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Shavit T, Hasson J, Hyman JH, Tsafrir A. Trends in patient age at planned oocyte cryopreservation. J Assist Reprod Genet 2024:10.1007/s10815-024-03237-z. [PMID: 39235517 DOI: 10.1007/s10815-024-03237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
PURPOSE The outcome of planned oocyte cryopreservation (POC) is inversely related to the age at the time of oocyte cryopreservation commencing in the mid-30 s. We sought to evaluate whether the age of women undergoing POC has changed over the last decade. METHODS The study employed a retrospective, observational multicenter design. It included all women who had at least one POC cycle in two large private IVF units belonging to the same medical organization in Israel. The main outcome measure was age at the first cycle. Data on the total number of women each year and their age at the first cycle were recorded. RESULTS Between 2011 and the end of 2023, 4488 women underwent POC. The average age at the first retrieval was 36.2 years (± 2.4). In 2011, the average age was 38.3 years (± 2.6), which decreased to 35.4 years (± 2.5) in 2023. The trendline indicates a decline in the average age of 3.0 months per year (β = - 0.252, F = 301.8, p < 0.001). The proportion of women aged < 36 at their first POC cycle increased from 14% in 2011 to 54% in 2023. CONCLUSIONS The age at the time of POC has significantly declined over the past decade. This trend may potentially lead to higher overall birth rates from POC, though further research is needed to confirm this hypothesis.
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Affiliation(s)
- Tal Shavit
- Faculty of Health Sciences, IVF Unit, Assuta Medical Centers, Ben-Gurion University, Be'er Sheva, Israel
| | - Joseph Hasson
- Faculty of Health Sciences, IVF Unit, Assuta Medical Centers, Ben-Gurion University, Be'er Sheva, Israel
| | - Jordana Hadassah Hyman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, IVF Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avi Tsafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Obstetrics and Gynecology, IVF Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Kasaven LS, Mitra A, Ostrysz P, Theodorou E, Murugesu S, Yazbek J, Bracewell-Milnes T, Ben Nagi J, Jones BP, Saso S. Exploring the knowledge, attitudes, and perceptions of women of reproductive age towards fertility and elective oocyte cryopreservation for age-related fertility decline in the UK: a cross-sectional survey. Hum Reprod 2023; 38:2478-2488. [PMID: 37816663 PMCID: PMC10694402 DOI: 10.1093/humrep/dead200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
STUDY QUESTION What are the knowledge, perceptions and attitudes towards fertility and elective oocyte cryopreservation (OC) for age-related fertility decline (ARFD) in women in the UK? SUMMARY ANSWER Awareness of OC for ARFD has reportedly improved compared to studies carried out almost a decade ago, but inconsistencies in knowledge remain regarding the rate of miscarriage amongst specific age groups, the financial costs and optimal age to undergo OC for ARFD. WHAT IS KNOWN ALREADY The age of first-time motherhood has increased amongst western societies, with many women of reproductive age underestimating the impact of age on fertility. Further understanding of women's awareness of their fertility, the options available to preserve it and the barriers for seeking treatment earlier are required in order to prevent the risk of involuntary childlessness. STUDY DESIGN, SIZE, DURATION A hyperlink to a cross-sectional survey was posted on social media (Instagram) between 25 February 2021 and 11 March 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Women from the general population aged 18-50 years were invited to complete the survey. MAIN RESULTS AND THE ROLE OF CHANCE In total, 5482 women fulfilled the inclusion criteria and completed the survey. The mean age of participants was 35.0 years (SD 10.25; range 16-52). Three quarters (74.1%; n = 4055) disagreed or strongly disagreed they felt well informed regarding the options available to preserve their fertility, in case of a health-related problem or ARFD. The majority overestimated the risk of miscarriage in women aged ≥30 years old, with 14.5% correctly answering 20%, but underestimated the risks in women ≥40, as 20.1% correctly answered 40-50%. Three quarters (73.2%; n = 4007) reported an awareness of OC for ARFD and 65.8% (n = 3605) reported that they would consider undergoing the procedure. The number of women who considered OC for ARFD across age groups were as follows: 18-25 (8.3%; n = 300), 26-30 (35.8%; n = 1289), 31-35 (45.9%; n = 1654), 36-40 (9.6%; n = 347), 41-45 (0.3%; n = 13), and 46-50 (0.1%; n = 2). The majority of women (81.3%; n = 4443) underestimated the cost of a single cycle of OC for ARFD (<£5000). Furthermore, 10.4% (n = 566) believed a single cycle would be adequate enough to retrieve sufficient oocytes for cryopreservation. Approximately 11.0% (n = 599) believed OC for ARFD may pose significant health risks and affect future fertility. Less than half agreed or strongly agreed that the lack of awareness regarding OC for ARFD has impacted the likelihood of pursuing this method of fertility preservation further (41.4%; n = 2259). LIMITATIONS, REASONS FOR CAUTION Results from cross-sectional studies are limited as interpretations made are merely associations and not of causal relationships. The online nature of participant recruitment is subject to selection bias, considering women with access to social media are often from higher socioeconomic and education backgrounds, thus limiting generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Further education regarding the financial costs and optimal age to undergo elective OC to increase the chances of successful livebirth are required. Clinicians should encourage earlier fertility counselling to ensure that OC is deemed a preventative measure of ARFD, rather than an ultimate recourse to saving declining fertility. STUDY FUNDING/COMPETING INTEREST(S) No funding was required for this article. There are no conflicts of interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L S Kasaven
- Department of Gynaecological Oncology, Queen Charlotte’s and Chelsea Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Cutrale Perioperative and Ageing Group, Imperial College London, London, UK
| | - A Mitra
- Department of Gynaecological Oncology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - P Ostrysz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - E Theodorou
- Department of Reproductive Medicine, Centre for Reproductive and Genetic Health, London, UK
| | - S Murugesu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - J Yazbek
- Department of Gynaecological Oncology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - T Bracewell-Milnes
- Department of Gynaecology and Reproductive Medicine, Lister Fertility Clinic, The Lister Hospital, London, UK
| | - J Ben Nagi
- Department of Reproductive Medicine, Centre for Reproductive and Genetic Health, London, UK
| | - B P Jones
- Department of Gynaecological Oncology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - S Saso
- Department of Gynaecological Oncology, Queen Charlotte’s and Chelsea Hospital, London, UK
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus 2023; 15:e47956. [PMID: 38034211 PMCID: PMC10685323 DOI: 10.7759/cureus.47956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.
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Affiliation(s)
- Udit Lahoti
- Obstretics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejas Shegekar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup Juganavar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Undergraduate students have low fertility knowledge and high anxiety regarding future fertility: An opportunity for education. Heliyon 2023; 9:e14623. [PMID: 36967893 PMCID: PMC10034448 DOI: 10.1016/j.heliyon.2023.e14623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Objectives To assess childbearing intentions, concerns about future fertility, knowledge about the age-related decline in fertility, and interest in receiving fertility education among undergraduate students. Design From March to April 2021, a cross-sectional, web-based survey with 42 reproductive and fertility-related questions was administered to and completed by actively enrolled undergraduates at Northwestern University in the United States. Results The survey was completed by 291 students (mean age 20.2 years). Of all participants, 62.5% plan to have children and 68.3% intend to delay childbearing. Significantly more females than males (70.7% vs 40.9%, P = 0.004) and premedical students compared to non-premedical students (78.2% vs 60.1%, P = 0.002) reported planning to delay childbearing due to educational or career aspirations. Significantly more females than males (43.5% vs 4.5%, P < 0.001) and premedical compared to non-premedical students (50.4% vs 31.5%, P = 0.002) also reported having anxiety about future fertility due to career aspirations.When surveyed about fertility knowledge, 31.1% of participants reported that females are as fertile in their forties as they are in their thirties, and 25.4% stated that female fertility does not dramatically decline until age 40 or later. When asked to estimate the oldest age a woman has conceived using autologous oocytes, 83.3% reported age 48 or older. Of all participants, 72.3% were interested in learning about fertility. Conclusions The majority of surveyed undergraduates plan to delay childbearing, yet they have concerns about how career goals will impact future fertility. Notably, females and premedical students reported higher rates of anxiety when compared to their male and non-premedical counterparts. Knowledge about the age-related decline in fertility was limited, but students have a strong interest in learning about fertility, highlighting an opportunity for educational intervention at the undergraduate level. With education, students may be empowered to make informed decisions about future reproductive strategy earlier in time, potentially decreasing future anxiety.
