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Hirsch A, Hirsh Raccah B, Rotem R, Hyman JH, Ben-Ami I, Tsafrir A. Planned oocyte cryopreservation: a systematic review and meta-regression analysis. Hum Reprod Update 2024:dmae009. [PMID: 38654466 DOI: 10.1093/humupd/dmae009] [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: 07/31/2023] [Revised: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Awareness of the age-related decline in fertility potential has increased the popularity of planned oocyte cryopreservation (POC). However, data regarding outcomes of POC, including rates of women returning to thaw oocytes, as well as pregnancy and live birth rates, are scarce and based mostly on small case series. OBJECTIVE AND RATIONALE POC was defined as cryopreservation exclusively for prevention of future age-related fertility loss. The primary outcome was live birth rate per patient. The secondary outcomes included the return to thaw rate and laboratory outcomes. A meta-regression analysis examining the association between live birth and age above 40 or below 35 was conducted. SEARCH METHODS We conducted a systematic database search from inception to August 2022. The search included PubMed (MEDLINE) and EMBASE. Our search strategies employed a combination of index terms (Mesh) and free text words to compile relevant concepts. The systematic review and meta-regression were undertaken following registration of systematic review (PROSPERO registration number CRD42022361791) and were reported following guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 (PRISMA 2020). OUTCOMES The database search yielded 3847 records. After the selection process, 10 studies, conducted from 1999 to 2020, were included. Overall, 8750 women underwent POC, with a mean cryopreservation age of 37.2 (±0.8). Of those, 1517 women returned to use their oocytes with a return rate of 11.1% (± 4.7%). The mean age at the time of cryopreservation for women who returned to use their oocytes was 38.1 (±0.4), with an average of 12.6 (±3.6) cryopreserved oocytes per woman. In a meta-analysis, the oocyte survival rate was 78.5% with a 95% CI of 0.74-0.83 (I2 = 93%). The live birth rate per patient was 28% with a 95% CI of 0.24-0.33 (I2 = 92%). Overall, 447 live births were reported. In a sub-group analysis, women who underwent cryopreservation at age ≥40 achieved a live birth rate per patient of 19% (95% CI 0.13-0.29, I2 = 6%), while women aged ≤35 years old or younger had a higher live birth rate per patient of 52% (95% CI 0.41-0.63, I2 = 7%). WIDER IMPLICATIONS POC emerges as a feasible option for women aiming to improve their chances of conceiving at a later reproductive age. Nonetheless, it must be acknowledged that the overall success rates of POC are limited and that the likelihood of successful live birth declines as the age at cryopreservation rises. With increasing interest in POC, the collation of comprehensive and high-quality data is imperative to clearly define the outcomes for various age groups. REGISTRATION NUMBER CRD42022361791.
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Affiliation(s)
- Ayala Hirsch
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Bruria Hirsh Raccah
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Jordana H Hyman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ido Ben-Ami
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avi Tsafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
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Murphy HG, Compton SD, Moravek MB, Rosen MW. Impact of employer-covered planned oocyte cryopreservation on decision-making for medical training. J Assist Reprod Genet 2024; 41:385-407. [PMID: 38008880 PMCID: PMC10894800 DOI: 10.1007/s10815-023-02990-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023] Open
Abstract
PURPOSE To characterize how employer coverage of planned oocyte cryopreservation (POC) might impact medical career decision-making. METHODS A cross-sectional survey was distributed to all medical students at two large academic programs in December 2022 to better understand attitudes towards childbearing, POC, and how employer coverage of POC might influence future career decisions. RESULTS Of the 630/1933 (32.6%) medical students who participated, 71.8% identified as women and 28.1% as men. More women (89.2%) than men (75.1%, P < 0.001) felt pressure to delay childbearing. Regarding childbearing, women more than men were concerned about the physical demand of residency (76.5% vs. 50.8%, P < 0.001), stigma in residency hiring practices (41.2% vs. 9.0%, P < 0.001), and parental leave interfering with team dynamics (49.6% vs. 20.9%, P < 0.001). Respondents were more likely to pursue POC if it were covered by residency employer health insurance (60.0% vs. 11.6%, P < 0.001). Women were more likely than men to state that employer-sponsored POC would influence their residency ranking (46.0% vs. 23.7%, P < 0.001), pursuit of additional degrees (50.9% vs. 30.5%, P < 0.001), and pursuit of fellowship training (50.9% vs. 30.5%, P < 0.001). Additionally, 25.4% of women and 19.8% of men felt their choice in medical specialty would be impacted by employer-sponsored POC. CONCLUSIONS Medical students, particularly women, feel pressure to delay childbearing during medical training and are concerned about future fertility. Both male and female students were interested in employer-sponsored POC and more likely to pursue it with financial coverage. Further research is needed to determine the full impact of employer-sponsored POC on medical career decision-making.
