSH Terms]) AND (“Women”[MeSH Terms] OR “Female”[MeSH Terms] OR woman OR women OR female OR females) AND (needs OR “patient needs” OR “healthcare needs” OR “psychological needs” OR “social needs” OR “informational needs” OR “decision making”[MeSH Terms] OR “patient satisfaction”[MeSH Terms] OR “patient experience” OR “autonomy” OR “emotional support” OR “social support”[MeSH Terms] OR counseling OR expectations OR motivations OR barriers OR challenges OR “quality of life”[MeSH Terms]) AND (“before egg freezing” OR “prior to egg freezing” OR “pre egg freezing” OR “post egg freezing” OR “after egg freezing” OR “before oocyte cryopreservation” OR “after oocyte cryopreservation” OR “pre-procedure” OR “post-procedure”) AND ((humans[Filter]) AND (female[Filter]) AND (english[Filter]) AND (alladult[Filter]) AND (2004:2024[pdat])) AND ((humans[Filter]) AND (female[Filter]) AND (english[Filter]) AND (alladult[Filter]) AND (2004:2024[pdat])) Search Strategy in PubMed We reviewed studies of all types: review papers, quantitative studies, and qualitative investigations. All relevant subjects regarding fertility preservation services, the role of healthcare providers, and barriers to the topic were selected. Title and abstract screenings were conducted separately by two members of the research team. Data extraction was carried out independently by two authors to ensure a thorough and unbiased process. During the screening phase, if an article referenced the fertility needs of individuals considering egg freezing in either the title or abstract, the full text was subsequently reviewed by the respective author. In instances where there was a difference of opinion regarding the extracted data, the authors engaged in constructive discussions to address the matter. Should any disagreements persist, a third author, recognized as an expert in the field, was consulted to offer further insights and facilitate a consensus. The data were extracted for each piece of evidence. We then compiled a table of studies, including the authors’ names, year of publication, study type, and key findings. Tabulation was provided separately for egg freezing applicants and health care providers.

The PRISMA flow diagram illustrates the study selection process and summarizes the reasons for exclusions ( Figure 1 ). Studies that investigated fertility preservation in men, children, and transgender individuals were excluded from the study. The primary search of the peer-reviewed literature generated 2552 studies. Thirty-five peer-reviewed studies were duplicates and removed. During the screening process, 2399 studies did not meet the inclusion criteria and were eliminated as irrelevant records, leaving 118 articles screened in terms of full text and abstracts. Forty-one studies were excluded from the study due to a lack of focus on the research question, and 33 studies did not provide information about the reproductive needs of egg freezing applicants and were excluded. Ultimately, 44 studies were used in the synthesis stage. Figure 1 PRISMA ScR flow diagram detailing the quantity of included and excluded papers at each stage of screening. **Studies did not meet the inclusion criteria and were eliminated as irrelevant records. PRISMA ScR flow diagram detailing the quantity of included and excluded papers at each stage of screening. **Studies did not meet the inclusion criteria and were eliminated as irrelevant records. We incorporated a diverse range of research, including 8 qualitative studies, 17 quantitative studies, 20 review studies, and two clinical guidelines. Out of the 44 studies included in the review, five key topics were organized. The number of studies conducted on each key topic related to women’s fertility needs before and after oocyte freezing in medical and non-medical reasons is specified ( Figure 2 ), so that a significant proportion of studies concerning the needs of egg-freezing applicants have centered on areas such as Counseling, and fertility-related discussions (18/44: 40%), in comparison, there appears to be a relatively smaller number of studies addressing the legal and support issues pertinent to applicants, with a fairly consistent distribution across this category, emotional care (5/44: 11%), Obtaining informed consent (8/44: 18%), Decision-making support (9/44:20%), and issues related to the secondary use of frozen eggs (5/44: 11%). The findings of the studies are separately presented in two tables: one outlining women’s fertility needs ( Table 2 ), including counseling, fertility-related discussions, emotional care, and decision-making support; the other highlighting areas of concern from health providers, including obtaining informed consent and issues related to secondary use of frozen eggs ( Table 3 ). The results have been organized into categorized sections as follows: Table 2 Study Characteristics of Papers and Key Outcomes of Women’s Fertility Needs in Oocyte Freezing for Medical and Non-Medical Reasons Authors (year)[ref.] Reason of Egg Freezing Type of Study Key Outcomes/Findings Cancer and Egg Freezing Disease and Egg Freezing Social Egg Freezing Tozzo et al (2019) 21 Porto et al (2024) 22 Akhondi et al (2023) 23 – – √ Survey The insufficient knowledge of students regarding age-related fertility decline in women