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Abdennebi I, Pasquier M, Vernet T, Levaillant JM, Massin N. Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience. J Gynecol Obstet Hum Reprod 2022; 51:102461. [DOI: 10.1016/j.jogoh.2022.102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022]
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Barron ML, Lithgow D, Wade GH, Mueller Luckey G. Fertility Health Knowledge in U.S. Adults: Men Narrowing the Knowledge Gap. Am J Mens Health 2022; 16:15579883221117915. [PMID: 36112813 PMCID: PMC9478737 DOI: 10.1177/15579883221117915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Much of young people's fertility health knowledge has been limited to avoiding sexually transmitted infections and preventing pregnancy thus lacking what is necessary to support future overall health as well as reproductive goals. This study assesses university students' knowledge related to fertility health factors to verify consistencies and discrepancies in fertility health knowledge, with a sub-assessment focusing on men's knowledge. The Fertility Health Knowledge survey was delivered to 17,189 students at three American universities. Twenty percent or 546 of the 2,692 participants were male. The 30-question survey addresses knowledge of modifiable and non-modifiable risk factors on fertility health in men and women, and four questions regarding fertility intentions. Across all 30 questions, 63% of female responses were correct and 61% of male responses were correct. For 10 questions, less than 70% of males and females answered correctly, with men answering correctly more often than females for six of the questions. Males exhibited more knowledge regarding male fertility. Knowledge of fertility health was consistently limited, regardless of site or demographics. Men demonstrated improved overall fertility health knowledge and more knowledge regarding male factors. There are still considerable gaps in knowledge of modifiable risk factors that may impact fertility health and future overall health. Fertility health promotion through education should be comprehensive and widely available in secondary schools, colleges, and universities. As well, increased education regarding fertility health in primary care settings should become the norm-with male inclusion as a standard of their care.
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Affiliation(s)
- Mary L. Barron
- School of Nursing, Southern Illinois
University-Edwardsville, Edwardsville, IL, USA,Mary L. Barron, School of Nursing, Southern
Illinois University-Edwardsville, Box 1066 Alumni Hall, Edwardsville, IL 62026,
USA.
| | - Diana Lithgow
- College of Graduate Nursing, Western
University of Health Sciences, Pomona, CA, USA
| | - Gail H. Wade
- University of Delaware School of
Nursing, Newark, DE, USA
| | - Georgia Mueller Luckey
- Department of Family and Community
Medicine, School of Medicine, Southern Illinois University, Springfield, IL,
USA
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Iino K, Fukuhara R, Yokota M, Yokoyama Y. Fertility awareness and subclinical infertility among women trying to get pregnant at home. BMC Womens Health 2022; 22:43. [PMID: 35184726 PMCID: PMC8859874 DOI: 10.1186/s12905-022-01626-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent studies on fertility awareness among the reproductive population have reported the lack of accurate knowledge about fertility and assisted reproductive technologies. However, there has been little information regarding women trying to get pregnant at home. The aim of this study was to explore the prevalence of subclinical infertility among women trying to get pregnant at home, and to evaluate awareness regarding infertility and reasons for not visiting infertility clinics among women who use pregnancy-assist mobile applications to help them conceive. Methods A total of 2084 Japanese women responded to this online survey. We selected 1541 women according to the study criteria. Based on the results of 61 questions, we evaluated knowledge regarding fertility, prevalence of subclinical infertility, and reasons for not visiting the clinic among the participants. Results Despite the desire to conceive, the participants had an apparent tendency to overestimate the age limit for childbearing. A total of 338 (21.9%) women answered that in general women aged > 45 years could get pregnant. Approximately 40% of the women had possible subclinical infertility and were unaware of the fact. Additionally, about 70% of the women considered themselves to have infertility problems. Women who were aware of the possibility of infertility hesitated to visit the clinic due to unfamiliarity with a gynecologist or clinic, and apprehensions about the gynecologic examination. Conclusions In our study, some women required treatment for infertility. Nonetheless, they hesitated to visit an infertility clinic. Sexual health education, together with proper accessibility to gynecology clinics, are necessary to reduce involuntary childlessness.
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Affiliation(s)
- Kaori Iino
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5 Zaifu Hirosaki, Hirosaki, Aomori, 036-8562, Japan. .,National Hospital Organization Hirosaki National Hospital, 1 Tominotyo, Hirosaki, Aomori, 036-8545, Japan.
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5 Zaifu Hirosaki, Hirosaki, Aomori, 036-8562, Japan
| | - Megumi Yokota
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5 Zaifu Hirosaki, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5 Zaifu Hirosaki, Hirosaki, Aomori, 036-8562, Japan
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Szalma I, Bitó T. Knowledge and attitudes about assisted reproductive technology: Findings from a Hungarian online survey. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 13:75-84. [PMID: 34381884 PMCID: PMC8340049 DOI: 10.1016/j.rbms.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 05/19/2023]
Abstract
This study aimed to evaluate the general knowledge and attitudes about assisted reproductive technology (ART) and the influence of sociodemographic features on knowledge and attitudes in a large sample of men and women of reproductive age in Hungary. A cross-sectional online survey study was conducted among 1370 men and women between 18 and 50 years of age in Hungary. The questionnaire included questions about self-rated knowledge, an attitude item, and eight questions concerning general knowledge about ART. In addition, participants were asked sociodemographic background questions. The results show that approximately half of the respondents (49.3%) rated themselves as fairly knowledgeable about ART. However, 56% of the respondents answered just three of the eight knowledge questions correctly. Both men and women had limited knowledge about the success rate of ART, the costs of ART and the age limit to access ART. The greatest lack of knowledge about ART was about its risks: the majority of respondents did not know that in-vitro fertilization poses health risks for women and conceived children. Regarding attitudes, the majority of respondents had a very positive attitude towards ART. Only those respondents who were religious were less supportive of ART. These data suggest that men and women of reproductive age overestimate their ART-related knowledge. As most men and women would like to have biological children in Hungary, there is a critical need for public education.
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Affiliation(s)
- Ivett Szalma
- Centre for Social Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary
- Corvinus University of Budapest, Budapest, Hungary
- Corresponding author at: Centre for Social Sciences, Hungarian Academy of Sciences Centre of Excellence, Budapest, Hungary.
| | - Tamás Bitó
- Department of Obstetrics and Gynaecology, University of Szeged, Szeged, Hungary
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Alon I, Pinilla J. Assisted reproduction in Spain, outcome and socioeconomic determinants of access. Int J Equity Health 2021; 20:156. [PMID: 34229664 PMCID: PMC8259134 DOI: 10.1186/s12939-021-01438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
RESEARCH QUESTION We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. DESIGN We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. RESULTS The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. CONCLUSIONS Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Delbaere I, Pitsillos T, Tydén T, Kerckhof L, Iliadis SI. Fertility awareness and parenthood intentions among medical students in three European countries. EUR J CONTRACEP REPR 2021; 26:312-322. [PMID: 33855916 DOI: 10.1080/13625187.2021.1901877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries. MATERIALS AND METHODS A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions. RESULTS Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child. CONCLUSIONS Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.
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Affiliation(s)
- Ilse Delbaere
- Department of Healthcare, VIVES University of Applied Sciences, Kortrijk, Belgium
| | - Tryfonas Pitsillos
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lisa Kerckhof
- Department of Healthcare, VIVES University of Applied Sciences, Kortrijk, Belgium
| | - Stavros I Iliadis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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A Survey of Women Who Cryopreserved Oocytes for Non-medical Indications (Social Fertility Preservation). Reprod Sci 2021; 28:2216-2222. [PMID: 33449346 DOI: 10.1007/s43032-021-00460-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the expectations, experiences, and fertility awareness status of women who underwent social oocyte cryopreservation. Cohort survey study was conducted at an academic medical center. All women who underwent social oocyte cryopreservation between January 2015 and June 2016 were recruited. One hundred thirty-three women were contacted by phone to participate in a survey. The questionnaire investigated the initial motivation towards freezing, intentions to use cryopreserved oocytes, treatment experience, awareness of fertility and knowledge about chances of having a live birth with their frozen oocytes. The mean age at the time of oocyte freezing was 38.5 ± 2.68 years. The average number of mature oocytes cryopreserved was 5.48 ± 6.6 (1-16). Two major motivations were absence of a male partner (40%) and an anticipated age-related fertility decline (42%). Almost 60% overestimated the chances of natural conception, as well as the success of IVF at the age of 40 years. Half of the oocyte bankers reported that fertility declined between ages 35 and 39, but only 28% of patients estimated the live birth rate per cryopreserved oocyte correctly. Overall 98.8% stated that they would recommend oocyte cryopresevation to a friend, and 72% felt more secure in terms of reproductive potential. Despite comprehensive personalized counseling prior to the start of ovarian stimulation, many women do not seem to have a realistic understanding of reproductive aging. Even though gamete cryopreservation provides some insurance, overestimating the effectiveness of oocyte cryopreservation can also lead to a false sense of security. Clinical Trial Registration: 2016.086.IRB1.006.
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Abstract
The 5 principal reasons a patient may consider fertility preservation are: treatment for cancer that may affect fertility, treatment for nonmalignant medical conditions that may affect fertility, planned indications, planned gender-affirming hormone therapy or surgery, or in the setting of genetic conditions that may increase the risks of premature ovarian insufficiency or early menopause. This paper will focus on describing who may consider preserving their fertility, how to provide the best clinical evaluation of those seeking fertility preservation, and current and future fertility preservation techniques. Last, we will highlight a need to continue to expand access to fertility preservation technologies.