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Affiliation(s)
- Hana G Murphy
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
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Katsani D, Paraschou N, Panagouli E, Tsarna E, Sergentanis TN, Vlahos N, Tsitsika A. Social Egg Freezing-A Trend or Modern Reality? J Clin Med 2024; 13:390. [PMID: 38256524 PMCID: PMC10816669 DOI: 10.3390/jcm13020390] [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: 11/13/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Egg freezing for social reasons is a process in which women who want to preserve their ability to fertilize their own oocytes at an older age freeze their eggs. With the help of in vitro fertilization, the cryopreservation of oocytes for future use is achieved. The aim of this article is to study the reasons, the risks and the effectiveness of the method from a worldwide aspect. METHODS A literature search was conducted to evaluate pertinent studies, using data from the search engines PubMed, Google and UptoDate as well as the medical literature. RESULTS The reasons for delayed procreation are non-medical, with the lack of an appropriate partner for a family being first on the list. The success rate of this method differs with the age of the woman, the number of fertilized eggs and other factors. Like every medical procedure, this method carries risks that relate to the mother (being of advanced age), the embryo and the procedure of in vitro fertilization. The policies that apply in each country differ depending on respective social, economic, religious and cultural factors. Due to the high cost of the method, its selection remains a choice for only a few, reinforcing social inequality. The question of the medicalization of reproduction remains unanswered in the industry of assisted reproduction. CONCLUSIONS In conclusion, egg freezing for social reasons is gradually becoming more widely known, with the United States of America and Israel being at the top the list. Unfortunately, there is no official data registry, and consequently, no statistical results are yet available for Greece, even though it is a method that more and more women are considering. Nevertheless, there is an imperative need for a universal legal framework for all countries with respect for the needs of every woman and different social conditions. More research and data from the literature are needed in relation to the effectiveness of the method from moral and social perspectives.
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Affiliation(s)
- Dimitra Katsani
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Nefeli Paraschou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Eleni Panagouli
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Theodoros N. Sergentanis
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, School of Medicine, ‘Aretaieion’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (N.V.)
| | - Artemis Tsitsika
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.K.); (N.P.); (E.P.); (T.N.S.)
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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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Namath A, Jahandideh S, Devine K, Kallen CB, O'Brien JE. Examining reasons that patients discard cryopreserved oocytes. J Assist Reprod Genet 2023; 40:2865-2870. [PMID: 37796420 PMCID: PMC10656384 DOI: 10.1007/s10815-023-02962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE Assess the rate, rationale, and characteristics of patients who cryopreserved and subsequently discarded their oocytes, and compare their characteristics to patients with continued cryopreservation of oocytes. METHODS All patients who disposed of cryopreserved oocytes between 2009 and 2022 reported their reason for discarding their oocytes. This was a retrospective cohort study. RESULTS Of 5,010 patients who underwent oocyte cryopreservation (OC) cycles, 201 (4%) patients elected to discard their oocytes and 751 (15%) thawed oocytes for clinical use. The average ages of OC and disposal were 35 and 39 years old, respectively. Of the 201 patients who discarded their oocytes, 71 patients (35%) requested disposal after having a child. Twenty-six (13%) discarded oocytes because of worsening cancer and three (1.4%) discarded because of death. 16 (8%) discarded oocytes due to cost of cryopreservation and eight (4%) due to low oocyte yield. Ten (5%) patients underwent new IVF cycles and discarded previously stored oocytes. Sixty-seven patients (33%) discarded oocytes for unspecified reasons. When comparing patients who discarded oocytes with those who did not, the former had lower AMH (2.7 vs 3.5 ng/ml, p < 0.001) but otherwise comparable age and number of cryopreserved oocytes. The mean age for those with continued cryopreservation was 35.4 years at time of OC and 40 years at time of data collection in June 2023. CONCLUSION Childbirth was the most common reason to dispose of oocytes followed by unspecified reasons. Larger studies of oocyte disposal may better define clinical characteristics of patients most likely to use, maintain or discard their oocytes.
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Affiliation(s)
- Amalia Namath
- Shady Grove Fertility Center, Rockville, MD, USA.