has been highlighted. Stevenson et al (2021) 24 – – √ Survey Insufficient knowledge regarding fertility preservation, the negative stigma associated with egg freezing, and financial barriers were reported. Platts et al (2020) 25 – – √ Systematic Review Accurate and relevant information regarding social egg freezing should be made readily accessible to the public. Mintziori et al (2019) 26 – – √ Review A strong negative correlation was identified between women’s age and reproductive outcomes. Financial difficulties were recognized as a significant factor. Dason et al (2023) 27 √ – – Survey Decision support had mainly consisted of delivering basic information either before or during the consultation. Hafezi et al (2022) 28 PubMed – –- √  Cross-sectional study A lack of awareness among women about age-related fertility decline has been highlighted. Harzif, et al (2020) 29 PMC – – √ Cross-sectional study Incorporating fertility discussions into women’s annual examinations is considered essential. Greenwood et al (2018) 30 Yee et al (2021) 31 PubMed – – √ Retrospective cohort Survey Following fertility preservation counseling, women are less likely to experience regret about not pursuing it. Emirdar et al (2023) 32 PubMed √ – =  Survey  There is a clear need to emphasize referrals and to raise awareness of fertility preservation methods among healthcare professionals. Navarria et al (2020) 33 – √ – Survey Interest in fertility preservation techniques has been reported among women diagnosed with endometriosis. Cermisoni et al (2023) 34 PubMed Hampton et al (2015) 35 – √ – Overview Review Fertility preservation counseling in people with genetic diseases is recommended. ESHRE (2020) 36 √ √ √ Guideline Emphasizing the importance of fertility preservation training for healthcare professionals is essential to improve patient care. Dolmans et al (2018) 37 √ – – Review The critical importance of early referral to fertility preservation before cancer treatment. Gorman et al (2011) 38 √ – – Qualitative study There is a need to create educational materials for patients and healthcare providers on the issue of informed consent. Salama et al (2018) 39 √ – – Review The barriers and opportunities associated with oncofertility practice have been discussed. Garvelink et al (2015) 40 – – √ Qualitative study The process of oocyte freezing for oncofertility patients involves multiple important decisions that must be made within a limited period. Wennberg et al (2019) 41 – – √ Review Egg freezing can contribute to empowering women in managing their fertility. Hammarberg et al (2017) 42 Petropanagos et al (2015) 43 – – √ C ross-sectional survey Some oocytes are destroyed during the thawing process, and frozen oocytes do not guarantee a pregnancy. Daniluk et al (2016) 44 Scopus √ – √ Survey Factors that influence women’s decisions to freeze their eggs include financial costs, health risks to themselves or their future children, and the procedure’s success rates. Hodes-Wertz (2013) 45 – – √ Survey Egg freezing technology may be useful for bridging the gap between the early reproductive years and when a woman is truly “ready” to have children, but financial issues are important. Proost et al (2022) 46 – – √ Qualitative study Women were interested in planning for their future fertility, so further discussion and policy development are needed. Inhorn et al (2017) 47 – – √ Qualitative study Egg freezing gives women a sense of empowerment. Drost et al (2023) 48 – – √ Qualitative study Expressed the negative stigma surrounding egg freezing. Baldwin et al (2020) 49 – – √ Qualitative study Emotionally challenging and feelings of isolation and stigma due to being single were mentioned. Mosavi et al (2014) 50 PubMed – – √ Qualitative study The influence of cultural taboos and the lack of accessible, accurate information have been recognized. Lawson et al (2015) 51 √ – – Qualitative Study The provision of psychological counseling for patients pursuing fertility preservation has been addressed. Jones et al (2020) 52 Survey Although egg freezing can impose physical, psychological, and financial burdens, women generally do not regret the decision. Their primary concern revolves around the duration of egg storage. Table 3 Study Characteristics of Papers and Key Outcomes of Healthcare Providers’ Concerns in Oocyte Freezing for Medical and Non-Medical Reasons Authors (Year)[ref.] Reason of Egg Freezing Type of Study Key Outcomes/Findings Cancer and Egg Freezing Disease and Egg Freezing Social Egg Freezing Gruben (2017) 53 Taghavi (2019) 54 – – √ Review Providing women with information, informed consent, and counseling in oocyte freezing. Ahmed et al (2022) 55 Loren et al (2013) 56 √ – – Review Systematic Review Oncologists should inform patients that treatment may lead to a potential reduction in fertility. Varlas et al (2021) 19 – – √ Review Many women are less aware of the safety and effectiveness of this method. Petropanagos et al (2015) 43 PubMed – – √ Review To support women in making informed choices, family physicians should engage in discussions about this practice within the larger context of reproductive health. Borovecki et al (2018) 57 – – √ Review Fertility preservation at earlier reproductive ages is generally associated with higher live birth