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Sandhu S, Hickey M, Braat S, Hammarberg K, Lew R, Fisher J, Ledger W, Peate M. Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information. J Assist Reprod Genet 2023; 40:1265-1280. [PMID: 37058261 PMCID: PMC10101825 DOI: 10.1007/s10815-023-02796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information. METHODS An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method. RESULTS Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53). CONCLUSION Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
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Peate M, Sandhu S, Braat S, Hart R, Norman R, Parle A, Lew R, Hickey M. Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221139673. [PMID: 36448651 PMCID: PMC9720825 DOI: 10.1177/17455057221139673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Uptake of elective egg freezing has increased globally. The decision to freeze eggs is complex, and detailed, unbiased information is needed. To address this, we developed an online Decision Aid for women considering elective egg freezing. Decision Aids are the standard of care to support complex health decisions. OBJECTIVES This study will measure the impact of the Decision Aid on decision-making (e.g. decisional conflict, engagement in decision-making, distress, and decision delay) and decision quality (e.g. knowledge, level of informed choice, and regret). METHODS AND ANALYSIS A single-blinded two-arm parallel-group randomized controlled trial. Women considering elective egg freezing will be recruited using social media, newsletters, and fertility clinics. Data will be collected at baseline (recruitment), 6-month, and 12-month post-randomization. The primary hypothesis is that the intervention (Decision Aid plus Victorian Assisted Reproductive Technology Authority website) will reduce decisional conflict (measured using the Decisional Conflict Scale) at 12 months more than control (Victorian Assisted Reproductive Technology Authority website only). Secondary outcomes include engagement in decision-making (Perceived Involvement in Care Scale), distress (Depression, Anxiety, and Stress Scale), decision delay, knowledge, informed choice (Multi-dimensional Measure of Informed Choice), and decisional regret (Decisional Regret Scale). ETHICS The study was approved by the University of Melbourne Human Research Ethics Committee (Ethics ID: 2056457). Informed consent will be obtained from all participants prior to enrolment. DISCUSSION This is the first international randomized controlled trial that aims to investigate the effect of an elective egg freezing Decision Aid on decision-related outcomes (e.g. decisional conflict, informed choice, and regret). It is anticipated that participants who receive the Decision Aid will have better decision and health outcomes. REGISTRATION DETAILS ACTRN12620001032943: Comparing different information resources on the process and quality of decision-making in women considering elective egg freezing.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia,Michelle Peate, Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, VIC 3052, Australia.
| | - Sherine Sandhu
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Roger Hart
- Division of Obstetrics and Gynaecology, The University of Western Australia, King Edward Memorial Hospital, Perth, WA, Australia,Fertility Specialists of Western Australia and City Fertility, Bethesda Hospital, Claremont, WA, Australia
| | - Robert Norman
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Parle
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Raelia Lew
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia,Reproductive Services Unit, The Royal Women’s Hospital and Melbourne IVF, Melbourne, VIC, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
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Fritz R, Jindal S. Reproductive aging and elective fertility preservation. J Ovarian Res 2018; 11:66. [PMID: 30098598 PMCID: PMC6087539 DOI: 10.1186/s13048-018-0438-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/02/2018] [Indexed: 01/05/2023] Open
Abstract
Reproductive aging is a natural process that occurs in all women, eventually leading to reproductive senescence and menopause. Over the past half century there has been a trend towards delayed motherhood. Postponing reproduction can increase the chance of a woman remaining involuntarily childless as well as an increase in pregnancy complications in those that do achieve pregnancy at advanced maternal age. Despite the well-documented decrease in fecundity that occurs as a woman ages, reproductive aged women frequently overestimate the age at which a significant decline in fertility occurs and overestimate the success of assisted reproductive technologies (ART) to circumvent infertility. Oocyte cryopreservation enables women to achieve genetically related offspring in the event that they desire to postpone their childbearing to an age after which a significant decline in fertility occurs or in circumstances in which their reproductive potential is compromised due to medical pathology. Available success rates and safety data following oocyte cryopreservation have been reassuring and is not considered experimental according to the American Society for Reproductive Medicine and the European Society for Human Reproduction and Embryology. This review article will focus on an evidence-based discussion relating to reproductive aging and oocyte cryopreservation.
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Affiliation(s)
- Rani Fritz
- Department of Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Minneapolis, USA
| | - Sangita Jindal
- Department of Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine/Montefiore Medical Center, Minneapolis, USA
- Montefiore’s Institute for Reproductive Medicine and Health, New York, USA
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Schneider J, Lahl J, Kramer W. Long-term breast cancer risk following ovarian stimulation in young egg donors: a call for follow-up, research and informed consent. Reprod Biomed Online 2018; 34:480-485. [PMID: 28473127 DOI: 10.1016/j.rbmo.2017.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
In the USA and other countries, oocyte donation is gaining increasing importance. Although sufficient data exist on procedure-associated short-term risks for oocyte donors, such as ovarian hyperstimulation syndrome, long-term follow-up studies of egg donors are lacking and their health risks are unknown. The lack of information may be misleadingly interpreted as lack of risk. Long-term hormone replacement therapy is recognized as a risk factor for breast cancer; the breast cancer risk of ovarian stimulation for egg donors is unknown but is a possibility. This commentary describes five individual cases of egg donors who developed breast cancer (four out of five women in their 30s) despite negative genetic testing results. Additionally, we summarize available studies of breast cancer in infertile women who experienced IVF. We emphasize the need to create egg donor registries that will facilitate long-term studies on egg donors. Until this information is available, we call for more realistic explanations to egg donors about the lack of knowledge of long-term risks as well as more transparent informed consent documents.
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Affiliation(s)
- Jennifer Schneider
- Professional Boundaries, Inc, 3052 N Palomino Park Loop, Tucson, AZ 85712, USA.
| | - Jennifer Lahl
- Center for Bioethics and Culture, 3380 Vincent Road, Pleasant Hill, CA 94523, USA
| | - Wendy Kramer
- Donor Sibling Registry, P.O. Box 1571, Nederland, CO 80466, USA
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Abstract
PURPOSE OF REVIEW Elective oocyte cryopreservation for deferred childbearing has gained popularity worldwide, commensurate with increased knowledge regarding age-related fertility decline. The purpose of this review is to summarize recent data regarding trends in delayed childbearing, review recent findings surrounding age-related fertility decline, acknowledge significant gaps in knowledge among patients and providers regarding fertility decline and review outcomes following elective oocyte cryopreservation. RECENT FINDINGS Despite an inevitable decline in fertility and increase in miscarriage with increasing female age, there is a growing worldwide trend to delay childbearing. Patients and providers alike demonstrate large gaps in knowledge surrounding age-related fertility decline. Oocyte cryopreservation is clinically approved for medically indicated fertility preservation, but a growing number of women are using oocyte cryopreservation to defer childbearing and maintain reproductive autonomy. Mounting data support the efficacy and safety of oocyte cryopreservation when used to electively defer childbearing, with recent studies demonstrating rates of euploidy, implantation and live birth rates equivalent to in-vitro fertilization (IVF) with fresh oocytes. SUMMARY Oocyte cryopreservation provides women with an option to defer childbearing and maintain reproductive autonomy, with IVF success rates on par with fresh IVF. However, it is critical that patients understand the limitations of oocyte cryopreservation. Greater education regarding age-related fertility decline should be geared toward patients and providers to prevent unintended childlessness.
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Affiliation(s)
- Kara N Goldman
- New York University Fertility Center (NYUFC), NYU Langone Medical Center, New York, New York, USA
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