- Rush University Medical Center, 1653 W Congress Pkway, Unit 720, Chicago, IL, 60612, USA.
| | | | - Kate Devine
- Shady Grove Fertility Center, Rockville, MD, USA
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Buderatska N, Gontar J, Petrushko M, Yurchuk T, Ilyin I, Piniaiev V, Fuller B. Embryological Characteristics and Preimplantation Genetic Testing for Aneuploidy of Embryos Derived from Cryopreserved Oocytes of Women of Different Reproductive Ages. Biopreserv Biobank 2023; 21:576-582. [PMID: 36409698 DOI: 10.1089/bio.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oocyte vitrification is widely used for female fertility preservation. However, the efficacy of this procedure may depend on the women's age. The aim of the study was to compare the morphology, viability of cryopreserved oocytes, and their fertilization outcomes (fertilization, blastulation rate, level of embryo chromosomal aneuploidy-preimplantation genetic testing for aneuploidy [PGT-A]) in women of different reproductive ages. The studied oocytes were divided into groups depending on the age of patients: up to 30 years (group 1), 30-35 years (group 2), 36-40 years (group 3), and older than 40 years (group 4). It has been shown that in women of older reproductive age, the number of oocytes with polymorphism of endo- and extracytoplasmic structures was higher compared with younger patients. This could reflect on their cryosurvival rate, which was the highest in group 1 (98.1%) and the lowest was in group 4 (47.4%). With increasing age, the fertilization rate of cryopreserved oocytes and subsequent blastulation was decreased. However, the number of embryos with an aneuploid chromosome set number was increased. The chromosome set number euploidy rate of the embryos obtained from cryopreserved oocytes of advanced age women (group 4) did not differ from the fresh group with the same age (31.2% vs. 24.4%, p > 0.05), but the number of euploid embryos per patient was less than one (0.8 ± 0.1). Therefore, the decision to cryopreserve the oocytes of a patient of older reproductive age should be made individually for each situation, taking into account the prospects of obtaining full-fledged embryos and the chances of pregnancy.
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Affiliation(s)
| | | | - Maryna Petrushko
- Institute for Problems of Cryobiology and Cryomedicine of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine
- ART-Clinic of Reproductive Medicine, Kharkiv, Ukraine
| | - Taisiia Yurchuk
- Institute for Problems of Cryobiology and Cryomedicine of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine
| | | | - Volodymyr Piniaiev
- Institute for Problems of Cryobiology and Cryomedicine of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine
- ART-Clinic of Reproductive Medicine, Kharkiv, Ukraine
| | - Barry Fuller
- Divison of Surgery & Interventional Science, Royal Free London NHS Trust & UCL, London, United Kingdom
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Aderaldo JF, Rodrigues de Albuquerque BHD, Câmara de Oliveira MTF, de Medeiros Garcia Torres M, Lanza DCF. Main topics in assisted reproductive market: A scoping review. PLoS One 2023; 18:e0284099. [PMID: 37527215 PMCID: PMC10393141 DOI: 10.1371/journal.pone.0284099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Infertility affects around 12% of couples, and this proportion has been gradually increasing. In this context, the global assisted reproductive technologies (ART) market shows significant expansion, hovering around USD 26 billion in 2019 and is expected to reach USD 45 billion by 2025. OBJECTIVES We realized a scoping review of the ART market from academic publications, market reports, and specialized media news, to identify the main terms and characterize them into the main topics in the area. DESIGN We apply an LDA topic modeling process to identify the main terms, and clustered them into semantic synonymous topics. We extracted the patterns and information to these topics and purposed a factor/consequence correlation to them. RESULTS We found 2,232 academic papers and selected 632 to include in the automatic term detection. We also included 34 market reports and seven notices produced by specialized enterprises. Were identified 121 most relevant cited terms covering 7,806 citations. These terms were manually aggregated into 10 topics based on semantic similarity: neutral terms (37.2%), economic aspects (17.6%), in vitro fertilization (IVF) commodities & cross-border reproductive care (CBRC) (10.6%), geographic distribution (9.5%), social aspects (7%), regulation (6%), trends & concerns (3.9%), accessibility (3.4%), internet influence (2.9%), and fertility preservation for non-medical reasons (2%). DISCUSSION The analysis indicates a market with expressive complexity. Most terms were associated with more than one topic, indicating the synergism of this market's behavior. Only seven terms related to economic aspects, surrogacy and donation represent around 50% of the citations. Except for the topic formed by generic terms, the topic of the economic aspects was the most represented, reflecting macro perspectives such as a-la-carte standard of treatments, many clinics operating on a small/medium scale, and the recent formation of conglomerates. The IVF commodities & CBRC topic brings an overview of gametes pricing and transnational surrogacy, and its regulation. The topic of geographic distribution indicates that that the Asia-Pacific (APAC) market has the most significant growth potential in all fields. Despite the increase in supply and demand for infertility treatments and technological advances in recent decades, the success rate of IVF cycles remains at around 30%. Terms referring to research and development or technical improvement were not identified in a significant way in this review. CONCLUSIONS The formation of topics by semantic similarity proved to be an initial path for the elaboration of in-depth studies on the dynamics between several factors, for this, we present the panel classifying main terms into factors (demand, pent-up demand, or distributive) or ART market consequences. Through this approach, it was possible to observe that most of the works addresses economic aspects, regulation and geographic aspects and that topics related to research and improvement have not been addressed. In this way, we highlight the need to deepen the analysis of market elements that may be related to increased efficiency of IVF in the technical field.
