Chen Meng-hsiu, managing partner at the Taipei office of law firm Infinity Attorneys-at-Law, represents families who lost relatives in the fatal 2021 Taroko Express accident. Last year, the 45-year-old lawyer began an egg-freezing cycle.

During the consulting process at the fertility center, Chen was stunned to find out that, due to Taiwan’s strict regulations on fertility treatment, she might not even be able to use her frozen eggs to have a baby in the future. On top of that, cryopreservation, the storage of these eggs at very low temperatures, would cost around NT$10,000 per year. Chen is not shy to admit that “Somehow I feel a sense of urgency.”

Chen Meng-hsiu (Source: Ming-Tang Huang)

This August, NTU Hospital published research results in the medical journal Reproductive Biology and Endocrinology which showed that an average of just 8.4 percent of women who had gone through an egg freezing procedure for social, non-medical reasons at hospitals between 2002 and 2020 used them at a later date.

Chen Shee-uan, the corresponding author of the study and head of the Department of Obstetrics and Gynecology at NTU Hospital, oversaw the first successful fertilization of thawed eggs in Taiwan in 2002. Over the past two decades, he witnessed how elective egg freezing evolved from a scientific endeavor into a business.

In the early days of oocyte freezing, the procedure served to preserve the fertility of women who were about to undergo chemotherapy for cancer treatment, which can damage the pool of eggs in the ovaries. In 2012, the American Society of Reproductive Medicine declared that egg freezing should no longer be considered “experimental” and that pregnancy success rates for thawed eggs in comparison with fresh eggs were good. This set the stage for selective egg freezing to be marketed as a means for healthy women to postpone childbearing without having to worry about the decline in fertility that comes with aging.

But Chen points out that the eight- percent average usage rate found in the study only represents the ratio of women who had returned to the center and tried to get pregnant using their frozen eggs. The successful pregnancies resulted in 21 live births, which means that babies born from frozen eggs account for just 3 percent of all cases reviewed in the study.

Given that NTU Hospital was the first medical institution in Taiwan to provide egg freezing, does a usage rate of 8.4 percent represent the real-life situation in Taiwan?

Lai Hsing-hua, founder of Taiwan’s first egg bank, the Stork Fertility Center, says that the rate of women who freeze their eggs and return to have them thawed there stands at below four percent. Lee Maw-sheng, president of Taichung-based Lee Women’s Hospital, which last year reported the highest number of fertility treatment cycles nationwide, says that at his hospital the frozen egg usage rate stands at around 10 percent. He opines that women typically do not return to use their frozen eggs because they are too busy with their careers or do not have a partner.

Chen Shee-uan (Source: Ming-Tang Huang)

Legal restrictions prevent 90 percent of women from using their frozen eggs

Is a usage rate of 8.4 percent considered low? Chen explains that there is only scarce scientific evidence regarding the usage rate. However, previous studies from Spain and the United States reported that each 12.1 percent and 38.1 percent of women who opted for elective oocyte cryopreservation subsequently had their eggs thawed, hoping to get pregnant.

Many believe that Taiwan’s legal restrictions on fertility treatment are to blame for the comparatively low usage rate. The Assisted Reproduction Act, which was adopted in 2007, stipulates that artificial insemination is limited to married heterosexual couples where one of the partners is infertile. This means that single women and same-sex couples are prevented from having children from their thawed eggs.

“I have a very strong sense of being deprived of my rights. Why can’t I use my own things, why is my life being restricted in such a way?” Chen asks.

In contrast, single women and same-sex couples in the United States can legally use sperm donation to get pregnant.

In 2020, the NYU Langone Prelude Fertility Center published a study in Fertility and Sterility covering 231 patients who had undergone egg freezing cycles at the center, which found that 33 women or 37.5 percent had created embryos with donor sperm.

Therefore, women who can afford it tend to decide to have their eggs frozen abroad.

One Ms. Liang, for instance, discovered after marrying her same-sex partner that Taiwanese law is quite restrictive regarding assisted reproduction. Therefore, she went to the United States, where she had her eggs retrieved, fertilized and the resulting embryos frozen. Since she was busy with her job, she was able to take a longer vacation just two years later, when she returned to the United States for embryo implantation. Unfortunately, the pregnancy resulted in stillbirth.

The entire procedure comes with a lot of red tape with documents likely going back and forth for as long as a year. Travel expenses can easily exceed NT$1 million, but Liang is determined to continue to try having a baby through another embryo implantation.

“Aren’t people like us helping to boost the national fertility rate? So just how are we contravening national policy?” she asks. She feels that her aspiration to have children should also be regarded as working toward increasing the birth rate. “But we always run into complex bureaucratic obstacles, and this should be improved,” she notes.

Chen Meng-hsiu, a lost relatives in the fatal 2021 Taroko Express accident holding a baby in arm. (Source: Chen Meng-hsiu)

Improving the low frozen egg usage rate through matchmaking

The fundamental question is whether Taiwan should aim for a higher frozen egg usage rate to improve the birth rate, which at below 1 birth per woman is one of the lowest worldwide. Tsai Yung-chieh, head of the Center of Reproductive Medicine at the Chi-Mei Medical Center in Tainan, points out that a low usage rate does not necessarily mean that women who do not return to thaw their eggs do not have babies. They could have gotten pregnant naturally.

However, Lai believes that the usage rate is bound to rise. He points to the obstacles that prevent single women from using their frozen eggs and sees a lot of room for improvement in that regard.

This year alone more than 800 women had their eggs frozen at the Stork Fertility Center, 40 times more than ten years ago, and even more women than the total number of patients who underwent egg freezing cycles at NTU Hospital since the treatment became available there.

While low usage rates reflect women’s predicaments and also creates operational pressure for the fertility centers, Lai is confident that “the usage rate will inevitably rise in the future.”

Matchmaking activity held by Stork Fertility Center (Source: Stork Fertility Center)

Have you read?

• One-third of Taiwanese men will face cancer at some point in their lives 
• Even as Birth Rates Decline, Overpopulation Remains a Global Challenge 
• The Fertility Effect of National Health Insurance in Taiwan

Translated by Susanne Ganz
Edited by TC Lin
Uploaded by Ian Huang