Oocyte cryopreservation — egg freezing — produces clinically meaningful live birth rates when oocytes are retrieved before age 35, with steep age-related decline thereafter. Cobo et al.’s 2016 Fertility and Sterility cohort of 1,468 women found a live birth rate per patient of 50% for women aged 35 or younger versus 22.9% for women aged 36 or older, with cumulative live birth rates climbing sharply once 8–10 mature oocytes were banked — and rising far more steeply for younger women than older ones. The ASRM Practice Committee concluded in its 2013 guideline that oocyte vitrification and warming should no longer be considered experimental, with fertilization and pregnancy rates similar to fresh IVF/ICSI for young women. Greenwood and colleagues’ 2018 retrospective survey of 201 women who had frozen eggs found that only 16% (33 women) experienced moderate-to-severe decision regret, while 89% affirmed they would be happy they froze even if they never use the eggs; regret was concentrated among women who banked fewer eggs and who felt under-informed before the procedure.
The asymmetry in the regret data is stark. A prospective cohort by Jaswa, Greenwood and colleagues (2023) followed 173 women who consulted about planned egg freezing and surveyed them six months later: moderate-to-severe regret was just 9% among women who went ahead and froze, but 51% among women who decided not to pursue treatment. This is a textbook inaction-regret pattern: the action (freezing) has a modest regret rate driven by uncertainty about whether the eggs will ever be needed; the inaction (declining) carries a much higher regret rate concentrated in those who later question having passed up the option.
Sperm freezing presents a simpler version of the same decision. Male gamete cryopreservation is substantially cheaper (typically under $1,000 vs. $10,000–$20,000 for oocyte cycles), requires no invasive procedure or hormone stimulation, and does not face the same age-related quality decline until the late 40s or 50s. For men in circumstances where biological parenthood is a desired but uncertain future goal, sperm banking resolves the optionality question at low cost and burden. The asymmetry in action vs. inaction regret is likely wider for sperm than for oocytes precisely because the cost of acting is so much lower relative to the regret of not having acted.