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Affiliation(s)
- Janaina Ferreira Aderaldo
- Applied Molecular Biology Lab (LAPLIC), Biochemistry Department, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Januário Cicco´s University Hospital (MEJC), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | | | | | - Mychelle de Medeiros Garcia Torres
- Applied Molecular Biology Lab (LAPLIC), Biochemistry Department, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
- Januário Cicco´s University Hospital (MEJC), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Daniel Carlos Ferreira Lanza
- Applied Molecular Biology Lab (LAPLIC), Biochemistry Department, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
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Sandhu S, Hickey M, Braat S, Hammarberg K, Lew R, Fisher J, Ledger W, Peate M. Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information. J Assist Reprod Genet 2023; 40:1265-1280. [PMID: 37058261 PMCID: PMC10101825 DOI: 10.1007/s10815-023-02796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information. METHODS An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method. RESULTS Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53). CONCLUSION Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
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Jaswa EG, Pasch LA, McGough A, Wong R, Corley J, Cedars MI, Huddleston HG. Decision regret among women considering planned oocyte cryopreservation: a prospective cohort study. J Assist Reprod Genet 2023; 40:1281-1290. [PMID: 37058259 PMCID: PMC10310667 DOI: 10.1007/s10815-023-02789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE To (1) prospectively characterize the incidence of decision regret among women considering planned oocyte cryopreservation (planned OC), comparing those who pursued treatment vs those who did not freeze eggs, and (2) to identify baseline predictors for future decision regret. METHODS A total of 173 women seen in consultation for planned OC were followed prospectively. Surveys were administered at (1) baseline (< 1 week after initial consultation) and (2) follow-up, 6 months after planned OC among participants who froze eggs or 6 months following consultation in the absence of further communication to pursue treatment. The primary outcome was the incidence of moderate-to-severe decision regret, indicated by a Decision Regret Scale score > 25. We also examined predictors of regret. RESULTS The incidence of moderate-to-severe regret over the decision to freeze eggs was 9% compared to 51% over the decision not to pursue treatment. Among women who froze eggs, adequacy of information at baseline to decide about treatment (aOR 0.16, 95% CI 0.03, 0.87) and emphasis on future parenthood (aOR 0.80, 95% CI 0.66, 0.99) were associated with reduced odds of regret. Forty-six percent of women who froze eggs regretted not doing so earlier. Among women who did not freeze eggs, the primary reasons were financial and time constraints, correlating with increased odds of decision regret in an exploratory analysis. CONCLUSIONS Among women undergoing planned OC, the incidence of decision regret is low compared to the regret confronting women seen in consultation for planned OC but who do not pursue treatment. Provider counseling is key to offset the regret risk.
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Affiliation(s)
- Eleni G Jaswa
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | - Lauri A Pasch
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Alexandra McGough
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Rebecca Wong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Jamie Corley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Marcelle I Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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10
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Sandhu S, Hickey M, Lew R, Hammarberg K, Braat S, Agresta F, Parle A, Allingham C, Peate M. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Med Inform Decis Mak 2023; 23:83. [PMID: 37147687 PMCID: PMC10161420 DOI: 10.1186/s12911-023-02178-4] [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: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Elective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making. METHODS The online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18-45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility. RESULTS Most participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45-80) pre-Decision Aid to 7.5/100 (Interquartile range: 0-37.5) post-Decision Aid review (p < 0.001). Median knowledge score increased from 8.5/14 (Interquartile range: 7-11) pre-Decision Aid to 11/14 (Interquartile range: 10-12) post-Decision Aid review (p = 0.01). CONCLUSION This elective egg freezing Decision Aid appears acceptable and useful for decision-making. It improved knowledge, reduced decisional conflict and did not raise serious concerns. The Decision Aid will be further evaluated using a prospective randomised control trial. STUDY REGISTRATION ACTRN12618001685202 (retrospectively registered: 12 October 2018).
