Oocyte Preservation Research Articles

Disposition preferences in oocyte preservation patients.

To characterize the frozen oocyte disposition preferences of patients undergoing medical and planned fertility preservation. All oocyte cryopreservation (OC) patients were identified between 2015 and 2018. Demographic information and fertility preservation (FP) indication (medical or planned) were identified for each patient. Oocyte disposition options included disposal, donation to research, or donation to a specified third party, which was decided at the time of initial consent and made available in the electronic medical record. The primary outcome was the disposition selection. Secondary outcomes included differences in demographic variables and disposition selections between medical and planned FP patients using chi-squared analysis. A total of 336 OC patients with a documented oocyte disposition preference were identified in the study timeframe. Patients were on average 34.5years old (SD = 5.1) and were predominantly White (70.2%), nulliparous (83.0%), with a BMI of 24.7 (SD = 5.4). A total of 101 patients underwent OC for medical FP and 235 for planned FP. In both groups, the most commonly selected disposition option was donation to research (50% planned, 52% medical), followed by donation to a specified third party (30% planned, 30% medical), and finally disposal of oocytes (20% planned, 18% medical). There were no significant differences in disposition selection between each group. When comparing patient variables between groups, medical FP patients were more likely to be under the age of 35 and were less likely to be nulliparous (p < .001). This study shows that oocyte disposition choices are similar in patients undergoing OC for medical and planned indications. As donation to research was the most commonly selected option in both groups, it is time to start thinking of streamlining ways to utilize this potential research material in the future.

Reproductive Considerations for Patients with Early-Onset Breast Cancer.

Early-onset breast cancer presents various challenges in regard to reproductive health. This review examines the current data pertaining to issues such as fertility preservation, preimplantation genetics, the impact of chemotherapy and endocrine therapy, contraception, and pregnancy in the young breast cancer population. Many breast cancer treatments such as chemotherapy and endocrine therapy can be gonadotoxic or teratogenic. Multiple fertility preservation options are now available to young breast cancer patients, including embryo and oocyte preservation, ovarian tissue preservation, and ovarian suppression with GnRH agonists. In patients with known cancer germline mutations, preimplantation genetic testing is an option. Fertility preservation and other reproductive services are expanding and offer great promise to the early-onset breast cancer community. Providers must be knowledgeable about the various options in order to better empower patients.

Fertility preservation in transgender men without discontinuation of testosterone

ObjectiveTo report two cases of fertility preservation in two transgender men without an extended period of higher dose testosterone cessation.DesignChart abstraction was completed for two cases of oocyte preservation in transgender men without stopping testosterone gender-affirming therapy before controlled ovarian stimulation (COS).SettingA university-affiliated fertility clinic in San Francisco, California.Patient(s)Two 27-year-old transgender men on higher dose testosterone undergoing oocyte cryopreservation.Intervention(s)Not applicable.Main Outcome Measure(s)Both patients had been on 6 and 20 months of testosterone therapy, respectively, and continued throughout COS. A random start antagonist plus letrozole protocol was used for the patient in case 1, with a leuprolide acetate trigger. A luteal start antagonist protocol was applied to the patient in case 2 with a leuprolide acetate trigger.Result(s)In case 1, a total of 35 oocytes were retrieved, with a total of 23 metaphase II (MII) oocytes cryopreserved. An additional 7 MII oocytes were obtained after in vitro maturation for a total of 30 MII oocytes that were vitrified. In case 2, 14 oocytes were retrieved, and 9 mature oocytes (MII) were vitrified.Conclusion(s)Transgender men have historically been advised to discontinue testosterone before COS, a process that may be distressing for many individuals. This is the first published case report demonstrating the proof of concept of COS without cessation of high-dose testosterone therapy in two transgender men. Future studies with larger sample sizes should be performed to confirm these findings.