rates. Walker et al (2022) 12 PubMed √ – – Review Higher oocyte yield, achieved through fewer ovarian stimulation cycles at younger ages, is associated with increased live birth rates. Hernández et al (2024) 58 – – √ Qualitative study Women emphasized the importance of being a mother and having one’s own biological child, and the complexities and limitations associated with adoption. Patrizioet al (2016), 59 An Ethics Committee opinion (2018) 15 √ – √ Review Storage period of the eggs and who will use them? should be specified with informed consent. Robertson et al (2014) 60 PubMed – – √ Review Issues concerning the disposition of oocytes and their potential donation represent important topics that warrant further investigation. Frydman et al (2016) 61 PubMed – – √ Review Raises numerous ethical questions regarding the decision to collect gametes and their future use. Chin et al (2022) 62 – – √ Review With the emergence of egg freezing and the potential for a surplus of unused frozen eggs in the coming years, there is an urgent need to comprehensively update regulations regarding donor anonymity and recipient rights. Figure 2 The number of articles in five key areas of women’s reproductive needs before and after oocyte freezing. Study Characteristics of Papers and Key Outcomes of Women’s Fertility Needs in Oocyte Freezing for Medical and Non-Medical Reasons Study Characteristics of Papers and Key Outcomes of Healthcare Providers’ Concerns in Oocyte Freezing for Medical and Non-Medical Reasons The number of articles in five key areas of women’s reproductive needs before and after oocyte freezing. Surveys in several countries indicate that students know little about age-related fertility decline in women. 21–23 One survey found that young female graduate students often obtain information on fertility from reliable sources, such as educational institutions or health care providers. However, they also rely on other sources, including the media, which can lead to incomplete or inaccurate knowledge about fertility preservation. 24 A systematic review suggests that accurate and relevant information about social egg freezing should be made available to the public through educational programs in schools, media portrayals, and counseling by health professionals to make informed decisions at the right time. 25 Other studies have stated that despite thorough counseling before ovarian stimulation to retrieve oocytes, many women did not fully understand the effect of diminishing ovarian reserve with age. 27 , 28 Studies indicate a strong negative correlation between reproductive outcomes following egg freezing and the woman’s age at the time of the procedure. 8 , 25 , 26 Significantly, younger age at the time of egg retrieval is associated with better egg quality and quantity, leading to higher fertilization rates and more live births. 63 The role of serum anti-Mullerian hormone (AMH) as a predictor of ovarian response has been confirmed. 36 Individuals who undergo oocyte cryopreservation at a younger age generally show higher ovulatory responses, require fewer cycles of ovarian stimulation, and achieve higher live birth rates, highlighting the critical impact of age on fertility preservation. 12 Some oocytes are destroyed during the thawing process, and frozen oocytes do not guarantee pregnancy. 43 Some have recommended including fertility preservation discussions in women’s annual check-ups. 29 One study found that an informed decision to freeze oocytes was associated with a lower likelihood of regretting it later. 31 In a retrospective cohort study, women who were thoroughly informed and emotionally supported during egg freezing reported fewer subsequent regrets. 30 One study highlights that referral rates for fertility preservation counseling among cancer patients of reproductive age remain inadequate, underscoring the need for increased referral and awareness of fertility preservation techniques among healthcare providers. The study also shows that patients’ level of education is related to their desire for fertility preservation. 32 The results of a survey of women with endometriosis show that they are interested in understanding their fertility potential and exploring fertility preservation options. 33 Studies indicate that fertility preservation counseling for individuals with genetic conditions associated with diminished ovarian reserve should be performed by a multidisciplinary team, consisting of a gynecologist, an embryologist, a psychologist or counselor, and a geneticist. 34–36 Research highlights the importance of referring patients to fertility specialists before starting chemotherapy or radiotherapy to optimize fertility preservation outcomes. 37 Concerns about patient survival often impact decisions regarding fertility preservation. There is an urgent need to develop educational resources for patients to support women and their healthcare providers in making well-informed decisions. 38 It is important to communicate the potential gonadotoxic effects of cancer treatment and ensure timely referral for fertility preservation support. 40 These clinical aspects underscore the need for timely decision-making and individualized fertility preservation strategies alongside psychosocial and ethical support. 