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Anna Parle
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Catherine Allingham
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
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11
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Caughey LE, White KM, Lensen S, Peate M. Elective egg freezers' disposition decisions: a qualitative study. Fertil Steril 2023:S0015-0282(23)00151-6. [PMID: 37032273 DOI: 10.1016/j.fertnstert.2023.02.022] [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: 12/23/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To explore the factors that influence elective egg freezers' disposition decisions toward their surplus-frozen oocytes. DESIGN Qualitative. SETTING Not applicable. PATIENT(S) Thirty-one participants: 7 past; 6 current; and 18 future oocyte disposition decision-makers. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Qualitative thematic analysis of interview transcripts. RESULTS Six inter-related themes were identified related to the decision-making process which are as follows: decisions are dynamic; triggers for the final decision; achieving motherhood; conceptualization of oocytes; the impacts of egg donation on others; and external factors affecting the final disposition outcome. All women reported a type of trigger event for making a final decision (e.g., completing their family). Women who achieved motherhood were more open to donating their oocytes to others but were concerned about the implications for their child and felt responsibility for potential donor children. Women who did not achieve motherhood were unlikely to donate to others due to the grief of not becoming a mother, often feeling alone, misunderstood, and unsupported. Reclaiming oocytes (e.g., taking them home) and closure ceremonies helped some women process their grief. Donating to research was viewed as an altruistic option as oocytes would not be wasted and did not have the "complication" of a genetically-linked child. There was a general lack of knowledge around disposition options at all stages of the process. CONCLUSION(S) Oocyte disposition decisions are dynamic and complex for women, exacerbated by a general lack of understanding of these options. The final decision is framed by: whether women achieved motherhood, dealing with grief if they did not achieve motherhood, and considering the complexities of donating to others. Additional decision support through counseling, decision aids, and early consideration of disposition when eggs are initially stored may help women make informed decisions.
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Affiliation(s)
- Lucy E Caughey
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarah Lensen
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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12
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Murugesu S, Charalambides MM, Jones BP, Saso S, Faris R, Parikh J, Nicopoullos J, Thum M, Bracewell‐Milnes T. Social egg freezing: Motivations, treatment experiences and the impact of Covid‐19 – a single‐center experience. Acta Obstet Gynecol Scand 2023; 102:760-773. [DOI: 10.1111/aogs.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
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13
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Drost L, Dason ES, Han J, Doshi T, Scheer A, Greenblatt EM, Jones CA. Patients' and providers' perspectives on non-urgent egg freezing decision-making: a thematic analysis. BMC Womens Health 2023; 23:49. [PMID: 36755254 PMCID: PMC9906951 DOI: 10.1186/s12905-023-02189-3] [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: 10/10/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The decision to undergo non-urgent egg freezing (EF) is complex for patients and providers supporting them. Though prior studies have explored patient perspectives, no study has also included the separate perspectives of providers. METHODS This qualitative study involved semi-structured individual interviews exploring the decision to undergo EF. Participants included patients considering EF at one academic fertility clinic and providers who counsel patients about EF from across Canada. Data analysis was accomplished using thematic analysis. Data saturation was met after interviewing 13 providers and 12 patients. FINDINGS Four themes were identified and explored, illuminating ways in which patients and providers navigate decision-making around EF: (1) patients viewed EF as a 'back-up plan' for delaying the decision about whether to have children, while providers were hesitant to present EF in this way given the uncertainty of success; (2) providers viewed ovarian reserve testing as essential while patients believed it unnecessarily complicated the decision; (3) patients and providers cited a need for change in broader societal attitudes regarding EF since social stigma was a significant barrier to decision-making; and (4) commonality and peer support were desired by patients to assist in their decision, although some providers were hesitant to recommend this to patients. CONCLUSIONS In conclusion, the decision to undergo EF is complex and individual patient values play a significant role. In some areas, there is disconnect between providers and patients in their views on how to navigate EF decision-making, and these should be addressed in discussions between providers and patients to improve shared decision-making.
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Affiliation(s)
- Leah Drost
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON, M5G 1X5, Canada.
| | - E. Shirin Dason
- grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
| | - Jinglan Han
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.25152.310000 0001 2154 235XDepartment of Obstetrics &, Gynecology University of Saskatchewan, Saskatoon, SK S7N 0W8 Canada
| | - Tanya Doshi
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada
| | - Adena Scheer
- grid.415502.7Department of General Surgery, St. Michaels Hospital, Unity Health Network, Toronto, ON M5B 1W8 Canada
| | - Ellen M. Greenblatt
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
| | - Claire A. Jones
- grid.416166.20000 0004 0473 9881Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, ON M5G 1X5 Canada ,grid.17063.330000 0001 2157 2938Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, 12Th Floor, 123 Edward St, Toronto, ON M5G 1E2 Canada
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14
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Do Aging and Parity Affect VEGF-A/VEGFR Content and Signaling in the Ovary?-A Mouse Model Study. Int J Mol Sci 2023; 24:ijms24043318. [PMID: 36834730 PMCID: PMC9966908 DOI: 10.3390/ijms24043318] [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: 12/30/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
In this study, the effects of aging and parity on VEGF-A/VEGFR protein content and signaling in the mice ovaries were determined. The research group consisted of nulliparous (virgins, V) and multiparous (M) mice during late-reproductive (L, 9-12 months) and post-reproductive (P, 15-18 months) stages. Whilst ovarian VEGFR1 and VEGFR2 remained unchanged in all the experimental groups (LM, LV, PM, PV), protein content of VEGF-A and phosphorylated VEGFR2 significantly decreased only in PM ovaries. VEGF-A/VEGFR2-dependent activation of ERK1/2, p38, as well as protein content of cyclin D1, cyclin E1, and Cdc25A were then assessed. In ovaries of LV and LM, all of these downstream effectors were maintained at a comparable low/undetectable level. Conversely, the decrease recorded in PM ovaries did not occur in the PV group, in which the significant increase of kinases and cyclins, as well phosphorylation levels mirrored the trend of the pro-angiogenic markers. Altogether, the present results demonstrated that, in mice, ovarian VEGF-A/VEGFR2 protein content and downstream signaling can be modulated in an age- and parity-dependent manner. Moreover, the lowest levels of pro-angiogenic and cell cycle progression markers detected in PM mouse ovaries sustains the hypothesis that parity could exert a protective role by downregulating the protein content of key mediators of pathological angiogenesis.