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Gamete preservation: knowledge, concerns and intentions of Israeli and Danish students regarding egg and sperm freezing. Reprod Biomed Online 2020; 41:957-965. [PMID: 32919878 DOI: 10.1016/j.rbmo.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION What do Danish and Israeli students of both sexes know about age in relation to fertility and gamete preservation, and what are their concerns and intentions for the future in this regard? DESIGN A cross-sectional comparative study of male and female Danish and Israeli students was conducted between November 2018 and April 2019. A total of 1010 students, 508 from Denmark and 502 from Israel, completed questionnaires assessing knowledge, perceptions and intentions regarding gamete preservation. RESULTS More than 70% of both genders in Israel thought that women start experiencing fertility decline at age 35 and up. A total of 60% of Danish women and 51% of Danish men chose 29-34 as the time where fertility decline starts. Some 95% of Danish students chose 20-29 as the best age for egg freezing, while the corresponding number in Israel was 85%, regardless of gender. In total, 51% of Israeli women said they are extremely or very worried about future infertility, compared with 31% of Danish women, 26% of Israeli men and 12% of Danish men. Regarding preservation intentions, no gender differences were found. Some 3% of Israeli students said they would consider gamete preservation, as compared with 14% of Danish students. CONCLUSIONS These findings suggest a widespread worry among Danish and Israeli women about their future fertility. Danish students report more awareness of age-related fertility decline. Unique to this study is the inclusion of male students. The preliminary findings reveal that men are less worried about their reproductive future.
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Bernardi LA, Luck M, Kyweluk MA, Feinberg EC. Knowledge gaps in the understanding of fertility among non-medical graduate students. F S Rep 2020; 1:177-185. [PMID: 34223241 PMCID: PMC8244259 DOI: 10.1016/j.xfre.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To assess knowledge of female and male fertility among students enrolled in a Master of Business Administration (MBA) program. Design Web-based cross-sectional survey. Setting Academic setting. Patient(s) Not applicable. Intervention(s) None. Main Outcome Measure(s) Knowledge of how female and male age impacts reproduction, fecundability, and success rates with in vitro fertilization (IVF). Result(s) A total of 133 female and male MBA students completed the survey. Nearly 10% of participants were not aware that women are born with a fixed number of oocytes and that oocyte quantity and quality decline with age. More than 30% of participants overestimated fecundability in women aged ≥35 years, and >50% overestimated IVF success rates in women older than 40 years. Fifteen percent of participants did not know that men have stem cells in the testes, and >25% were not aware that men experience a decrease in sperm concentration and quality with age. Nearly 30% believed that a man’s age never impacts reproductive outcomes. Less than 30% of participants correctly estimated fecundability and IVF success rates based on male age. Conclusion(s) These data highlight important knowledge gaps in a highly educated group of MBA students, most whom desire future childbearing. Specifically, there is a lack of understanding of both male and female reproductive aging and an overestimation of treatment success. As delayed childbearing continues, particularly among those with high educational attainment, attention should be focused on introducing broad fertility education at a younger age to improve future reproductive success.
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Affiliation(s)
- Lia A Bernardi
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marissa Luck
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moira A Kyweluk
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Barron ML, Lithgow D, Wade G, Mueller-Luckey G. Measuring Fertility Health Knowledge in University Students: Development and Testing of a Survey Tool. J Nurs Meas 2020; 28:JNM-D-18-00060. [PMID: 32179725 DOI: 10.1891/jnm-d-18-00060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Few surveys address fertility health in both men and women. This report details development of a fertility knowledge assessment tool for clinical and research settings that would sensitize young adults to habits that would promote healthy fertility. METHODS A pilot study (N = 31) followed by a larger study of students at three schools (N = 465, 335, & 375) at a midwestern university using a new 30-item survey. RESULTS Face and content validity of the survey tool were determined by a panel of experts. Internal consistency and reliability were acceptable for a new instrument (α = .81 for the total group; α = .80 for each school. CONCLUSIONS This instrument is a valid and reliable short screening tool that can be used to assess knowledge of fertility and possibly open discussions about fertility self-care.
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Affiliation(s)
- Mary Lee Barron
- Southern Illinois University-Edwardsville, Edwardsville, Illinois
| | - Diana Lithgow
- Western University of Health Sciences, Pomona, California
| | - Gail Wade
- University of Delaware, Newark, Delaware
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16
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Evans A, de Lacey S, Tremellen K. Australians' understanding of the decline in fertility with increasing age and attitudes towards ovarian reserve screening. Aust J Prim Health 2019; 24:428-433. [PMID: 30158051 DOI: 10.1071/py18040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/21/2018] [Indexed: 01/18/2023]
Abstract
The aim of this study is to determine Australians' understanding of the decline in fertility with age, social determinants that influence their decision to start a family and attitudes towards ovarian reserve screening as a tool allowing personalised reproductive life planning. An online survey of 383 childless Australian men and women, aged 18-45 years, was conducted. Both sexes overestimated natural and in vitro fertilization (IVF)-assisted fertility potential with increasing age, with the magnitude of overestimation being more pronounced for men and IVF treatment compared with natural conception. The primary determinants for starting a family were a stable relationship, followed by establishment of career; availability of accessible child care and paid parental leave were considered less important. Finally, the majority of women (74%) would alter their reproductive life planning if they were identified as having low ovarian reserve on screening. Despite increased education, Australians continue to have a poor understanding of age-related decline in natural and IVF-assisted conception, potentially explaining why many delay starting a family. Ovarian reserve screening may help identify individuals at increased risk of premature diminished fertility, giving these women the ability to bring forward their plans for natural conception or undertake fertility preservation (oocyte freezing).
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Affiliation(s)
- Alisha Evans
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Sheryl de Lacey
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Kelton Tremellen
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
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17
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Baldwin K. The biomedicalisation of reproductive ageing: reproductive citizenship and the gendering of fertility risk. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1651256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kylie Baldwin
- Centre for Reproduction Research, De Montfort University Leicester, Leicester, UK
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18
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Alon I, Guimón J, Urbanos-Garrido R. Regulatory responses to assisted reproductive technology: a comparative analysis of Spain and Israel. J Assist Reprod Genet 2019; 36:1665-1681. [PMID: 31346936 PMCID: PMC6708013 DOI: 10.1007/s10815-019-01525-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The market of assisted reproductive technologies (ARTs) is rapidly evolving, raising growing ethical and social dilemmas. This paper compares the regulatory responses to technological and market developments in Israel and Spain, both intensive users of ART. We identify strengths and deficiencies in the regulation of ART in these two countries. METHODS We developed a conceptual framework to classify the factors affecting regulations and priority setting, and applied it using a Delphi survey combined with in-depth interviews. We selected two panels of experts from various fields, trying to simulate the bioethics committees of Israel and Spain. RESULTS ART is often wrongfully perceived as a solution to age-related infertility. Both panels embraced alternative solutions. The impact of private commercial interest on regulations is resulting in excessive practices such as the repeat of ineffective cycles and the push of sometimes unnecessary treatment add-ons. Our findings show experts dissatisfaction with the regulations of donor-eggs concerning reimbursement and registries in both countries. CONCLUSIONS The adequacy of ART to solve age-related infertility should be confronted with alternative approaches, with emphasis on the distribution of accurate information. The magnitude of ART markets, particularly the use of donor-eggs, should raise the need for additional societal debate and the reform of regulations. The impact factors analysis leads us to question the current regulatory framework, which could be improved by nominating a non-governmental statutory central regulatory agency in Israel and by reforming the Spanish agency.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Jose Guimón
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Rosa Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, Complutense University of Madrid, Madrid, Spain
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19
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Mahesan AM, Sadek S, Ramadan H, Bocca S, Paul ABM, Stadtmauer L. Knowledge and attitudes regarding elective oocyte cryopreservation in undergraduate and medical students. FERTILITY RESEARCH AND PRACTICE 2019; 5:5. [PMID: 31007938 PMCID: PMC6458751 DOI: 10.1186/s40738-019-0057-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/01/2019] [Indexed: 11/16/2022]
Abstract
Background To assess knowledge and attitudes regarding elective oocyte cryopreservation among female undergraduate students (UG) and medical students (MS) in Eastern Virginia. Methods An anonymous cross-sectional study surveying female UG at a local university and MS at our academic medical center in May of 2017. The survey contained questions on demographic information, interest in fertility preservation, and knowledge about age related changes in fertility. Results There were 74 of 102 female UG and 95 of 117 female MS who responded, for a response rate of 73 and 81% respectively. UG were significantly younger than MS (21.4 vs 26.8, p < 0.001). Further, UG generally planned on conceiving at a younger age than MS (age 26–30 vs 31–35), and favored younger ages to consider oocyte cryopreservation (age 26–30 vs 31–35). Only a minority of both UG and MS were willing to undergo egg freezing at the current price of approximately $10,000 (15% vs 26% respectively, p = 0.044). Moreover, 73% of students overall responded that they would be more likely to freeze oocytes if their employer paid. Notably, both UG and MS underestimated age of fertility decline. Conclusion Both UG and MS revealed a need for education on age-related changes in fertility. Most UG and MS would not undergo elective oocyte cryopreservation at the present cost but would consider it at a lower cost. Electronic supplementary material The online version of this article (10.1186/s40738-019-0057-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arnold M Mahesan
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Seifeldin Sadek
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Hadi Ramadan
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | - Silvina Bocca
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
| | | | - Laurel Stadtmauer
- 1Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507 USA
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20
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Mu Q, Hanson L, Hoelzle J, Fehring RJ. Young Women’s Knowledge About Fertility and Their Fertility Health Risk Factors. J Obstet Gynecol Neonatal Nurs 2019; 48:153-162. [DOI: 10.1016/j.jogn.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 11/16/2022] Open
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21
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García D, Rodríguez A, Vassena R. Actions to increase knowledge about age-related fertility decline in women. EUR J CONTRACEP REPR 2018; 23:371-378. [PMID: 30354690 DOI: 10.1080/13625187.2018.1526895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is a strong body of published data corroborating the current lack of awareness of age-related fertility decline (ARFD), but few studies have evaluated specific interventions aimed at increasing ARFD knowledge. Here, we review the literature examining the instruments developed and the educational interventions performed to date. METHODS We carried out a narrative review based on a literature search in PubMed, Web of Science, PsycINFO and Scopus between January 2010 and December 2017. RESULTS The instruments available comprise websites, paper brochures, slide presentations and tailored information, mainly developed with the input of university students. The eight interventions reviewed include surveys before and/or after a specific intervention, with and without a control group, in randomised and non-randomised designs. Overall, the interventions were effective in increasing ARFD knowledge and lowering the desired age for childbearing in the short term. These results were not always maintained, however, in the long term, possibly due to a lack of perceived risk of future infertility among those studied. CONCLUSION Further interventions need to be targeted to both young people and health care providers, and should be as personalised as possible. A greater number of validated instruments are also needed to reliably measure the effectiveness of any intervention.
