Exploring the Demand for Elective Egg Freezing : An Incentive-Compatible Experiment

Background: Infertility affects one in eight couples worldwide. In vitro fertilization (IVF) is now considered a mainstream fertility treatment to increase the chance of conceiving a child in infertile individuals. The main cause of infertility is advanced female age due to the number and quality of eggs available. Elective egg freezing (EEF) is an increasingly common novel type of fertility treatment to prolong fertility in young female patients by freezing eggs for later use. Currently EFF is not funded by any government health insurance schemes. There is limited data on the responsiveness of demand for EEF to treatment costs and patient income.Objective: We conducted a proof-of-concept analysis to demonstrate that government funding decisions can be studied within a lab experiment: We explore the effects of government funding levels and various participant characteristics on the demand for EEF and IVF and determine price and income elasticities of demand within an incentive-compatible experiment.Methods: 217 adult female participants of reproductive age between 20-29 years old (average age: 23.7 years) and without children were recruited from a pool of students as well as from Prolific, an online data collection platform. To assess their preferences and sensitivity to treatment costs of either immediate EEF and using frozen eggs at age 40 years, or IVF treatment at 40 years, participants were assigned to one of three experimental treatments that were calibrated to real-world data from Australia and elsewhere: (1) low-income endowment + full information about infertility and available treatments; (2) high income + full information; (3) high income + low information. The experiment consisted of 3 experimental conditions corresponding to different levels of government funding for IVF and EEF with 2 decision periods (a ‘planning period’ and a ‘family-formation period’) to explore how demand for IVF and EEF changes based on the level of government funding. In each period, participants had to indicate their preferred treatment choice with the goal of achieving a live birth within each experimental condition. The experiment was followed by risk- and time-preference elicitation tasks. Compensation was based on decisions made and associated final outcomes to achieve proper incentivization. The experiment was pre-registered on the Open Science Framework Platform (https://doi.org/10.17605/OSF.IO/K5PXY and https://doi.org/10.17605/OSF.IO/G6D7Q).Results: Under the experimental condition where disposable income was set at AU$5,000 per annum, full information on procedures was provided and no government funding was provided, 75.0% of participants chose immediate EEF in their 20s, 19.4% chose IVF at age 40 years, and 5.6% chose to attempt conception naturally at age 40. A higher proportion of women chose to undergo EEF with higher levels of income, increased government funding, and the provision of full information on procedures. More than 95% of participants chose EEF in the condition with full government funding. The demand for EEF and IVF were shown to be inelastic to price, with price elasticities ranging from -0.10 to -0.18 for EEF and -0.36 to -0.41 for IVF. Demand did not significantly change with income level. The level of government funding had a significant impact on treatment demand with the odds of selecting EEF increasing by 1,354% when the price of EEF decreased from AU$19,000 to AU$0.Conclusions: Our study shows that government funding decisions for medical interventions can be explored within an experimental setting. The fact that most participants chose to undergo EEF in the experiment suggests that the demand for EEF by women in their twenties is high if they are provided with accurate information about the age-related fertility decline and benefits of EEF to prolong their fertility. Overall, we find that the increase in the price for EEF and IVF through restrictions in government funding significantly reduces demand for such treatments. However, income level was not shown to have an effect on demand, suggesting a high value associated with fertility treatment