Whole exome sequencing in a cohort of familial premature ovarian insufficiency cases reveals a broad array of pathogenic or likely pathogenic variants in 50% of families

To study the diagnostic yield, including variants in genes yet to be incriminated, of whole exome sequencing (WES) in familial cases of premature ovarian insufficiency (POI). Cross-sectional study. Endocrinology and reproductive medicine teaching hospital departments. Familial POI cases were recruited as part of a nationwide multicentric cohort. A total of 36 index cases in 36 different families were studied. Fifty-two relatives were available, including 25 with POI and 27 affected who were nonaffected. Karyotype analysis, FMR1 screening, single nucleotide polymorphism array analysis, and WES were performed in all subjects. None. The primary outcome was a molecular etiology, as diagnosed by karyotype, FMR1 screening, single nucleotide polymorphism array, and WES. A likely molecular etiology (pathogenic or likely pathogenic variant) was identified in 18 of 36 index cases (50% diagnostic yield). In 12 families, we found a pathogenic or likely pathogenic variant in a gene previously incriminated in POI, and in 6 families, we found a pathogenic or likely pathogenic variant in new candidate genes. Most of the variants identified were located in genes involved in cell division and meiosis (n = 11) or DNA repair (n = 4). The genetic etiologic diagnosis in POI allows for genetic familial counseling, anticipated pregnancy planning, and ovarian tissue preservation or oocyte preservation. Identifying new genes may lead to future development of therapeutics in reproduction based on disrupted molecular pathways. NCT01177891.

Preserving Oocytes in Oncofertility†.

The prodigious rise of cancer survival rates enables many cancer survivors to live long lives. Therefore, the side effects of cancer treatments as well as the long-term quality of life after cancer have become more relevant. Ovarian toxicity is a major off-target effect of anticancer agents for childhood and young adult female cancer patients. Both chemotherapy and irradiation have been demonstrated to damage the ovary and increase the risks of premature ovarian failure (POF), early menopause, ovarian endocrine disorders, and sub- or infertility. Oncofertility is an emerging and multidisciplinary research and medical field that focuses on providing cancer patients with fertility preservation options. Oocyte quality and quantity are one of the most important factors to determine women's fertility success; therefore, preserving oocytes is paramount for maintaining the ability of young female cancer patients' reproduction after their recovery. This review summarizes peer-reviewed literature on current oocyte preservation options in oncofertility. We describe in-depth oocyte and embryo cryopreservation, ovarian suppression, ovarian tissue cryopreservation, in vitro maturation, ovarian transposition, and adjuvant therapy. Further, we discuss current guidelines and practices of female fertility preservation that cover preserving oocytes.

Mouse Oocyte Vitrification With and Without Dimethyl Sulfoxide: Influence on Cryo-Survival, Development, and Maternal Imprinted Gene Expression

(Abstracted from J Assist Reprod Genet 2021;38:2129–2138) Oocyte preservation allows preservation of fertility in women for a multitude of reasons including those at genetic risk of diminished ovarian reserve, those undergoing cancer treatment, or those aiming to protect against future infertility due to reproductive aging. The 2 primary methods of human oocyte cryopreservation include slow rate freezing/thawing and vitrification/warming.

Fertility preservation among young breast cancer patients: A single-center experience in China

ObjectiveThis study aims to investigate the status of fertility preservation (FP) in young breast cancer patients. Materials and methodsA clinical database of six women with breast cancer who wished to undergo FP before starting chemotherapy were analyzed between January 2018 and December 2019 in our hospital. Among the six women, three were unmarried and three were married. ResultsThree patients chose oocyte preservation and obtained 23, 7, and 17 MII oocytes, respectively. One patient chose embryo freezing, and three embryos were frozen. Fertility preservation failed for two patients, one of whom had premature ovulation, while the other patient abandoned egg retrieval on the human chorionic gonadotropin (HCG) day. ConclusionThe present results indicate that oocyte and embryo cryopreservation are effective optional methods for young breast cancer patients. However, a lack of knowledge, the urgency of cancer treatment, and financial constraints are causes for a low access rate regarding this process.