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22
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Fooladi E, Weller C, Salehi M, Abhari FR, Stern J. Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial. Midwifery 2018; 67:77-86. [PMID: 30267937 DOI: 10.1016/j.midw.2018.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/23/2018] [Accepted: 09/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women. DESIGN A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60). SETTING A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran. PARTICIPANTS Women of reproductive age who were able to conceive. INTERVENTIONS The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up. FINDINGS At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful. KEY CONCLUSIONS Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established. IMPLICATIONS FOR PRACTICE The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.
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Affiliation(s)
- Ensieh Fooladi
- School of Nursing and Midwifery, Monash University, Melbourne, Australia; Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Maryam Salehi
- Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Farideh Rezaee Abhari
- Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Jenny Stern
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Sándor J, Vicsek L, Bauer Z. Let us talk about eggs! Professional resistance to elective egg vitrification and gendered medical paternalism. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:311-323. [PMID: 29027632 DOI: 10.1007/s11019-017-9805-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, by applying a feminist bioethical perspective, we identify a new form of medical paternalism that still shapes contemporary legal policies on human egg cryopreservation performed without medical reasons. The fear of negligent, careless women who opt to delay their pregnancy for mere convenience is a widely known gender biased stereotype. Nevertheless, the opinions and judgments of medical professionals on this issue have not yet been sufficiently explored by in-depth research. In this essay, therefore, first we look at the broader bioethical, legal, and social aspects of human egg cryopreservation. In the second part of the paper we discuss a unique qualitative study conducted with professionals working at Hungarian IVF clinics. We argue, based on a bioethical analysis of the collected data, that when new reproduction technologies provide opportunities for women to widen their range of reproductive choices, the traditional forms of medical paternalism can be reinforced by gendered paternalism, as well. We identify several elements of gendered paternalism that characterized the attitudes of the IVF staff and discuss the professionals' resistance to elective egg freezing and vitrification of eggs for the future. We conclude by suggesting directions for future policy. Although we focus on the Hungarian case in this paper, we are aware that similar attitudes can be observed in some other countries where this technology has become available and requested by women, but where they also face difficulties in their access to it.
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Affiliation(s)
- Judit Sándor
- Faculty of Political Science, Legal Studies and Gender Studies of the Central European University (CEU), Nádor u. 9, Budapest, Hungary.
| | - Lilla Vicsek
- Institute of Sociology and Social Policy, Corvinus University of Budapest, Közraktár u. 4-6, Budapest, 1093, Hungary
| | - Zsófia Bauer
- Institute of Sociology and Social Policy, Corvinus University of Budapest, Közraktár u. 4-6, Budapest, 1093, Hungary
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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: 41] [Impact Index Per Article: 6.8] [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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Fritz R, Klugman S, Lieman H, Schulkin J, Taouk L, Castleberry N, Buyuk E. Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge. J Assist Reprod Genet 2018; 35:1613-1621. [PMID: 30073435 DOI: 10.1007/s10815-018-1273-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/17/2018] [Indexed: 01/25/2023] Open
Abstract
PURPOSE What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP). METHODS A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP. RESULTS Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34 years old, compared to 75.8% aged 35-44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP. CONCLUSIONS In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.
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Affiliation(s)
- Rani Fritz
- Montefiore Institute for Reproductive Medicine and Health, Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Susan Klugman
- Montefiore Institute for Reproductive Medicine and Health, Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Harry Lieman
- Montefiore Institute for Reproductive Medicine and Health, Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, 10461, USA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 98195, USA
| | - Laura Taouk
- Research Department, The American College of Obstetricians and Gynecologists (ACOG), Washington, DC, 20024, USA
| | - Neko Castleberry
- Research Department, The American College of Obstetricians and Gynecologists (ACOG), Washington, DC, 20024, USA
| | - Erkan Buyuk
- Montefiore Institute for Reproductive Medicine and Health, Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, 10461, USA.
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Peterson B, Gordon C, Boehm J, Inhorn M, Patrizio P. Initiating patient discussions about oocyte cryopreservation: Attitudes of obstetrics and gynaecology resident physicians. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 6:72-79. [PMID: 30519650 PMCID: PMC6259041 DOI: 10.1016/j.rbms.2018.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/02/2018] [Accepted: 10/04/2018] [Indexed: 05/04/2023]
Abstract
This study examined the attitudes of obstetrics and gynaecology (OB/GYN) resident physicians to initiating patient discussions regarding medical and elective oocyte cryopreservation (OC). The study used a cross-sectional online survey of OB/GYN medical residents in the USA, sampled from residency programmes approved by the American Council for Graduate Medical Education. In total, 208 medical residents, distributed evenly between postgraduate years 1-4, participated in the study. Residents' fertility knowledge and attitudes to initiating discussions about OC were gathered. Forty percent (n = 83) believed that OB/GYN residents should initiate discussions about OC with patients (initiators), while 60% (n = 125) did not (non-initiators). Initiators were less likely to overestimate the age at which a woman's fertility begins to decline, and were more likely to believe that discussions about OC and age-related fertility decline should take place during a well-woman annual examination. Initiators and non-initiators did not differ in their attitudes towards discussing OC with patients undergoing cancer treatments; however, initiators were significantly more likely to discuss elective OC with patients who were currently unpartnered or who wished to delay childbearing to pursue a career. Given the increasing age of childbearing among women, and the fact that women prefer to receive reproductive information from their healthcare providers, it is critical that such topics are discussed in consultations to assist patients in making more informed reproductive decisions. Further research is needed to assess the existing barriers to these discussions from both physician and patient perspectives.
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Affiliation(s)
- B. Peterson
- Chapman University, Crean College of Health and Behavioral Sciences, Marriage and Family Therapy Program, One University Drive, Orange, CA 92688, USA
- Corresponding author.
| | - C. Gordon
- University of California Irvine Obstetrics and Gynecology Residency Program, Orange, CA, USA
| | - J.K. Boehm
- Chapman University, Crean College of Health and Behavioral Sciences, Department of Psychology, Orange, CA, USA
| | - M.C. Inhorn
- Yale University, Department of Anthropology, New Haven, CT, USA
| | - P. Patrizio
- Yale University, Fertility Center, New Haven, CT, USA
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Prior E, Lew R, Hammarberg K, Johnson L. Fertility facts, figures and future plans: an online survey of university students. HUM FERTIL 2018; 22:283-290. [PMID: 30058411 DOI: 10.1080/14647273.2018.1482569] [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] [Indexed: 10/28/2022]
Abstract
Most people want and expect to have children but lack of awareness about the biological limits of fertility may reduce their chance of achieving their parenthood goals. We surveyed Australian university students' intentions and expectations for future parenthood, knowledge about fertility and preferred sources of fertility information. Male and female students (n = 1215) completed an anonymous 34-item online questionnaire. Fewer than 10% did not want children. Of those who wanted children, most (75%) wanted two or more. Although most participants wanted to have children within the biological limits of fertility they also expected to achieve many other life goals before becoming parents. Most underestimated the impact of female and male age on fertility (>75% and >95%, respectively). General practitioners and the Internet were the most preferred sources of fertility information. Almost all stated they would not feel uncomfortable if their general practitioner brought up the topic of future reproductive plans. To help women and men achieve their parenthood goals better education about fertility protection; proactive discussions with young people in primary care settings about reproductive life planning; and social policies and health promotion strategies that support becoming parents during the most fertile years are needed.