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15
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“It gives me time, but does it give me freedom?”: a contextual understanding of anticipatory decision-making in social egg freezing. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Hafezi M, Zameni N, Nemati Aghamaleki SZ, Omani-Samani R, Vesali S. Awareness and attitude toward oocyte cryopreservation for non-medical reasons: a study on women candidates for social egg freezing. J Psychosom Obstet Gynaecol 2022; 43:532-540. [PMID: 35998044 DOI: 10.1080/0167482x.2022.2090332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
PURPOSE The present study was to investigate awareness and attitudes toward female fertility and aging, desire for a child and motherhood, and oocyte freezing for non-medical reasons among women candidates for Social Egg Freezing (SEF). MATERIALS AND METHODS This was a cross-sectional study on all 216 women who sought oocyte cryopreservation for nonmedical reasons at Royan Institute. A 24-item self-administered questionnaire measured knowledge and attitudes to SEF. Responses were as yes/no or a 4-point Likert scale. RESULTS Only 40% of participants accurately indicated that having a sexual partner does not help to preserve their fertility. A quarter of women correctly recalled chance of pregnancy with unprotected intercourse during a period of a year, for women 20 to 40 years old. Only one-third of respondents accurately identified the age-related fertility decline at 35-39 years. Only 6.9% correctly mentioned the low chance of pregnancy after egg freezing at 35 years old. Almost a third of women knew that the age range of 31-35 years is the right age to freeze an egg with the highest chance of pregnancy. Aging and health of offspring were most influential in women's decisions on SEF. CONCLUSION In conclusion, there was significant gaps in knowledge about age-related fertility decline, and egg cryopreservation conditions and its complications. It is crucial to impart to these women a better knowledge about fertility and a realistic picture about SEF, especially on the number of high-quality retrieved mature oocytes and live birth rates depend on women's age.
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Affiliation(s)
- Maryam Hafezi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nadia Zameni
- School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Seyyedeh Zahra Nemati Aghamaleki
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Omani-Samani
- Department of Medical Ethics and Law, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Samira Vesali
- Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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17
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Peate M, Sandhu S, Braat S, Hart R, Norman R, Parle A, Lew R, Hickey M. Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221139673. [PMID: 36448651 PMCID: PMC9720825 DOI: 10.1177/17455057221139673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Uptake of elective egg freezing has increased globally. The decision to freeze eggs is complex, and detailed, unbiased information is needed. To address this, we developed an online Decision Aid for women considering elective egg freezing. Decision Aids are the standard of care to support complex health decisions. OBJECTIVES This study will measure the impact of the Decision Aid on decision-making (e.g. decisional conflict, engagement in decision-making, distress, and decision delay) and decision quality (e.g. knowledge, level of informed choice, and regret). METHODS AND ANALYSIS A single-blinded two-arm parallel-group randomized controlled trial. Women considering elective egg freezing will be recruited using social media, newsletters, and fertility clinics. Data will be collected at baseline (recruitment), 6-month, and 12-month post-randomization. The primary hypothesis is that the intervention (Decision Aid plus Victorian Assisted Reproductive Technology Authority website) will reduce decisional conflict (measured using the Decisional Conflict Scale) at 12 months more than control (Victorian Assisted Reproductive Technology Authority website only). Secondary outcomes include engagement in decision-making (Perceived Involvement in Care Scale), distress (Depression, Anxiety, and Stress Scale), decision delay, knowledge, informed choice (Multi-dimensional Measure of Informed Choice), and decisional regret (Decisional Regret Scale). ETHICS The study was approved by the University of Melbourne Human Research Ethics Committee (Ethics ID: 2056457). Informed consent will be obtained from all participants prior to enrolment. DISCUSSION This is the first international randomized controlled trial that aims to investigate the effect of an elective egg freezing Decision Aid on decision-related outcomes (e.g. decisional conflict, informed choice, and regret). It is anticipated that participants who receive the Decision Aid will have better decision and health outcomes. REGISTRATION DETAILS ACTRN12620001032943: Comparing different information resources on the process and quality of decision-making in women considering elective egg freezing.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia,Michelle Peate, Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, VIC 3052, Australia.