P–213 Comparative optical analysis of spindle reformation after oocyte vitrification with media containing differing basal formulations

Abstract Study question Do the base ingredients and total composition of vitrification media have an effect on meiotic spindle reformation in warmed donor oocytes? Summary answer Meiotic spindle reformation occurs more readily in donor oocytes vitrified and warmed with a contemporary culture media based vitrification formulation than in traditional vitrification media. What is known already Embryo culture trends continue towards more freeze-all cycles and oocyte preservation is becoming more prevalent across all age groups, thus vitrification continues to serve a pivotal role in today’s laboratory; however, the formulation of vitrification media remains largely unchanged from the m199 or mHTF base composition of antiquated slow freeze media. Literature identifies temperature as a key determiner in spindle reformation. Our preliminary data utilizing a robust vitrification medium with a basal formulation specifically designed for human embryo growth demonstrates a pronounced positive effect on oocytes post-warm in regard to spindle recovery time. Study design, size, duration In a prospective study, 30 oocytes obtained from a diverse population of 10 oocyte donors donating to an egg bank were imaged prior to vitrification to identify the meiotic spindle using the Oosight Imaging System (Hamilton Thorne). Donor oocytes were then split between two vitrification media groups, Vitrification Kit NX (FujiFilm Irvine Scientific) and Vitrification Media (Kitazato USA). After warming, oocytes were again imaged at various time points and meiotic spindle retardance was noted. Participants/materials, setting, methods Oocytes from approved egg bank donors were imaged, vitrified and warmed using protocols recommended by the manufacturers. The oocyte donors were all cycled and retrieved in the same private IVF Clinic and Laboratory between October 2019 and February 2020. Temperature of media, culture dishes, incubators and work stations were all monitored and maintained. Retrieved oocytes were imaged prior to vitrification. Oocytes were imaged immediately upon warm, and at 1 and 3 hours post warm. Main results and the role of chance Oocyte survival was similar across the two media groups, with Vitrification Kit NX at 86.7% and Vitrification Media at 80.0% survival. 100% of the degenerated oocytes in Vitrification Kit NX did not display an initial meiotic spindle when imaged prior to vitrification as opposed to 67% of the degenerate oocytes in Vitrification Media. Upon warming, immediate imaging showed oocytes from Vitrification Kit NX displayed a spindle at a rate of 41.7%, while Vitrification Media allowed this in 0% of the oocytes. At 1-hour post warm, Vitrification Kit NX and Vitrification Media displayed meiotic spindles in 83.3% and 22.2% of oocytes, respectively. The final time point was imaged at 3-hours post warm and showed meiotic spindle reformation in 91.7% of Vitrification Kit NX oocytes and 66.7% of Vitrification Media oocytes. While none of the time points imaged show significance, there is a defined trend towards a faster rate of meiotic spindle recovery in vitrification media formulated with a more modern culture media base. Limitations, reasons for caution The preliminary findings of this study offer that the composition and formulation of the vitrification medium perhaps do have an effect on the reformation of the meiotic spindle post-warm; however, more information is needed and a larger population size must be examined prior to discerning any significance. Wider implications of the findings: If, through further study and imaging, it is ascertained that meiotic spindle reformation is determined in part by the vitrification media composition, it could lead to potentially healthier warmed oocytes for the patient and less workload and scheduling stress on the embryologists due to shorter wait times prior to ICSI. Trial registration number Not applicable

O-175 Impact of female chromosomal polymorphic variants on ovarian reserve markers and fertility treatments prognosis