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Affiliation(s)
- Eugenie Prior
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Raelia Lew
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,The Royal Women's Hospital, Parkville, Australia.,Melbourne IVF, East Melbourne, Australia
| | - Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia.,Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
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28
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Pedro J, Brandão T, Schmidt L, Costa ME, Martins MV. What do people know about fertility? A systematic review on fertility awareness and its associated factors. Ups J Med Sci 2018; 123:71-81. [PMID: 29957086 PMCID: PMC6055749 DOI: 10.1080/03009734.2018.1480186] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/01/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Recent evidence indicates that reproductive-age people have inadequate fertility awareness (FA) concerning fertility, infertility risk factors, and consequences of delaying childbearing. However, no study has tried to summarize these studies and to clarify the variables associated with FA, namely the role of gender, age, education, and reproductive status on FA. METHODS A literature search up to February 2017 was conducted using the EBSCO, Web of Science, Scielo, and Scopus electronic databases with combinations of keywords and MeSH terms (e.g. 'awareness' OR 'health knowledge, attitudes, practice' AND 'fertility'; 'fertile period'; 'assisted reprod*'). RESULTS Seventy-one articles met the eligibility criteria and were included. The main results showed that participants report low-to-moderate FA. Higher levels of FA were shown by women, highly educated individuals, people who reported difficulties with conceiving, and those who had planned their pregnancies. Having or desiring to have children was not related to FA level. An inconsistent association between study participant age and FA was observed, with some studies indicating that older participants had higher FA, but others found an opposite result or did not find any association. CONCLUSION The current findings suggest that interventions to increase FA are warranted, especially those targeting men, people with low education, and in family planning settings. Interventions and campaigns should be customized to meet individuals' needs regarding FA. Because of the high heterogeneity regarding the assessment of FA, these conclusions must be interpreted with caution.
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Affiliation(s)
- Juliana Pedro
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Centre for Psychology, University of Porto, Porto, Portugal
| | - Tânia Brandão
- Centre for Research in Psychology (CIP-UAL), Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria E. Costa
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Centre for Psychology, University of Porto, Porto, Portugal
| | - Mariana V. Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Centre for Psychology, University of Porto, Porto, Portugal
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Levin G, Rottenstreich A. Social egg freezing-Better early than never. Acta Obstet Gynecol Scand 2018; 97:1530. [PMID: 29791032 DOI: 10.1111/aogs.13385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Cheung NK, Coffey A, Woods C, de Costa C. Natural fertility, infertility and the role of medically assisted reproduction: The knowledge amongst women of reproductive age in North Queensland. Aust N Z J Obstet Gynaecol 2018; 59:140-146. [PMID: 29658986 DOI: 10.1111/ajo.12806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 02/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The demand for medically assisted reproduction continues to increase, with more women encountering challenges with fertility. Due to misconceptions and gaps in knowledge, women are often unaware of the risks related to delayed childbearing. Lack of understanding of natural fertility, infertility and the role of medically assisted reproduction can lead to emotional suffering and changes in family plans. AIMS To assess the understanding and knowledge that women of reproductive age in North Queensland have regarding natural fertility, infertility and the role of medically assisted reproduction. MATERIALS AND METHODS Data were collected from 120 women (30 nurses, 30 teachers, 30 university students and 30 Technical and Further Education students) via the distribution of a structured questionnaire. Participants were surveyed in person about their personal plans and opinions, knowledge about natural fertility, infertility and medically assisted reproduction, and their preferred source of information. RESULTS Participants demonstrated suboptimal knowledge levels throughout all sections of the questionnaire, in particular when asked about medically assisted reproduction. When asked to identify their main source of information, 'friends and family' was the most popular choice. CONCLUSIONS Results from this North Queensland study add to the existing international literature, highlighting the widespread nature of the problem. Without adequate understanding of natural fertility, the risks of infertility, and the role and limitations of medically assisted reproduction, women make uninformed decisions. Development of local reproductive health education programs need to be instigated in response.
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Affiliation(s)
- Nicole K Cheung
- James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Anne Coffey
- Queensland Fertility Group, Cairns, Queensland, Australia
| | - Cindy Woods
- James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Caroline de Costa
- James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
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31
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Van der Heijde CM, Collard PR, Vonk P, Meijman FJ. Better informed is better decided: Addressing the risks of delaying childbearing for female higher educational students. Int J Adolesc Med Health 2018; 32:ijamh-2017-0175. [PMID: 29432205 DOI: 10.1515/ijamh-2017-0175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/15/2022]
Abstract
Objective Delayed childbearing has gradually started to become the norm for higher educational students, with possible increased future fertility risks and psychological distress as a consequence. What do female students expect from their general practitioners (GP) and other health care providers (HCPs) with regard to delaying childbearing? We also looked into indicators that can be used by HCPs to detect female university students who have issues regarding delayed childbearing. Methods Cross sectional study: A total of 398 female students (mean age 21.83; SD = 2.4) from at least three different universities completed the questionnaire (distributed through the Internet and at a students' health service). Potential predictors for having an issue regarding delayed childbearing were assessed with multivariate logistic regression. Results Thirteen percent of 398 female students experienced being childless as more or less problematic. Forty-nine percent thinks having children deserves more attention and 33% of the students expect attention from their GP regarding a possible desire to have children during contraceptive consultations. Four factors demonstrated significant associations with having an issue concerning delayed childbearing: age (these issues also occur in younger students), worrying about fertility, not opting for an abortion if pregnant and dissatisfaction with current contraceptive use. Conclusion HCPs should discuss delayed childbearing with female students, addressing both the decrease of fertility after a certain age (30), the limited range of fertility methods, and the possible negative physical and psychological consequences of postponement. These elements could be included into programmes of sexual and reproductive health training and into pre-conception care and pre-conception education.
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Affiliation(s)
- Claudia M Van der Heijde
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Oude Turfmarkt 151, 1012 GC Amsterdam, The Netherlands, Phone: +31 20 525 5306
| | - Pascal R Collard
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, The Netherlands.,Ethics of Care, University of Humanistic Studies, Utrecht, The Netherlands
| | - Peter Vonk
- Department of Research, Development and Prevention, Student Health Service, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans J Meijman
- Department of General Practice and Elderly Care Medicine, VUmc School of Medical Sciences Amsterdam, Amsterdam, The Netherlands
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Isbir GG, Ozan YD. Nursing and midwifery students’ experiences with the course of infertility and assisted reproductive techniques: A focus group study from Turkey. Nurse Educ Pract 2018; 28:235-241. [DOI: 10.1016/j.nepr.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/19/2017] [Accepted: 10/05/2017] [Indexed: 11/24/2022]
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Podfigurna A, Lukaszuk K, Czyzyk A, Kunicki M, Maciejewska-Jeske M, Jakiel G, Meczekalski B. Testing ovarian reserve in pre-menopausal women: why, whom and how? Maturitas 2017; 109:112-117. [PMID: 29292013 DOI: 10.1016/j.maturitas.2017.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Numerous social and environmental factors (environmental hazards, social factors such as education and career, higher economic status desired before the decision is made to have children) influence a women's decision to postpone pregnancy until late reproductive age. In turn, age is related to a fall in ovarian reserve. The main goal of testing ovarian reserve is the identification of women with so-called diminished ovarian reserve (DOR). Additionally, it provides assistance in the counselling of women who are planning to use assisted reproductive techniques (ART). This review examines current methods of testing ovarian reserve and their application. The most useful methods of assessing ovarian reserve are ultrasonographic count of ovarian antral follicles (AFC) and serum tests of both the anti-Müllerian hormone (AMH) level and the third-day level of follicle stimulating hormone (FSH). However, there are limitations to the currently used methods of testing ovarian reserve, especially in relation to their specificity and sensitivity. It is also difficult to predict egg quality based on these tests. The value of screening programmes of ovarian reserve is yet to be determined.