| | - Sherine Sandhu
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Roger Hart
- Division of Obstetrics and Gynaecology, The University of Western Australia, King Edward Memorial Hospital, Perth, WA, Australia,Fertility Specialists of Western Australia and City Fertility, Bethesda Hospital, Claremont, WA, Australia
| | - Robert Norman
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Anna Parle
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Raelia Lew
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia,Reproductive Services Unit, The Royal Women’s Hospital and Melbourne IVF, Melbourne, VIC, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women’s Hospital, Parkville, VIC, Australia
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Tsafrir A, Ben-Ami I, Eldar-Geva T, Gal M, Dekel N, Levi H, Schonberger O, Srebnik N, Weintraub A, Goldberg D, Hyman J. Clinical outcome of planned oocyte cryopreservation at advanced age. J Assist Reprod Genet 2022; 39:2625-2633. [PMID: 36264444 PMCID: PMC9723084 DOI: 10.1007/s10815-022-02633-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/30/2022] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To report outcome of planned oocyte cryopreservation (POC) in the first 8 years of this treatment in our center. METHODS A retrospective study in a university-affiliated medical center. RESULTS A total of 446 women underwent POC during 2011-2018. Fifty-seven (13%) women presented to use these oocytes during the study period (until June 2021). POC was performed at a mean age of 37.9 ± 2.0 (range 33-41). Age at thawing was 43.3 ± 2.1 (range 38-49). A total of 34 (60%) women transferred their oocytes for thawing at other units. Oocyte survival after thawing was significantly higher at our center than following shipping to ancillary sites (78 vs. 63%, p = 0.047). Forty-nine women completed their treatment, either depleting their cryopreserved oocytes without conceiving (36) or attaining a live birth (13)-27% live birth rate per woman. Only one of eleven women who cryopreserved oocytes aged 40 and older had a live birth using thawed oocytes. CONCLUSION Women should be advised to complete planned oocyte cryopreservation before age 40, given low success rates in women who underwent cryopreservation at advanced reproductive age. In this study, oocyte shipping was associated with lower survival rate. These findings may be relevant for women considering POC and utilization of cryopreserved oocytes.
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Affiliation(s)
- Avi Tsafrir
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Ido Ben-Ami
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Talia Eldar-Geva
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Gal
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nava Dekel
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Hadassah Levi
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Oshrat Schonberger
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
| | - Naama Srebnik
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Weintraub
- IVF Unit, Laniado Medical Center and the Rappaport Faculty of Medicine-Technion, Netanya, Israel
| | - Doron Goldberg
- Clalit Health Services, Fertility clinic, Modi'in Illit, Israel
| | - Jordana Hyman
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Shmu'el Bait St 12, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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19
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Kasaven LS, Jones BP, Heath C, Odia R, Green J, Petrie A, Saso S, Serhal P, Nagi JB. Reproductive outcomes from ten years of elective oocyte cryopreservation. Arch Gynecol Obstet 2022; 306:1753-1760. [PMID: 35988095 PMCID: PMC9519701 DOI: 10.1007/s00404-022-06711-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/17/2022] [Indexed: 11/24/2022]
Abstract
RESEARCH QUESTION To assess the relationship between the number of oocytes retrieved during elective oocyte cryopreservation (EOC) cycles with various clinical, biochemical, and radiological markers, including age, body mass index (BMI), baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥ 12 mm on the day of trigger. To also report the reproductive outcomes from women who underwent EOC. METHODS A retrospective cohort of 373 women embarking on EOC and autologous oocyte thaw cycles between 2008 and 2018 from a single London clinic in the United Kingdom. RESULTS 483 stimulation cycles were undertaken amongst 373 women. The median (range) age at cryopreservation was 38 (26-47) years old. The median numbers of oocytes retrieved per cycle was 8 (0-37) and the median total oocytes cryopreserved per woman was 8 (0-45). BMI, E2 level and number of follicles ≥ 12 mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed there was no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. Thirty six women returned to use their cryopreserved oocytes, of which there were 41 autologous oocyte thaw cycles undertaken. There were 12 successful livebirths achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths were achieved in women who underwent EOC ≥ 40 years old, and 82% of all livebirths were achieved in women who had done so between 36 and 39 years old. CONCLUSION Clinical, biochemical and radiological markers can predict oocyte yield in EOC cycles. Reproductive outcomes are more favourable when cryopreservation is performed before the age of 36, with lower success rates of livebirth observed in women aged 40 years and above.
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Affiliation(s)
- Lorraine S Kasaven
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK.
