Article by Maryam Rahbar, NDWRH Alumni
When I arrived at Oxford to begin my MSc in Clinical Embryology, I was drawn by the promise of science meeting human impact, of understanding how life begins, and how we might support it. Later, during my PhD in Women’s & Reproductive Health, I realised that an equally important part of that promise is giving people the knowledge and choice to plan their reproductive futures. My time at Oxford taught me to ask questions: What do we know? What do we not yet know? How do we translate scientific insight into meaningful action? Today, I am putting what I learned into action, with a mission to raise awareness around fertility decline and preservation options, not out of fear, but out of empowerment.
Understanding fertility decline
Many assume that fertility remains fairly steady until the late 30s or 40s, but biology tells a different story. Women are born with a finite number of eggs, and both the quantity and quality of those eggs decline with age. One study modelling ovarian reserve showed that by age 30 most women have already lost the majority of their peak egg-reserve, and by age 40 only a few percent of the maximal pre-birth pool remains 1. The practical implication is that while conception remains possible into the late 30s and beyond, the chances of successful pregnancy naturally decrease over time. For example, a review of elective oocyte (egg) cryopreservation emphasises that success is strongly dependent on age at the time of freezing, with much higher success rates in those aged 35 years and under 2.
Fertility preservation: what we mean
Modern reproductive science now offers options that were simply unavailable a generation ago. One of the most widely discussed is egg freezing (also called oocyte cryopreservation). This technique has advanced substantially, with vitrification (rapid freezing) providing outcomes much closer to fresh eggs than earlier methods 1. Egg freezing is not a guarantee of future pregnancy (no medical intervention can offer that) but it can provide reproductive flexibility, particularly for people who wish to delay childbearing for education, career, partner situation or health reasons. An up-to-date review summarises that elective oocyte cryopreservation “should be incorporated in women’s reproductive options to ensure informed decisions and reproductive autonomy” 3.
In practical terms:
- The younger at the time of freezing, the higher the potential benefit, because egg quality is better and fewer eggs may be needed 2.
- The procedure involves stimulation, egg retrieval, freezing and storage. Later, if needed, thawing, in vitro fertilisation (IVF) and embryo transfer may follow.
- It’s also important to recognise limitations: not everyone who freezes eggs returns to use them, and not every thawed egg leads to embryo, let alone live birth. For instance, one European centre found only ≈ 7% of women who froze eggs later returned for treatment 5.
Making proactive choices
At its heart, this is a story of choice rather than pressure. Whether you choose fertility preservation or not, simply understanding how fertility changes with age gives you agency.
Here are three practical suggestions:
- Reflect on your reproductive goals and timing. When might you wish to have children? What factors are important to you (partner, career, health)?
- Seek accurate information and counselling. Because this is a nuanced field, it helps to consult fertility specialists or trusted educational resources.
- Consider your options before you feel pressured by time. If you’re intrigued by fertility preservation, early exploration keeps the door open. If you choose not to freeze eggs, knowing your fertility timeline still helps inform decisions (e.g., when to start trying, when to seek advice).
Closing
My Oxford journey has always been about bridging knowledge and impact. I believe raising awareness around fertility preservation is part of that legacy through empowering alumni, students and the broader community with science-based education and compassionate choice. I hope this initiative offers people a chance to reflect, to understand, and to act in accordance with their life’s path. Let’s make informed choice the norm, not the exception.
References & Suggested Reading:
1) Dunne C, Roberts J. Social egg freezing: A viable option for fertility preservation. BCMJ. 2016. BC Medical Journal
2) Royal College of Obstetricians & Gynaecologists. Elective Egg Freezing for Non-Medical Reasons: Scientific Impact Paper No. 63. PubMed. PubMed
3) Chronopoulou et al. Elective oocyte cryopreservation for age-related fertility decline. PubMed. PubMed
4) Sandhu S et al. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Med Inform Decis Mak. 2023. BioMed Central
5) Only seven percent of social egg freezers have returned for fertility treatment at a large European center. ESHRE. 2018. Medical Press.
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