36 A study examining nine developing countries identified common barriers to oncofertility practices, including limited awareness among providers and patients, cultural and religious constraints, lack of insurance coverage, and inadequate funding for infertility programs. 39 In one study, women with cancer seeking fertility preservation generally reported satisfaction with the information provided. However, they also highlighted challenges, particularly the pressure to gather information quickly and make critical decisions within a limited timeframe. 40 Raising public awareness of age-related fertility decline and encouraging informed decision-making about egg freezing can empower women to take control of their reproductive choices. 41 One study recommends that women considering egg freezing for non-medical reasons are thoroughly counseled about key factors, including their age, the number of eggs retrieved, and the possibility that some eggs may not be viable or may go unused. 42 It is important to understand that using stored eggs does not guarantee the birth. 8 , 42 One study found that factors influencing women’s decision to freeze their oocytes included the financial cost, the health risks to themselves or their potential children, and the success rates of the procedure. 44 Financial considerations were frequently cited as an important factor in decision-making in several studies. 24–26 One study has shown that egg freezing technology can bridge the gap between the early reproductive years and when a woman is truly “ready” to have children. 45 Egg freezing, therefore, empowers women by reducing societal pressure and preserving the option of biological motherhood in the future. 47 A qualitative study found that women increasingly need to plan their future reproductive decisions. In addition to postponing childbearing, they are choosing to freeze their eggs to preserve their fertility. This issue needs to be discussed further, and supportive policies need to be developed. 46 Recent studies have shown that the negative social stigma surrounding oocyte cryopreservation is a significant barrier to decision-making regarding oocyte freezing. 24 , 48 In another study, some applicants described the process of egg freezing as emotionally challenging, often associated with feelings of isolation and the stigma associated with being single. 49 A study conducted in Iran linked cultural taboos and lack of access to accurate information to unmarried women’s reluctance to seek sexual and fertility services. 50 One study indicated that cancer patients have to make psychologically complex decisions about preserving their fertility. 51 Given the wide range of fertility options and uncertainty about their future, thorough screening for anxiety and depression is essential. 38 Early identification of patients who may benefit from additional psychological counseling is crucial. 51 One of the included studies reported that women did not regret their decision to pursue oocyte cryopreservation despite the associated physical, psychological, and financial burdens. Nevertheless, dissatisfaction was observed regarding the limitation on the length of time their eggs were stored. 52 Studies recommend that healthcare providers talk to patients about potential fertility risks as soon as possible after a cancer diagnosis. This information should be effectively communicated and fully documented to ensure informed consent. 53 , 54 Oncologists should inform patients about the potential reduction in fertility as a result of treatment and discuss fertility preservation options. 55 , 56 As oocyte freezing technology is new, many women are unaware of its safety and effectiveness. 19 One study recommended that all women, regardless of their sexual orientation, age, disabilities, health status, relationships, or socioeconomic background, should be fully informed about social egg freezing. To help women make informed decisions, family physicians should discuss this practice in the broader context of reproductive health and family planning. 43 The American Society of Ethics Committee recommends that healthcare providers provide complete information on live birth and success rates associated with frozen eggs to assist individuals undergoing fertility treatment in making informed decisions. To ensure that patients fully understand the procedure and its potential outcomes, education, counseling, and informed consent are critical. 15 Studies suggest that women who follow fertility preservation at a younger age generally have higher live birth rates. With in vitro fertilization (IVF), the chance of pregnancy decreases with age, from nearly 38% at age 35 to 2% at age 45, suggesting that younger women may have better outcomes. 12 , 57 A study investigating ethical dimensions of oocyte cryopreservation revealed that women prioritized family formation in their decisions and placed great importance on the experience of motherhood and pregnancy. Participants also highlighted the complexities and limitations of adoption, as well as the ethical and genetic considerations. 58 The research highlights the experimental nature of many aspects of reproductive medicine, due to both the techniques used and the populations undergoing fertility preservation. This emerging field raises critical ethical questions regarding the collection of gametes and their future use. 61 There are different national regulations regarding the maximum storage periods for these biological samples. 