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Affiliation(s)
- Agnieszka Podfigurna
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland; INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Kunicki
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
| | | | - Grzegorz Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland; Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
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Hammarberg K, Collins V, Holden C, Young K, McLachlan R. Men's knowledge, attitudes and behaviours relating to fertility. Hum Reprod Update 2017; 23:458-480. [PMID: 28333354 DOI: 10.1093/humupd/dmx005] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/26/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasingly common practice in high-income countries to delay childbearing to the fourth and fifth decades of life increases the risk of involuntary childlessness or having fewer children than desired. Older age also increases the risk of age-related infertility, the need for ART to conceive, and obstetric and neonatal complications. Existing research relating to childbearing focusses almost exclusively on women, and in public discourse declining fertility rates are often assumed to be the result of women delaying childbearing to pursue other life goals such as a career and travel. However, evidence suggests that the lack of a partner or a partner willing to commit to parenthood is the main reason for later childbearing. OBJECTIVE AND RATIONALE To better understand men's contributions to childbearing decisions and outcomes, the literature pertaining to men's fertility-related knowledge, attitudes and behaviours was reviewed. SEARCH METHODS The electronic databases of Medline, Embase and PsycINFO were searched to identify investigations of men's knowledge, attitudes and behaviours relating to fertility, infertility, reproductive health or childbearing using relevant fertility keyword search terms. Studies were included if they had investigated factors associated with men's fertility-related knowledge, attitudes and behaviours, had been conducted in a high-income country and were published in an English language peer-reviewed journal between January 2005 and August 2016. OUTCOMES The search yielded 1349 citations. Of these, 47 papers representing 43 unique studies were included in the review. Where response rate was reported, it ranged between 13 and 94%. Studies varied in terms of research design; inclusion and exclusion criteria; recruitment strategies; adequacy of sample size; recruitment and retention rates and data collection tools. However, findings were consistent and indicate that men almost universally value parenthood, want and expect to become fathers, and aspire to have at least two children. Yet most men have inadequate knowledge about the limitations of female and male fertility and overestimate the chance of spontaneous and assisted conception. Perceptions of ideal circumstances in which to have children included being in a stable and loving relationship, having completed studies, secured a permanent job and a dependable income, having achieved personal maturity, and having a partner who desires children and is 'suitable' as a potential co-parent. Although all studies were conducted in high-income countries, between-country social and cultural differences may have influenced the findings relating to attitudes. WIDER IMPLICATIONS Men aspire to parenthood as much as women do but have limited knowledge about the factors that influence fertility. The gap between ideal biological and ideal social age for having children appears to be widening, narrowing the time frame in which parenthood can be achieved. This may lead to unfulfilled parenthood aspirations. The findings can inform government policies and public education strategies aimed to support childbearing during the most fertile years, reduce the personal and societal cost of infertility and ART use, and allow people to fulfil their parenthood goals.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia.,Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
| | - Veronica Collins
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Carol Holden
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Kate Young
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia
| | - Robert McLachlan
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne 3004, Australia.,Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168, Australia
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Kudesia R, Chernyak E, McAvey B. Low fertility awareness in United States reproductive-aged women and medical trainees: creation and validation of the Fertility & Infertility Treatment Knowledge Score (FIT-KS). Fertil Steril 2017; 108:711-717. [PMID: 28911930 DOI: 10.1016/j.fertnstert.2017.07.1158] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create, validate, and use a fertility awareness survey based on current U.S. DATA DESIGN Cross-sectional study. SETTING Not applicable. PATIENT(S) Phase 1 included U.S. women ages 18-45; phase 2 included female medical students and obstetrics and gynecology trainees at two urban academic programs. INTERVENTION(S) Survey including demographics, the Fertility & Infertility Treatment Knowledge Score (FIT-KS) instrument, and General Nutrition Knowledge Questionnaire. MAIN OUTCOME MEASURE(S) Knowledge of natural fertility and infertility treatments. RESULT(S) The FIT-KS was validated through detailed item and validity analyses. In phase 1, 127 women participated; their median age was 31 years, and 43.7% had children. Their mean FIT-KS score was 16.2 ± 3.5 (55.9% correct). In phase 2, 118 medical trainees participated; their median age was 25 years, and 12.4% had children. Their mean FIT-KS score was 18.8 ± 2.1 (64.9% correct), with year of training correlating to a higher score (r=0.40). Participant awareness regarding lifestyle factors varied, but it was particularly low regarding the effects of lubricants. The majority underestimated the spontaneous miscarriage rate and overestimated the fecundability of 40-year-old women. There was general overestimation of success rates for assisted reproductive technologies, particularly among medical trainees. CONCLUSION(S) The FIT-KS is validated to current U.S. data for use in both general and medical populations as a quick assessment of fertility knowledge. The knowledge gaps demonstrated in this study correlate with national trends in delayed childbearing and time to initiate treatment. For medical trainees, these results raise concerns about the quality of fertility counseling they may be able to offer patients. Greater educational outreach must be undertaken to enhance fertility awareness.
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Affiliation(s)
- Rashmi Kudesia
- Division of Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Hartsdale, New York.
| | - Elizabeth Chernyak
- Division of Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Hartsdale, New York
| | - Beth McAvey
- Division of Reproductive Endocrinology and Infertility, Albert Einstein College of Medicine, Hartsdale, New York
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Almeida-Santos T, Melo C, Macedo A, Moura-Ramos M. Are women and men well informed about fertility? Childbearing intentions, fertility knowledge and information-gathering sources in Portugal. Reprod Health 2017; 14:91. [PMID: 28778211 PMCID: PMC5545029 DOI: 10.1186/s12978-017-0352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The postponement of parenthood may increase the number of couples experiencing infertility and prolonged time to pregnancy. Previous research has revealed that childless people are not well informed regarding fertility, which may threat their childbearing intentions. This study aimed to examine fertility knowledge and childbearing intentions held by Portuguese people and their use and perceived usefulness of information sources on fertility. METHODS Participants were recruited using a random-route domiciliary approach. A total of 2404 individuals aged 18-45 were asked to complete a structured questionnaire evaluating socio-demographic characteristics, childbearing intentions, fertility knowledge and information-gathering sources regarding fertility. RESULTS In total, 95.5% of the participants indicated the desire to have children in the future, and 61.7% reported that having children would contribute to life satisfaction. Most of the participants expressed the desire to have two children in the future. The discrepancy between the numbers of planned and desired children was higher in men, in participants with lower education levels, in professionally active participants and in the unemployed participants. Relationship stability seemed to be more important in influencing childbearing decisions than financial stability or family support. Participants' knowledge regarding fertility was poor. Women, the participants who were older than 25, the participants with longer education and the participants with higher income exhibited the greatest levels of knowledge of fertility, although this knowledge was only slightly enhanced in these subgroups. Also, the participants overestimated both the chances of spontaneous pregnancy and the success rates of assisted reproduction techniques. Finally, the results revealed that websites were the main information sources used by the participants and only 18.0% of the participants had previously discussed fertility issues with their doctors. CONCLUSIONS Although Portuguese men and women reported the desire to have children in the future, their knowledge regarding fertility and infertility risk was poor. In addition, participants used more general sources of information, such as website, but not specialized sources, such as their doctors. There is a real need to work with general practitioners to empower them to provide adequate fertility information to every childless patient.
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Affiliation(s)
- Teresa Almeida-Santos
- Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,Centro Hospitalar Universitário de Coimbra, Av. Bissaya Barreto e Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Cláudia Melo
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Ana Macedo
- KeyPoint, Edifício Miraflores Premium, Al. Fernão Lopes, n°16, 6° Andar, 1495-190, Miraflores, Portugal
| | - Mariana Moura-Ramos
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal.
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Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture. Int J Behav Med 2017. [DOI: 10.1007/s12529-017-9656-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hammarberg K, Norman RJ, Robertson S, McLachlan R, Michelmore J, Johnson L. Development of a health promotion programme to improve awareness of factors that affect fertility, and evaluation of its reach in the first 5 years. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2017; 4:33-40. [PMID: 29774264 PMCID: PMC5952837 DOI: 10.1016/j.rbms.2017.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/27/2017] [Accepted: 06/08/2017] [Indexed: 06/08/2023]
Abstract
Awareness among people of reproductive age about the factors that influence fertility and reproductive outcomes, including medically assisted reproduction outcomes, is generally low. To improve awareness about the potentially modifiable factors that affect fertility and reproductive outcomes, 'Your Fertility', a fertility health promotion programme funded by the Australian Government, was established in 2011. This paper describes the development and evaluation of the reach of the Your Fertility programme from its inception in 2011 to June 2016. Systematically recorded outcomes for the programme's key focus areas and Google Analytics data were collated. Key achievements include developing and maintaining an internationally renowned website that experiences high growth and demand for fertility-related information; by 2016, over 5 million users had viewed more than 10 million webpages, and over 96,000 users had engaged in programme messages across social media. Programme messages have reached more than 4 million Australian social media users, and a potential audience of 150 million through media coverage across more than 320 media features. More than 4200 education and health professionals have completed online learning modules, and external partnerships have been established with 14 separate organizations. Data collected over 5 years indicate that the Your Fertility programme meets a need for targeted, evidence-based, accessible fertility-related information.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert J. Norman
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, Australia
| | - Sarah Robertson
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, Australia
| | | | | | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne 3000, Australia
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Vassard D, Lallemant C, Nyboe Andersen A, Macklon N, Schmidt L. A population-based survey on family intentions and fertility awareness in women and men in the United Kingdom and Denmark. Ups J Med Sci 2016; 121:244-251. [PMID: 27347691 PMCID: PMC5098488 DOI: 10.1080/03009734.2016.1194503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Across several European countries family formation is increasingly postponed. The aims of the study were to investigate the desire for family building and fertility awareness in the UK and Denmark. METHODS A population-based internet survey was used among women (n = 1,000) and men (n = 237) from the UK (40%) and Denmark (60%). Data covered socio-demographics, family formation, and awareness of female age-related fertility. Data analysis used descriptive statistics and logistic regression analysis for studying associations between low fertility awareness and desired family formation. RESULTS The majority of all participants desired two or three children. Two-thirds of the childless participants desired a first child at 30+ years, and one-fifth of the women and one-third of the men desired a last child at age 40. Overall, 83% of women and 73% of men were aware that female fertility starts to decline around 25-30 years. Men had significantly lower fertility awareness. Women who underestimated the impact of age on female fertility were significantly more likely to have a desire or attempted their first child at a higher age. CONCLUSION Even though the majority were aware of the age-related decrease in female fertility, most desired having children at an age when female fertility has declined. Women who were not sufficiently aware of the impact of advanced age were significantly more likely to have their first child at a higher age. There is a need for developing educational programs for women and men in order to increase the population's knowledge of fertility and risk factors for infertility.
