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Alon I, Bussod I, Golan OC, Ravitsky V. Mapping ethical, legal, and social implications (ELSI) of fertility preservation. J Assist Reprod Genet 2024; 41:2495-2514. [PMID: 39141169 PMCID: PMC11405582 DOI: 10.1007/s10815-024-03210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
RESEARCH QUESTION The study examines the ethical, legal, and social implications of fertility preservation, highlighting its importance across oncofertility, elective egg freezing, and posthumous assisted reproduction, as well as its impact on transgender individuals undergoing gender-affirming surgeries. DESIGN A comprehensive analysis of 600 articles, focusing on a diverse range of disciplines, including bioethics, psychology, and sociology, to explore public and healthcare professionals' knowledge, patient experiences, and regulatory constraints. RESULTS The body of literature is growing, indicating increasing recognition of FP's significance. Key themes included the centrality of counseling and informed decision-making, especially in oncofertility and EEF, and ethical debates surrounding informed consent and the autonomy of involved individuals. The analysis underscored a western-centric bias in current research, emphasizing the need for more inclusive and culturally sensitive studies. CONCLUSIONS The study calls for a nuanced understanding of FP, advocating for policies that consider ethical, cultural, and social dimensions. It suggests the necessity for interdisciplinary research to address identified gaps, particularly in understanding non-Western perspectives and ensuring equitable access to FP services globally. Moreover, the review emphasizes the importance of integrating patient-centric approaches and ethical frameworks to guide FP practices and policies, ensuring they respect diverse values and meet individuals' needs.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Autonomous University of Madrid, Madrid, Spain.
- University of Montreal, Montreal, Canada.
| | | | - Orit Cherny Golan
- University of Montreal, Montreal, Canada
- Yezreel Valley College, Yezreel Valley, Israel
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2
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Wo L, Eidelson SA, Zheng C, Mouhanna J, Bussies P, Zhang C, Möller MG. Coverage of Fertility Preservation and Treatment Among Surgical Trainees in the United States of America. JOURNAL OF SURGICAL EDUCATION 2023; 80:689-696. [PMID: 36933957 DOI: 10.1016/j.jsurg.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Surgery trainees spend their prime fertility years in training, which leads to delays in childbearing, accompanying infertility challenges, and high-risk pregnancies. Literature report of institutional support for fertility preservation (egg/sperm freezing) and treatment is lacking. The cost is particularly prohibitive while receiving a resident physician salary. This study aimed to assess availability of fertility resources and institutional coverage of fertility services to US General Surgery Residents (GSR) and Breast Fellows. METHODS We composed and distributed a 26-question survey to GS residency and fellowship program directors nationwide to survey residents and fellows. Summary and descriptive statistics were tabulated, and categorical variables were analyzed using Pearson's chi square test. RESULTS A total of 234 US surgical trainees (male n = 75, female n = 155, unreported n = 4) completed the survey. Total of 12 % of trainees reported having been counseled on family planning/fertility treatment during training, and only 5.1% were counseled on fertility preservation. Perceived lack of support from program (p = 0.027) and counseling of fertility preservation (p = 0.009) were significantly associated with female gender. A minority (12.5%) reported having insurance coverage for fertility preservation and 26% had coverage of fertility treatment. In addition, 2.6% respondents pursued fertility preservation while in training and 33% reported they would pursue fertility preservation if it was covered by insurance. CONCLUSIONS Fertility preservation is rarely discussed in US General Surgery residency programs. The large majority of GSR lacks awareness of insurance coverage of fertility preservation and treatment. Strong efforts are necessary to improve fertility education for GSR and insurance coverage to meet trainee's needs.
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Affiliation(s)
- Luccie Wo
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sarah A Eidelson
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Caiwei Zheng
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Joelle Mouhanna
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Parker Bussies
- Cleveland Clinic Foundation, Women's Health Institute, Cleveland, Ohio
| | - Chi Zhang
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Mecker G Möller
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Peipert BJ, Harris BS, Selter JH, Ramey-Collier K, Blenden R, Unnithan S, Erkanli A, Price TM. Direct-to-consumer fertility testing: utilization and perceived utility among fertility patients and reproductive endocrinologists. Reprod Biomed Online 2023; 46:642-650. [PMID: 36610890 DOI: 10.1016/j.rbmo.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What is the utilization of direct-to-consumer fertility tests (DTCFT) among fertility patients? How does the perceived utility of DTCFT differ between patients and reproductive endocrinologists (REI)? DESIGN Infertility patients visiting the Duke Fertility Center between December 2020 and December 2021 were sent an electronic invitation to participate in a patient survey. Members of the Society of Reproductive Endocrinology and Infertility were also sent e-mail invitations to participate in the REI survey. DTCFT were defined as tests not ordered by a physician or performed at a physician's office, including calendar methods of ovulation prediction, urinary ovulation prediction kits, basal body temperature (BBT) monitoring, hormone analysis, ovarian reserve testing and semen analysis. Patients and REI were asked how likely they were to recommend a given DTCFT, on a 0-10 Likert scale. RESULTS In total, 425 patients (response rate 50.5%) and 178 REI (response rate 21.4%) completed the surveys. Patients reported the utilization of calendar methods of ovulation prediction (83.8%), urinary ovulation prediction (78.8%), BBT monitoring (30.8%), hormone analysis (15.3%), semen analysis (10.1%) and ovarian reserve testing (9.2%). REI rated the utility of all DTCFT significantly lower than patients did (average discordance -4.2, P < 0.001), except for urinary ovulation prediction, which REI gave a significantly higher score (discordance +1.0, P < 0.001). Prior pregnancy was significantly associated with home ovulation prediction utilization among patients (adjusted odds ratio 3.21, 95% confidence interval 1.2-9.83). CONCLUSIONS Methods of ovulation prediction are commonly used by fertility patients. Significant discordance exists in the perceived utility of DTCFT between patients and REI. Patient education and guidelines are needed to better inform individuals considering DTCFT.