15 Studies recommend that at the time of signing the egg freezing contract, the storage period of the eggs and their intended use should be specified with the informed consent of the applicant, following the rules and guidelines established by the centers. 15 , 59 The consent forms should address the future status of frozen eggs, and the applicant’s preferences regarding marriage, divorce, and wishes regarding posthumous reproduction and inheritance rights. 15 The decision-making process regarding the storage, fertilization, and transfer of the frozen eggs falls under the woman’s legal rights. However, for many aspects of assisted reproductive technology, there are no comprehensive regulatory guidelines, and egg freezing is no exception. 60 Not all individuals who undergo oocyte cryopreservation will ultimately use their frozen oocytes, so there may be opportunities for oocyte donation. There is therefore an urgent need for a comprehensive update of the regulations on donor anonymity and recipient rights. At the same time, recipients must be informed about the egg donor’s health information, and their various ethical concerns must be taken into account. 62

This scoping review synthesized current evidence on the fertility needs of women before and after oocyte freezing for both medical and non-medical reasons. The findings highlight several key needs, including access to accurate counseling and fertility-related information, support for informed decision-making, and the provision of emotional and psychological care. From the perspective of healthcare providers, particular emphasis must be placed on ensuring comprehensive informed consent and addressing ethical concerns related to the secondary use of frozen oocytes. Despite the potential of oocyte freezing to empower women in managing reproductive choices, several challenges remain. Financial barriers, limited awareness of age-related fertility decline, cultural and religious restrictions, and inadequate referral practices continue to hinder equitable access. Furthermore, gaps persist in the provision of post-freezing support and in regulatory frameworks that govern storage duration, donation, and posthumous use of gametes. Realistic counseling is essential to ensure that women understand both the opportunities and limitations of oocyte freezing. While the procedure may mitigate age-related fertility decline, it does not guarantee future pregnancy. Balanced, evidence-based guidance can help women make informed decisions while avoiding unrealistic expectations. Future efforts should focus on integrating fertility preservation education into public health strategies, expanding insurance or subsidy programs to reduce financial burden, and developing culturally sensitive counseling frameworks. Strengthening regulations and support systems will be critical to ensuring that oocyte cryopreservation truly addresses women’s reproductive needs and contributes to informed, patient-centered care.

While fertility preservation by egg freezing is widely used in infertility treatment centers, it is essential to carefully assess the specific needs of women who choose this method. This scoping review summarized existing information on women’s fertility needs before and after oocyte freezing for medical and non-medical reasons and identified three key areas of women’s fertility needs for egg freezing included: 1) counseling and fertility-related discussions, 2) emotional care, 3) decision-making support, and for health providers two ears were identified: 1) obtaining informed consent, and 2) issues related to the secondary use of frozen eggs. Studies have shown that fertility preservation counseling empowers women to make timely decisions about their reproductive needs and improve their quality of life. 41 , 47 , 55 There is an urgent need to improve public education about fertility preservation. Many women report that they have received information about egg freezing from friends and non-medical sources. 24 , 25 , 45 Numerous studies have highlighted the limited awareness of fertility preservation options available to women in society and the urgent need to improve understanding and advocacy. 21–24 Limited knowledge and awareness of age-related fertility decline in women exacerbate infertility rates and hinder the achievement of their reproductive goals. Biologically, oocyte cryopreservation is highly age-dependent, as ovarian reserve and oocyte quality decline significantly after the age of 35. Younger women not only produce more oocytes during hormonal stimulation but also achieve higher survival and fertilization rates after thawing. 12 , 36 The highest number of eggs and the best live birth rate were observed in women under 37.5 years of age or those with an AMH greater than 1.995 ng/dL at the time of egg retrieval. 