Abstract Study question Could the presence of chromosomal polymorphisms in women undergoing fertility treatments influence ovarian reserve, oocyte preservation or IVF clinical outcomes? Summary answer Polymorphic variants of chromosomes seem to adversely influence the Anti-Müllerian Hormone (AMH) serum levels and the post-thawing oocyte survival rate. What is known already Infertile couples have been reported to have a higher incidence of karyotype abnormalities than the general population, which could lead to lower fertility rates. However, few studies have demonstrated the controversial relationship between these karyotype alterations in women and the specific involvement of these variants and their combinations in an IVF cycle. Therefore, there is a growing interest in categorizing chromosomal polymorphic variants and relating them to the subsequent evolution in ART cycles. Study design, size, duration Retrospective evaluation of a cohort of women undergoing IVF cycles in a private fertility center. The sample included 280 cycles performed between July 2017 and December 2020. The study explored the correlation between karyotype polymorphisms and IVF outcomes in terms of: Anti-Müllerian Hormone (AMH) level, Antral Follicle Count (AFC), Oocyte Maturity (MII), Oocyte Survival after Thawing (TS), Fertilization (FZ), Useful Embryos (UE), Biochemical (BP) and Clinical Pregnancy (CP), Miscarriage (M) and Live Birth (LB) rates. Participants/materials, setting, methods Women with karyotype performed before an IVF cycle. Chromosome analysis was carried out according to the International System for Human Cytogenetic Nomenclature guidelines (ISCN). Only own eggs cycles were included, and testicular sperm cycles were excluded. The normality of the distribution of the variables was assessed using the Shapiro-Wilk test. The association between IVF cycle parameters and the presence of polymorphisms was assessed by T-Student (parametric) or U-Mann-Whitney (non-parametric). Main results and the role of chance From a total of 280 IVF cycles, 198 met the inclusion criteria: Control Group (CG) with normal karyotype (94) and Study Group (SG) with presence of polymorphisms (104) were analyzed. Cycles with fresh (136) and warmed (62) oocytes were included. Mean female age was 37.66 ± 3.99 (CG) and 36.61 ± 3.72 (SG). The overall outcome rates were: 75.82% MII, 81.39% TS, 72.78% FZ, 49.07% UE on day 5, 21.82% BP, 78.18% CP, 14.53% M and 63.65% LB. Statistically significant differences were found between the presence of polymorphisms and mean AMH serum level between CG (2.36 ng/mL) and SG (1.74 ng/mL) (p = 0.04), especially when the type “qh+” was detected (1.01 ng/mL) (p = 0.02). Furthermore, statistically significant differences were found regarding oocyte thawing survival rate, which decreased in the SG (78.94%) compared to the CG (93.69%) (p = 0.02), mainly when the type “ps+” was detected (75.13%) (p &amp;lt; 0.01). No statistically significant differences were found between the presence of polymorphism and the AFC (p = 0.25), MII (p = 0.10), FZ (p = 0.93) or UE (p = 0.52) rate on day 5. In the same way, from 106 embryo transfers (ET) performed, no significant differences were found for BP, CP, M and LB rates (p &amp;gt; 0.05). Limitations, reasons for caution Larger prospective studies including homogeneous cohorts are needed in order to corroborate our initial results. Wider implications of the findings Our findings may represent a practical tool in order to advise these patients about their reproductive success, especially, in terms of post-thawing oocyte survival prognosis. Therefore, it could be provided more personalized prognostic information before embarking on IVF treatments. Trial registration number Not Applicable

Standardization of fertility preservation discussion amongst pediatric oncology and bone marrow transplant patients.

10051 Background: As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options. Methods: Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014-2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or radiation treatment. We implemented a standard fertility preservation note and patient handouts, then surveyed our department to identify diagnoses that place patients at risk for infertility and barriers to formalized fertility consultations. We then provided educational sessions to address these barriers with pre- and post-evaluation to measure efficacy. Our longitudinal assessment, encompassing multiple points of intervention, was compared to results from previous chart review (2010-2013). Results: Of 474 patients diagnosed between 2014-2020, 175 (90 females, 85 males) warranted a fertility discussion per inclusion criteria. 61 (67.8%) females received a fertility discussion and of those 8 (8.9%) completed oocyte or gonadal tissue preservation, all between 2017-2020. 52 (61.2%) males received a fertility discussion and 20 (23.5%) completed sperm cryopreservation, with even distribution pattern between 2014-2020. Following implementation of an electronic fertility consult process and standardized fertility preservation documentation, there was an increase in documented fertility discussions from 30% in 2014 to 63.6% in 2020. Internal department survey responses identified a lack of comfort with knowing fertility preservation options available and diagnoses that should prompt this conversation. Education sessions with pre- and post-provider assessment demonstrated more comfort discussing fertility preservation (average score increase from 3.44 to 4.33) and knowledge regarding diagnoses at higher risk of infertility (average score increase from 3.67 to 4.33). Conclusions: Integration of a standardized fertility preservation process and addressing barriers identified within our division have led to a 33.6% increase in fertility discussions over the last 6 years. While the data shows a promising increase in oocyte and ovarian tissue preservation, sperm banking completion rates remained unchanged. Further steps include incorporation of an automated fertility consultation order into electronic chemotherapy orders, hospital-wide identification of other high-risk patient populations, and continued education of patient, families, and the health care team.