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Affiliation(s)
- Benjamin J Peipert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA
| | - Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA
| | - Jessica H Selter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA
| | - Khaila Ramey-Collier
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA
| | - Randa Blenden
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA
| | - Shakthi Unnithan
- Biostatistics Core, Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham NC, USA
| | - Alaattin Erkanli
- Biostatistics Core, Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham NC, USA
| | - Thomas M Price
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham NC, USA.
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Özöztürk S, Çiçek Ö. Factors affecting the decisions of women considering oocyte cryopreservation: A blog study. Health Care Women Int 2022; 45:101-112. [PMID: 35763334 DOI: 10.1080/07399332.2021.2005067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/07/2021] [Indexed: 10/17/2022]
Abstract
The aim was to explain the factors that affect the decision-making processes of women considering oocyte cryopreservation. In this study, a web page was scanned between March and April 2020 that was appropriate to the "Evaluation of the Quality and Content of Websites Form." As a result, 4 main themes (unknown process, financial burden, social stigma, and future concerns) were created from the experiences of 23 women. The majority of women feel anxiety associated with the oocyte cryopreservation process. It is recommended that reliable information should be presented to society by health care professionals.
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Affiliation(s)
- Sevcan Özöztürk
- Department of Gynecology & Obstetrics Nursing, Nursing Faculty, Dokuz Eylül University, Izmir, Turkey
| | - Özlem Çiçek
- Health Sciences Faculty, Bakırçay University, Izmir, Turkey
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Gurbuz A, Cil AP, Karakis LS, Abali R, Ceyhan M, Aksakal E, Kilic A, Bahceci M, Urman B. Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline. J Assist Reprod Genet 2021; 38:1469-1479. [PMID: 33797008 PMCID: PMC8266947 DOI: 10.1007/s10815-021-02164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the prevalence and factors associated with decision regret following oocyte cryopreservation (OC) in women with diminished ovarian reserve (DOR) and/or age-related fertility decline (ARFD). METHODS A cross-sectional survey study was conducted to five hundred fifty-two women with DOR and/or ARFD who underwent OC between 2014 and 2019 in two private-assisted reproductive units in Istanbul, Turkey. Decision regret was measured using the validated Decision Regret Scale (DRS). RESULTS The median and mean DRS scores were 10 (interquartile range: 25) and 13.4 (SD: 13.2, range 0-70), respectively. Eighty-five (52.5%) women reported mild regret and 26 (16%) had moderate to severe regret. Decision regret was inversely associated with the belief in fate regarding childbearing and trust in the efficacy of OC. CONCLUSIONS The prevalence of severe decision regret among patients with DOR and/or ARFD undergoing OC is low. Women who had belief in fate and trusted in the efficacy of oocyte cryopreservation had significantly lower decisional regret.
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Affiliation(s)
- Aysen Gurbuz
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Aylin Pelin Cil
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey.
| | | | - Remzi Abali
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Mehmet Ceyhan
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Ece Aksakal
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Azer Kilic
- Department of Sociology, Istanbul Bilgi University, 34060, Istanbul, Turkey
| | - Mustafa Bahceci
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
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Yee S, Lipton NJ, Fu V, Goodman CV, Librach C. Planned Oocyte Cryopreservation: Outcomes, Motivations, and Involvement of Primary Health Care Providers. J Womens Health (Larchmt) 2021; 31:285-292. [PMID: 34030468 DOI: 10.1089/jwh.2020.8888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: With improvements in oocyte cryopreservation and widespread delays in childbearing, planned oocyte cryopreservation (POC) has become an increasingly attractive option. This study aimed to (1) review POC cycle outcomes at an academic in vitro fertilization (IVF) center and (2) examine POC users' motivations for pursuing POC, fertility knowledge, and the involvement of their primary health care providers (PHP). Materials and Methods: POC cycle outcomes were collected from IVF records of the 224 women who underwent ≥1 cycle from 2012 to 2018. The 198 who were reachable by e-mail were invited to complete an online survey. The study was approved by the University of Toronto Research Ethics Board (No. 32951). Results: Mean age of the 224 women at first cycle was 36.4 (range: 25-42), with a significant decrease in anti-Müllerian hormone level (p = 0.001) and mean number of oocytes retrieved (p = 0.006) and cryopreserved per cycle (p = 0.042) with increasing age. From those invited for survey participation, 98 (49.5%) questionnaires were returned, with 86 evaluable. Majority of respondents were Caucasian (66%), single (93%), and earned a gross annual income of >$70,000 (74%). Strongest motivation for pursuing POC was concern about age-related fertility decline in the absence of a partner. Respondents' annual income was positively correlated with the number of completed cycles (p = 0.032). Half the respondents correctly identified age of onset of marked fertility decline as ≥35 years. In only 19% of cases was the conversation PHP initiated, and 29% never discussed POC with their PHP. Conclusions: More than 50% of women underwent POC at an age when fertility has begun to markedly decline. It is important for PHPs to identify and discuss POC with appropriate patients and offer accurate preliminary information and timely referrals for those interested in exploring this option.