12 Proper counseling for those considering oocyte freezing plays a crucial role in minimizing regret and achieving better outcomes. In certain societies, cultural norms contribute to the social stigmatization of oocyte cryopreservation and present significant barriers for unmarried women considering this option. Stigma is a complex concept that encompasses interrelated factors. Pescosalido and Martin define stigma as a set of interrelated and heterogeneous systemic structures, from the individual to society, that lead to reactions with cultural manifestations such as prejudice and discrimination. 64 Religious and cultural factors significantly influence women’s autonomy and decision-making regarding oocyte cryopreservation. In the Middle East and Asia, traditional gender norms, religious rules, and societal expectations restrict women’s reproductive choices. 23 Future research should seek to systematically quantify the impact of specific cultural and religious factors on decision-making regarding oocyte cryopreservation across diverse populations. The success rates of oocyte freezing in achieving pregnancy are crucial, with studies emphasizing that the woman’s age at the time of egg freezing is a key factor for success. 65 Implementing effective fertility preservation options for women whose fertility is declining due to age increases the likelihood of successful pregnancy and reduces the significant psychological stress associated with unintended childlessness. 66 Given the growing evidence that decision aids improve knowledge and reduce conflict and regret in decision-making, routine fertility preservation counseling is recommended for women with cancer. It is imperative to develop a training program for healthcare workers to improve their knowledge and awareness of fertility preservation support for cancer patients. 14 In terms of maternal health, Bachmann (2018) suggests that counseling should be recommended for women using frozen oocytes for pregnancy, especially about the risks of pregnancy at advanced maternal age. 67 Several studies have highlighted financial constraints and inadequate insurance coverage as major barriers to oocyte cyropreservation. 24–26 , 44 , 52 Given the high cost of oocyte cryopreservation, financial support plays an important role in decision-making. Ohno (2024) suggests educational and awareness programs targeting urban citizens have been effective, and financial support from local municipalities for women to cover the initial costs of oocyte cryopreservation has been recommended. 68 If the frozen eggs are not used and the woman wishes to donate them as a nondirected donor (a status that has replaced anonymous donor status), informed consent should be obtained again if the donor is over 34 years old, as recommended by ASRM. In addition, genetic counseling, a physical health and sexually transmitted disease examination, and a psychological evaluation of the donor were recommended. 69 Currently, the proportion of medical patients who ultimately use their frozen oocytes is less than 10%, and nearly 40% of social oocyte cryopreservation cases return to use their cryopreserved oocytes. This presents challenges for evaluating long-term clinical outcomes in the future. 12 It is recommended that written consent be obtained at the time of egg freezing, specifying the status of posthumous reproduction, and ensuring that healthcare providers provide accurate information to help women make an informed decision. Some countries have introduced time restrictions on the storage of eggs, 70 and require applicants to use the frozen eggs within a certain time frame. Therefore, applicants need to be aware of such restrictions and make informed decisions about the appropriate age for freezing. Research shows a positive correlation between education level and fertility awareness. Women with a higher level of education are more likely to seek information and, consequently, pay more attention to their fertility. 71 The goal of health planning in biomedicine and public health is to recognize and address the different health needs of men and women according to their biological differences. This approach is integral to the development of a health policy aimed at promoting gender equality. 57 The new ideology of human rights emphasizes the satisfaction of basic human needs as a fundamental goal, contributing to social equality. 72 Over the past half-century, family planning policies have generally focused on birth control, which has had a significant impact on global population growth, which is now falling below replacement rates in some countries. 73 As women’s societal roles in society change and childbearing is increasingly delayed, their reproductive needs have shifted accordingly. To prevent infertility, a proactive approach is essential. Oocyte freezing is a medically and emotionally complex process. This study highlights the necessity of a comprehensive support system for women undergoing oocyte cryopreservation, including counseling, detailed information, emotional care, and decision support. Going forward, it is crucial to address challenges such as uncertainty, financial issues, and the secondary use of frozen oocytes.

In this study, cultural and religious issues related to oocyte freezing were addressed only to a limited extent. Future research should explore cultural aspects of women’s fertility needs in the context of oocyte freezing. In addition, the limited number of studies specifically addressing post-egg-freezing needs may limit the scope of findings.