Fertility Counseling and Preservation in Breast Cancer

Young women represent a minority of breast cancer patients for which fertility, family planning, and pregnancy represent unique vulnerabilities. This review intends to discuss recent published evidence regarding treatment-related infertility, fertility counseling, and preservation. Fertility concerns are common among young women with breast cancer and may negatively affect treatment decisions. Data is available to aid providers in approximating odds of post-treatment amenorrhea and infertility. Multiple fertility preservation techniques are available. While embryo preservation is most commonly used, recent guidelines endorse oocyte preservation and support for ovarian tissue cryopreservation is increasing. Most recently, the contribution of ovarian suppression during chemotherapy to ovarian function preservation has been established. Germline BRCA mutations may impact fertility potential and challenge fertility preservation and preimplantation genetic testing should be discussed with this subset. Fertility counseling and preservation have become an integral part of the multidisciplinary care for breast cancer at diagnosis and throughout survivorship. Efforts to further individualize recommendations are necessary.

The narratives of fertility clinic’s websites in Spain

One of the important developments in assisted reproductive technology is the technique of oocyte preservation, which enables women to preserve their eggs when there is a threat of becoming infertile in the future. In spite of the still experimental status of this procedure, fertility clinics widely recommend it to healthy women who wish to postpone childbearing for social reasons. Since in fertility clinic’s websites appear extensive recommendations and promotion about this technology, it seems important to analyze their online persuasive communication. Our analysis applies a mixed methodology of content and discourse analysis from a framing theory perspective. It provides an in-depth analysis of the content of fertility clinics’ websites in Spain, describing their communication/information strategies regarding fertility preservation for social reasons. The present article confirms the inconsistency that exists in terms of the clarity of the information given by these websites, since the information is framed intending to attract more women to the egg freezing services.

The Near Future of Vitrification of Oocytes and Embryos: Looking into Past Experience and Planning into the Future

Currently vitrification is the method of choice for low-temperature preservation of oocytes and embryos. However, that was not the case until about 10 years ago when freezing methods were used relatively successfully for embryos and investigated (unsuccessfully) for oocyte preservation. In this paper we will review the history of oocyte and embryo cryopreservation and look into ways and methods for overcoming and improving the vitrification method since it suffers from inherent disadvantages since it is a cumbersome, time-consuming and costly procedure.

Ten-year single-centre experience in fertility preservation of 459 patients suffering from acute leukaemia.

Acute leukaemia is a life-threatening disease that needs treatment without delay. Fertility preservation is recommended, but often not possible because of the necessity to start treatment as soon as possible. The present study is a retrospective single-centre analysis of 459 patients diagnosed with acute leukaemia between 2002 and 2012. Sperm or oocyte preservation was successfully performed in only 29 (6%) patients. Of the 150 children, no paediatric patient sample was taken. The collected samples enabled the conception of 2 children by invitro fertilisation; in addition, 3 spontaneous, non-assisted births in partners of male patients were observed. Fertility preservation is important but difficult to accomplish in patients with acute leukaemia; more efforts are clearly needed to preserve fertility in long-term survivors of acute leukaemia.

Freezing fertility or freezing false hope? A content analysis of social egg freezing in U.S. print media

In 2012, the American Society for Reproductive Medicine (ASRM) lifted the experimental label on oocyte preservation, but cautioned against women using it to avoid age-related infertility, known as social egg freezing (SEF). In 2014, Facebook and Apple announced that they would offer SEF as a workplace benefit. Within the context of a rapidly growing market for SEF, we were interested in how these two decisions affected media discussions, given that such discourse can strongly influence public perceptions and behaviors. We used a content analysis methodology to code 138 articles published in U.S. newspapers and magazines between 2012 and 2015. Focusing on a financial concern over the cost of SEF and the lack of insurance for SEF, we found that media portrayals of SEF pivot away from the ethical principle of nonmaleficence centered in the ASRM decision to discourage SEF. Instead, they highlight an issue of justice that can be remedied through the offer of SEF as a workplace benefit. Overall, media portrayals of SEF paint a simplistic and rosy picture that more options, especially more reproductive and economic options, automatically enhance women’s autonomy.

