First study to map decision pathways for egg disposition reveals complexity of choices

Elective egg freezers' disposition decisions pathways. (Caughey, 2025)

Caughey, L., White, K. M., Lensen, S., Polyakov, A., Rodino, I. S., Agresta, F., & Peate, M. (2025). Elective egg freezers' disposition decisions pathways. Reproductive BioMedicine Online. https://doi.org/10.1016/j.rbmo.2025.105133

Geographic Region: Australia

Research Question: What are the significant decision-making pathways for oocyte disposition outcomes for elective egg freezers?

Design: Observational cross-sectional study conducted from May to November 2023. The researchers used the Prototype Willingness Model with six additional theoretical constructs identified from previous qualitative research (see below). They analyzed data to map the unique decision pathways for six disposition outcomes: donating to friends/family, couples advertising online, egg banks/fertility clinics, research, discarding, or reclaiming eggs.

Core Topics in Survey

1. Attitude - Whether patients have positive/negative overall favorability toward each disposition choice

2. Subjective Norm - What important others would think of making each choice and What friends would do if faced with the same situation

3. Prototype Similarity - How similar patients feel to the type of person who would make each choice

4. Prototype Favorability - How favorably patients view the typical person who would make each choice

Additional Topics in Survey

1. Concern about other people raising the respondent’s genetically-related child

2. Concern for wellbeing of the donor child (e.g., being mistreated by recipient families)

3. Concern for wellbeing of my child (e.g., feeling overwhelmed by having unknown half-siblings)

4. Empathy for others facing infertility

5. Desire to meet recipient before deciding

6. How much time was spent considering the disposition decision

Sample: 175 women aged 18+ living in Australia who had undergone elective egg freezing with at least one egg in storage. Participants averaged 37 years old at the time of the survey and 34 years when they first froze their eggs. Most were born in Australia (79%), heterosexual (90%), not in committed relationships (52%), tertiary educated (94%), and earned over AUD $100,000 annually (75%). The sample was predominantly from Victoria (75%) and New South Wales (15%). The participants were recruited via social media, newsletters, and snowball sampling.

Key Findings

• Each disposition choice had its own unique decision-making pattern. There was no single pathway that explained all disposition decisions.

• Personal attitudes matter most. Across all six disposition options, having a positive attitude toward a particular choice was the strongest predictor of being willing to pursue it.

• Worry about others raising their genetic child was the biggest barrier to donation. Meeting recipients helps overcome donation concerns. When women could meet or know the potential recipients (especially for family/friend donations), this reduced their worries about others raising their genetic child.

• Social approval influences research donation. For donating eggs to research, what others thought of the decision was important.

• Women who don't judge others for discarding are more likely to discard themselves.

• The researchers' framework explained between 45% and 75% of why women were willing to pursue different options, with egg bank/clinic donation being most predictable (75%) and research donation least predictable (45%).

Limitations: Self-selected participants may have held strong views on disposition outcomes, potentially introducing bias. Not all factors influencing disposition decisions could be included in the model (such as awareness of donor egg demand, clinic experiences, and conceptualization of eggs).

Applications: Rather than discussing disposition options only at the time of egg freezing when women are focused on preservation, clinics should implement staged conversations that revisit disposition choices over time as women's circumstances and attitudes evolve.

Funding Source: This research was supported by a University of Melbourne A.E. Rowden White and Edward R. White Foundation Trust "People and People Support" Grant.

Lead Author: Lucy Caughey is a PhD student and researcher at the Faculty of Medicine, University of Melbourne, with a background in psychology who focuses on helping women make informed fertility decisions. Her research interests include elective egg freezing, egg disposition decision-making, egg donation, decision tools, and information portals. No personal link to donor conception was disclosed.

Regulatory Context

• The National Health and Medical Research Council (NHMRC) provides ethical guidelines for assisted reproductive technology (ART), including donor conception.

• Each state and territory has its own laws governing donor conception, which can lead to some variation across the country.

• Since the early 2000s, most states have moved away from anonymous donation. Donor-conceived individuals generally have the right to access identifying information about their donors once they reach a certain age (usually 18).

• Many states limit the number of families a single donor can contribute to, to reduce the risk of inadvertent consanguineous relationships.

• Most jurisdictions require counseling for donors and recipients before proceeding with donor conception.

• Several states maintain central registries with information about donors and donor-conceived individuals.

• It’s illegal to pay donors for their gametes (eggs or sperm) beyond reasonable expenses.

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