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Affiliation(s)
- Samantha Yee
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Nechama J Lipton
- Research Department, CReATe Fertility Centre, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vivian Fu
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Carly V Goodman
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Clifford Librach
- Research Department, CReATe Fertility Centre, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
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Fuchs Weizman N, Baram S, Montbriand J, Librach CL. Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective. BJOG 2020; 128:950-962. [PMID: 33021076 DOI: 10.1111/1471-0528.16555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advances in vitrification techniques have enabled planned oocyte cryopreservation ('Planned OC'). OBJECTIVES To explore the cost-efficiency and utilisation of planned OC, as well as patients' perspectives on the process. SEARCH STRATEGY A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019. SELECTION CRITERIA The protocol followed PRISMA guidelines in PECO format, and was registered with PROSPERO. DATA COLLECTION AND ANALYSIS Two independent reviewers evaluated all manuscripts for inclusion eligibility. Authors were contacted for missing data. Included studies were assessed for risk of bias and for heterogeneity. Weighted effects were measured and plotted. MAIN RESULTS The search yielded 12 545 records, of which 43 were included. Planned OC is cost-efficient at 35, assuming 60% utilisation; and at 37 assuming utilising donor sperm when necessary. At 38 it is cost-efficient to defer planned OC in favour of undergoing 2 IVF cycles. Currently, utilisation of banked-oocytes within 22-58 months, is up to 15%. Nine percent of warmed banked oocytes result in life births. Online resources and treating physicians are equally important sources of information regarding planned OC. Most patients think planned OC is ideal before age 35 and are not fully aware of what the process entails and tend to overestimate the success rates. The main barrier to wider endorsement of planned OC is being wary of potential health implications or of limited success. CONCLUSION Planned OC is an adequate method for preserving fertility. However, knowledge gaps result in under-utilisation leading to reduced cost-efficiency. TWEETABLE ABSTRACT Identifying facilitators and barriers for wider adoption of banking oocytes can enhance the cost-efficiency of this modality.
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Affiliation(s)
| | - S Baram
- CReATe Fertility Centre, Toronto, ON, Canada
| | - J Montbriand
- Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C L Librach
- CReATe Fertility Centre, Toronto, ON, Canada.,Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
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Yee S, Goodman CV, Fu V, Lipton NJ, Librach CL. Parenthood desire, childbearing plans and oocyte utilization among women who previously underwent planned oocyte cryopreservation. Reprod Biomed Online 2020; 42:442-450. [PMID: 33246804 DOI: 10.1016/j.rbmo.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION To examine the motivations, life circumstances and parenthood aspirations of a cohort of women who underwent planned oocyte cryopreservation (POC) at a Canadian academic IVF centre. DESIGN A single-site, cross-sectional, anonymous quantitative study using a study-specific questionnaire administrated via SurveyMonkey®. Of the 224 women who completed at least one POC cycle between 2012 and 2018, 198 were reached by email and invited to participate. RESULTS Of the 98 (49.5%) questionnaires returned, 86 were fully completed and were analysed. Mean age at first POC cycle was 35.7 ± 2.4 (range 27-43) and at survey was 37.7 ± 2.5 years. At POC, 77% were single and 97.7% childless. At survey, 96% had not attempted to use their cryopreserved oocytes, yet 26 (30%) had tried natural conception or fertility treatments. Of these, three conceived naturally and two by assisted reproduction. Eighty-five per cent expressed a strong motherhood desire and 67.1% indicated that usage of their cryopreserved oocytes was mostly contingent on relationship status. Many expressed a desire for shared genetic parenthood within a committed relationship. Forty-seven per cent did not want to carry a pregnancy beyond the age of 46. CONCLUSION The findings of this study confirm the central role of age and relationship status in influencing women's POC decisions and oocyte utilization plans. The late age at POC could be explained by women using it toward the end of their peak reproductive years to leverage their remaining chances of genetic motherhood. Surveying women at later points following POC would help to gain a more comprehensive picture of their oocyte utilization and disposition plans.
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Affiliation(s)
| | | | - Vivian Fu
- CReATe Fertility Centre, Toronto, Canada
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, Canada
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