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Affiliation(s)
- Ditte Vassard
- Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
- CONTACT Ditte Vassard Department of Public Health, University of Copenhagen, 5 Øster Farimagsgade, PO Box 2099, DK-1014 Copenhagen K, Denmark
| | - Camille Lallemant
- Complete Fertility Centre, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK
| | - Anders Nyboe Andersen
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen Ø, Denmark
| | - Nick Macklon
- Complete Fertility Centre, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
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García D, Vassena R, Prat A, Vernaeve V. Poor knowledge of age-related fertility decline and assisted reproduction among healthcare professionals. Reprod Biomed Online 2016; 34:32-37. [PMID: 28341417 DOI: 10.1016/j.rbmo.2016.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Reproduction is a matter of concern for individuals and society due to the postponement of childbearing, and healthcare professionals are the main source of information and counselling. This study aims to evaluate how knowledgeable healthcare professionals are about fertility and assisted reproduction, and to explore attitudes towards social oocyte freezing. A cross-sectional study was performed with 201 professionals (gynaecologists, physicians and nurses) from four public centres in Spain. Participants completed a survey about fertility, IVF, oocyte donation (OD) and social oocyte freezing, between May 2013 and March 2014. Reported mean age limits for pregnancy were 39.5 ± 4.5 (spontaneously), 43.7 ± 5.2 (IVF) and 49.0 ± 6.5 (OD). Gynaecologists reported a younger limit for spontaneous and IVF pregnancies (P < 0.001); 36.1% reported a limit for a spontaneous pregnancy >39, compared with 77.3% of other physicians and 72.9% of nurses. Regarding social oocyte freezing, 41.8% of gynaecologists thought it should be offered to every young woman, versus 62.7% of other physicians and 48.9% of nurses (P = 0.041). In conclusion, gynaecologists are more knowledgeable about fertility and assisted reproduction, while more restrictive towards social oocyte freezing. Knowledge and attitudes could influence the quality of information and counselling given to patients.
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Affiliation(s)
| | | | - Andrés Prat
- Department of Public Health, School of Medicine, University of Barcelona, Spain
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Abiodun O, Alausa K, Olasehinde O. Ignorance could hurt: an assessment of fertility awareness, childbirth intentions and parenting attitudes among university students. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0091/ijamh-2016-0091.xml. [PMID: 27740927 DOI: 10.1515/ijamh-2016-0091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/03/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND An emerging pattern of increasing median age at first birth among women has been well documented in Western countries. A similar but less remarkable trend is being experienced in sub-Saharan Africa. There is a paucity of information in Sub-Saharan Africa about awareness of age-related fertility decline. The aim of this study was to assess the perception of fertility, childbirth intentions and parenting attitudes among university students. MATERIALS AND METHODS A cross-sectional survey of 231 female and 158 male students randomly selected university undergraduates in Nigeria using a self-reported questionnaire. RESULTS The respondents overestimated the ages of slight (92.1%) and marked decline (89.4%) in female fertility. The chance of pregnancy after unprotected sex during ovulation was overestimated by 93.1% of the respondents. Over three-quarters of them overestimated the success rate of in-vitro fertilization. The sources of information regarding fertility issues were mainly school (40.1%), the media (20.6%) and family members (18.8%). About 98.7% of the childless respondents reported an intention to have children in the future. The mean number of children desired was 3.29±1.14. Females desire to have their first and last children earlier than males (p=0.000). The perceived potential obstacles to having the desired children were the pursuit of career aspirations (35.5%) and the pursuit of personal interests (20.8%). CONCLUSIONS Misconceptions about fertility issues have grave implications for involuntary childlessness and secondary infertility. Comprehensive family planning education that will address the misconceptions about female fecundity and parenting issues are required.
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Affiliation(s)
- Olumide Abiodun
- Department of Community Medicine, Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan, Nigeria, Phone: +234 703 856 9725
| | - Kamil Alausa
- Department of Community Medicine, Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan, Nigeria.,Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan, Nigeria
| | - Olanrewaju Olasehinde
- Department of Community Medicine, Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan, Nigeria.,Benjamin Carson (Snr) School of Medicine, Babcock University, Ilishan, Nigeria
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Gizzo S, Noventa M, Quaranta M, Venturella R, Vitagliano A, Gangemi M, D'Antona D. New frontiers in human assisted reproduction - from research to clinical practice: Several considerations. Mol Med Rep 2016; 14:4037-4041. [DOI: 10.3892/mmr.2016.5749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 08/22/2016] [Indexed: 11/06/2022] Open
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Abstract
Objective Fertility declines as women age. Advancing maternal age increases pregnancy
risks such as diabetes or hypertension. Studies suggest women are not aware
of the risks of aging on fertility and pregnancy. The study objective was to
assess women's knowledge of fertility and reproductive outcomes affected by
aging. Methods Prospective IRB approved survey of women (n=94) attending an obstetrics and
gynecology (OB/GYN) clinic. Data collected included demographics, pregnancy
history, and knowledge of age-related fertility decline and pregnancy risks.
Statistical analysis performed using JMP Pro11.0. Results Ages ranged from 18 to 67. One third (30.5%) were aware fertility begins to
decline at age 35, however this varied among groups depending on prior
history of infertility or requiring fertility treatment. Nulliparous women
were more unaware of the health risks of pregnancy over age 35 (1.4% vs
13.6%, P 0.02). African Americans (AA) women were less
likely to think obesity (76% Caucasian vs 47.8% AA vs 66.7% other,
P < 0.05) and older age (88% Caucasian vs 60.9% AA
vs 82.7% other, P 0.02) affected fertility. Conclusion Knowledge regarding fertility and reproduction related to aging was variable
and differed by age and race. Difficulty conceiving appears to be associated
with higher knowledge levels. Public education will increase awareness of
age-related fertility declines. Increased contact during pregnancy is an
excellent opportunity to educate women in a nondirective way.
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Affiliation(s)
- Sara Deatsman
- Department of Obstetrics and Gynecology. Division of Reproductive Endocrinology and Infertility. University of Florida
| | | | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology. Division of Reproductive Endocrinology and Infertility. University of Florida
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Lewis EI, Missmer SA, Farland LV, Ginsburg ES. Public support in the United States for elective oocyte cryopreservation. Fertil Steril 2016; 106:1183-1189. [PMID: 27473351 DOI: 10.1016/j.fertnstert.2016.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether public support for oocyte cryopreservation (OC) exists and if support varies by demographic factors. DESIGN Cross-sectional electronic survey. SETTING Not applicable. PATIENT(S) A nationally representative sample based on age, sex, and race of 1,064 people in the United States recruited by the company SurveyMonkey. INTERVENTIONS(S) Completion of an online questionnaire. MAIN OUTCOME MEASURE(S) Supporters of OC for various indications were compared with participants who were neutral or in opposition by means of log binomial regression to calculate risk ratios. Statistical models were adjusted for demographic characteristics, including sex, race, age, income, sexual orientation, education, marital status, state political party affiliation, and history of being a parent. RESULT(S) OC for cancer patients was the indication most supported (89%), followed by delayed childbearing for career advancement (72%), current lack of a partner (63%), and insufficient funds for child rearing (58%). Despite considerable support for OC, only 37% agreed employers should fund egg freezing for employees. Older age was associated with lower support for all indications of OC. Younger age, single status, never being a parent, identifying as a sexual minority, and atheist/agnostic religion were associated with the survey taker personally considering OC. Compared with women, men demonstrated lower support for women undergoing OC for "lack of a male partner," and for future use of cryopreserved oocytes without being married. CONCLUSION(S) In a nationally representative sample, the majority of respondents support elective OC. The indication for OC was associated with significant differences in support.