Oocyte freezing: reproductive panacea or false hope of family?

Advanced technology now allows young women to freeze and store oocytes with a realistic chance of future pregnancy. Vitrification has revolutionized oocyte preservation, with comparable pregnancy rates to fresh oocyte use. Traditionally used for women who were about to undergo sterilizing oncology treatment, now the opportunity has been extended for 'social freezing'. A steady rise in all women accessing freezing continues. Despite this, there is a lack of understanding of natural fertility and the impact of age on pregnancy outcomes. The optimum time for freezing is before a woman reaches her late 30s, which unfortunately is not reflected in those accessing egg freezing. The underlying message prevails that planning for fertility is best done early, whether that be by physical completion of family size or storing oocytes before the passage of time and age prevents it.

Oocyte cryopreservation for women with GATA2 deficiency.

To describe controlled ovarian stimulation (COS) in a population of women with GATA2 deficiency, a genetic bone marrow failure syndrome, prior to allogeneic hematopoietic stem cell transplant METHODS: This is a retrospective case series of nine women with GATA2 deficiency who underwent oocyte preservation at a research institution. Main outcomes measured include baseline fertility characteristics ((antimullerian hormone (AMH) and day 3 follicle-stimulating hormone (FSH) and estradiol (E2)) and total doses of FSH and human menopausal gonadotropins (HMG), E2 on day of trigger, and total number of metaphase II oocytes retrieved. The mean age was 24years [16-32], mean AMH was 5.2ng/mL [0.7-10], and day 3 mean FSH was 5.1U/L [0.7-8.1], and E2 was 31.5pg/mL [< 5-45]. The mean dose of FSH was 1774IU [675-4035], and HMG was 1412IU [375-2925] with a mean E2 of 2267pg/mL [60.7-4030] on day of trigger. The mean total of metaphase II oocytes was 7.7 [0-15]. One patient was diagnosed with a deep vein thrombosis (DVT) with pulmonary embolism (PE) during COS. This study is the first to analyze the outcomes of COS in women with GATA2 deficiency. The response to ovarian stimulation suggests that oocyte cryopreservation should be considered prior to gonadotoxic therapy. However, due to the risk of potentially life-threatening complications, it is prudent that patients are properly counseled of the risks and are evaluated by a multi-disciplinary medical team prior to COS.

Fertility preservation in a premenarcheal female with sickle cell anemia

The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.

Strategies for fertility preservation in young patients with cancer

Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.

Trust women to choose: a response to John a Robertson's 'Egg freezing and Egg banking: empowerment and alienation in assisted reproduction'.

In ‘Egg Freezing and Egg Banking: Empowerment and Alienation in Assisted Reproduction’, John A Robertson responds to the American Society of Reproductive Medicine's statement that oocyte preservation should no longer be considered an experimental treatment. He explores the implications of this development, focusing on the potentially empowering impact of oocyte preservation as a means for women to preserve their fertility. He also engages with concerns about the possibility that such a development may raise issues of alienation. He highlights some of the potential problems that may emerge as women gain the capacity to store and either donate or sell any eggs they do not need for their own reproductive purposes. Much of his paper is valuable and considered, but in places, his views rest on assumptions about women's attitudes to their fertility, understanding of the technology, and relationship with their gametes that are open to dispute. This paper teases out some of these assumptions and puts pressure on them by drawing on the growing body of data about what women actually do think and feel about fertility issues. It focuses on two of his main concerns—that social egg freezing may give women a false sense of security and that women may be harmed if a market in eggs leads to their alienation from their gametes. Via this response to Robertson, I aim to redress the tendency often seen in discussions around women, infertility, aging, and empowerment to unquestioningly accept what I argue are stereotypes and assumptions about women's views and capacity to reason.