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Affiliation(s)
- Erin I Lewis
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie V Farland
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Meissner C, Schippert C, von Versen-Höynck F. Awareness, knowledge, and perceptions of infertility, fertility assessment, and assisted reproductive technologies in the era of oocyte freezing among female and male university students. J Assist Reprod Genet 2016; 33:719-29. [PMID: 27125212 DOI: 10.1007/s10815-016-0717-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aims of our study were to analyze university student's knowledge and attitude towards parenthood, female fertility, fertility assessment, and oocyte freezing and to explore associations between these aspects and the participant's sex or degree program they were registered for. METHODS The study was designed as an online-based cross-sectional survey. A total of 1144 participants answered 27 questions. The data were analyzed using descriptive statistics. Linear regression models were employed to explore associations between sex or university program and attitude towards parenthood, fertility assessment, and oocyte freezing. RESULTS Female students and students of non-medical degree programs were more likely to plan to have children earlier than male students or students of medical degree programs. Female sex or medical degree program was associated with an overall better knowledge about women's fertility. The better the participant's knowledge about fertility, the more likely the students would consider assisted reproductive technology (ART) treatments as an option to become pregnant when ovarian reserve is low. The majority of students knew the principal of oocyte freezing but would not consider using it. However, in the case of a low ovarian reserve, oocyte freezing would be accepted as an option. CONCLUSIONS Students planned to have children at an age when women's fertility is already declining. Gaps in knowledge about female fertility and the potential of ART were more pronounced in male students and students of non-medical degree programs suggesting an increase of fertility awareness is necessary in these groups to prevent them from infertility and unwanted childlessness.
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Affiliation(s)
- C Meissner
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - C Schippert
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Frauke von Versen-Höynck
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
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Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum Reprod Update 2016; 22:440-9. [DOI: 10.1093/humupd/dmw007] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/15/2016] [Indexed: 11/15/2022] Open
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Kraemer S, Steinberg Z. In Hope’s Shadow: Assisted Reproductive Technology and Neonatal Intensive Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/15289168.2015.1127737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Revelli A, Razzano A, Delle Piane L, Casano S, Benedetto C. Awareness of the effects of postponing motherhood among hospital gynecologists: is their knowledge sufficient to offer appropriate help to patients? J Assist Reprod Genet 2016; 33:215-20. [PMID: 26727932 DOI: 10.1007/s10815-015-0640-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aim of this study is to ascertain the awareness of hospital gynecologists about the effects of woman's age on spontaneous fecundity and on the efficacy of assisted reproduction techniques (ARTs). METHODS One hundred fifty-six gynecologists working in public or private Italian hospitals, without specific experience in reproductive medicine and ART, were administered a multiple-choice answer questionnaire addressing (a) the effect of age on woman's spontaneous fecundity, (b) the tools to estimate the ovarian follicular reserve, and (c) the outcome of ART in women above 40 years. RESULTS Approximately half of the interviewed gynecologists indicated the woman's age limit for successful reproduction between 44 and 50 years; fertility lifespan was believed to be prolonged by oral contraception, pro-fertility medical treatments, or ART. The correct meaning of serum FSH measurement was known by approximately one third of the interviewed doctors. The effectiveness of ART for women of advanced age was overestimated by half of the gynecologists, especially in case of patients having regular cycles and/or small follicles at ultrasound. CONCLUSIONS Overall, the survey clearly showed that the knowledge of hospital gynecologists about the effects of age on woman's fertility and ART effectiveness is largely insufficient to offer scientifically correct, helpful information to patients. Properly targeted corrections to academic and periodical educational programs for Ob/Gyn specialists are warranted.
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Affiliation(s)
- Alberto Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy.
| | - Alessandra Razzano
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Luisa Delle Piane
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Simona Casano
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Gynecological and Obstetrical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy
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Yu L, Peterson B, Inhorn MC, Boehm JK, Patrizio P. Knowledge, attitudes, and intentions toward fertility awareness and oocyte cryopreservation among obstetrics and gynecology resident physicians. Hum Reprod 2015; 31:403-11. [PMID: 26677956 DOI: 10.1093/humrep/dev308] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/20/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What knowledge, attitudes and intentions do US obstetrics and gynecology (OB/GYN) residents have toward discussing age-related fertility decline and oocyte cryopreservation with their patients? SUMMARY ANSWER Most OB/GYN residents believe that age-related fertility decline, but not oocyte cryopreservation, should be discussed during well-woman annual exams; furthermore, nearly half of residents overestimated the age at which female fertility markedly declines. WHAT IS KNOWN ALREADY Oocyte cryopreservation can be utilized to preserve fertility potential. Currently, no studies of US OB/GYN residents exist that question their knowledge, attitudes, and intentions toward discussing age-related fertility decline and oocyte cryopreservation with patients. STUDY DESIGN, SIZE, DURATION A cross-sectional online survey was conducted during the fall of 2014 among residents in American Council for Graduate (ACOG) Medical Education-approved OB/GYN residency programs. Program directors were emailed via the ACOG Council on Resident Education in Obstetrics and Gynecology server listing and asked to solicit resident participation. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included 238 residents evenly distributed between post-graduate years 1-4 with varied post-residency plans; 90% of residents were women and 75% were 26-30 years old. The survey was divided into three sections: demographics, fertility awareness, and attitudes toward discussing fertility preservation options with patients. Descriptive and inferential statistics were conducted. MAIN RESULTS AND THE ROLE OF CHANCE A strong majority of residents (83%) believed an OB/GYN should initiate discussions about age-related fertility decline with patients (mean patient age 31.8), and 73% percent believed these discussions should be part of an annual exam. One third of residents overestimated the age at which there is a slight decline in female fertility, while nearly half of residents overestimated the age at which female fertility markedly declines. Over three-quarters of residents (78.4%) also overestimated the likelihood of success using assisted reproductive treatments (ARTs). Residents were likely to support oocyte cryopreservation in cancer patients irrespective of the woman's age, but much less likely to support elective oocyte cryopreservation. For elective oocyte cryopreservation, 40% believed OB/GYNs should initiate discussions with patients (mean age 31.1), while only 20% believed this topic should be part of an annual exam. LIMITATIONS, REASONS FOR CAUTION Because the study invitation was sent through US OB/GYN residency program directors rather than directly to residents, it is possible that some residents did not receive the invitation to participate. This limits the generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Within the USA, there appears to be a critical need for improved education on fertility decline in OB/GYN residency programs. To promote informed reproductive decision-making among patients, efforts should be made to help OB/GYNs provide comprehensive fertility education to all women, while also respecting patient choices. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- L Yu
- Yale University School of Medicine, Obstetrics Gynecology and Reproductive Sciences, New Haven, CT, USA
| | - B Peterson
- Chapman University, Crean College of Health and Behavioral Sciences, Orange, CA, USA
| | - M C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - J K Boehm
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - P Patrizio
- Yale University School of Medicine, Obstetrics Gynecology and Reproductive Sciences, New Haven, CT, USA Yale University Fertility Center, New Haven, CT, USA
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Tsafrir A, Haimov-Kochman R, Margalioth EJ, Eldar-Geva T, Gal M, Bdolah Y, Imbar T, Hurwitz A, Ben-Chetrit A, Goldberg D. Ovarian stimulation for oocyte cryopreservation for prevention of age-related fertility loss: one in five is a low responder. Gynecol Endocrinol 2015; 31:779-82. [PMID: 26291805 DOI: 10.3109/09513590.2015.1062859] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Oocyte cryopreservation for age-related fertility loss is gaining interest considering the tendency to postpone motherhood in many societies. Little is currently known about the actual efficiency of this approach. We aimed to explore ovarian response of presumably fertile women undergoing in vitro fertilization for this indication. A total of 105 women underwent 151 stimulation cycles at mean age 37.7 ± 2.4. None had known infertility. Mean daily starting FSH dose was 371 ± 110 (225-600). Mean number of mature oocytes cryopreserved at the first completed cycle was 9.7 ± 7.5 (0-43). However, 21% of started cycles were either cancelled before egg retrieval or resulted in 0-3 mature oocytes retrieved. Therefore, women considering oocyte cryopreservation for prevention of age-related fertility decline should be encouraged to perform this procedure at younger age than, preferably before 35.
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Affiliation(s)
- Avi Tsafrir
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
| | - Ronit Haimov-Kochman
- b IVF Unit, Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Mt Scopus , Jerusalem , Israel
| | - Ehud J Margalioth
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
| | - Talia Eldar-Geva
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
| | - Michael Gal
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
| | - Yuval Bdolah
- b IVF Unit, Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Mt Scopus , Jerusalem , Israel
| | - Tal Imbar
- b IVF Unit, Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Mt Scopus , Jerusalem , Israel
| | - Arye Hurwitz
- b IVF Unit, Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Mt Scopus , Jerusalem , Israel
| | - Avraham Ben-Chetrit
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
| | - Doron Goldberg
- a Shaare-Zedek, IVF Unit, Department of Obstetrics and Gynecology , Affiliated with the Hebrew University School of Medicine , Jerusalem , Israel and
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