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK.
- Department of Cutrale Perioperative and Ageing Group, Imperial College London, London, W12 0NN, UK.
| | - Benjamin P Jones
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK
| | - Carleen Heath
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Joycelia Green
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London, WC1X 8LD, UK
| | - Srdjan Saso
- Department of Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London NHS Trust, Du Cane Road, London, W12 OHS, UK
- Department of Cancer and Surgery, Imperial College London, London, W12 0NN, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
| | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, Great Portland Street, London, W1W 5QS, UK
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20
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Kasaven LS, Saso S, Getreu N, O'Neill H, Bracewell-Milnes T, Shakir F, Yazbek J, Thum MY, Nicopoullos J, Ben Nagi J, Hardiman P, Diaz-Garcia C, Jones BP. Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation? Hum Reprod 2022; 37:1970-1979. [PMID: 35734904 PMCID: PMC9433842 DOI: 10.1093/humrep/deac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/29/2022] [Indexed: 11/21/2022] Open
Abstract
Age-related fertility decline (ARFD) is a prevalent concern amongst western cultures due to the increasing age of first-time motherhood. Elective oocyte and embryo cryopreservation remain the most established methods of fertility preservation, providing women the opportunity of reproductive autonomy to preserve their fertility and extend their childbearing years to prevent involuntary childlessness. Whilst ovarian cortex cryopreservation has been used to preserve reproductive potential in women for medical reasons, such as in pre- or peripubertal girls undergoing gonadotoxic chemotherapy, it has not yet been considered in the context of ARFD. As artificial reproductive technology (ART) and surgical methods of fertility preservation continue to evolve, it is a judicious time to review current evidence and consider alternative options for women wishing to delay their fertility. This article critically appraises elective oocyte cryopreservation as an option for women who use it to mitigate the risk of ARFD and introduces the prospect of elective ovarian cortex cryopreservation as an alternative.
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Affiliation(s)
- Lorraine S Kasaven
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Cutrale Perioperative and Ageing Group, Sir Michael Uren Hub, Imperial College London, London, UK
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalie Getreu
- Translational Ovarian Physiology and Pathophysiology, Institute for Women's Health, University College London, London, UK
| | - Helen O'Neill
- Genome Editing and Reproductive Genetics Group, Institute for Women's Health, University College London, London, UK
| | | | - Fevzi Shakir
- Royal Free London NHS Foundation Trust, London, UK
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, London, UK
| | | | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | | | - Cesar Diaz-Garcia
- IVI London, IVIRMA Global, London, UK.,EGA Institute for Women's Health, University College London, London, UK
| | - Benjamin P Jones
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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21
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Bozzaro C. Medical technologies, time, and the good life. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:29. [PMID: 35680709 PMCID: PMC9184407 DOI: 10.1007/s40656-022-00504-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Against the backdrop of emerging medical technologies that promise transgression of temporal limits, this paper aims to show the importance that an individual lifetime's finitude and fugacity have for the question of the good life. The paper's first section examines how the passing of an individual's finite lifetime can be experienced negatively, and thus cause "suffering from the passing of time." The second section is based on a sociological analysis within the conceptual framework of individualization and capitalism, which characterizes many modern individualized and consumerist societies and explains how the described problem of time's passage is particularly relevant today. The paper then proceeds to show and discuss how individuals employ various, primarily medical, enhancement-technologies like social egg freezing, anti-aging-medicine and physical- and neuro-enhancement in an attempt to overcome time's passing. Finally, the paper seeks to explain why such attempts fail and, moreover, why it is exactly the awareness of time's passing that can constitute a prerequisite for a good life.
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Affiliation(s)
- Claudia Bozzaro
- Institute for experimental Medicine, Department of Medical Ethics, Christian-Albrecht's-University Kiel, Kiel, Germany.
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22
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Giannopapa M, Sakellaridi A, Pana A, Velonaki VS. Women Electing Oocyte Cryopreservation: Characteristics, Information Sources, and Oocyte Disposition: A Systematic Review. J Midwifery Womens Health 2022; 67:178-201. [DOI: 10.1111/jmwh.13332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Maria Giannopapa
- Department of Nursing National and Kapodistrian University of Athens Athens Greece
| | - Anna Sakellaridi
- Department of Nursing National and Kapodistrian University of Athens Athens Greece
| | - Anastasia Pana
- Department of Nursing National and Kapodistrian University of Athens Athens Greece
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23
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Walker Z, Lanes A, Ginsburg E. Oocyte cryopreservation review: outcomes of medical oocyte cryopreservation and planned oocyte cryopreservation. Reprod Biol Endocrinol 2022; 20:10. [PMID: 34996479 PMCID: PMC8740039 DOI: 10.1186/s12958-021-00884-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The utilization of oocyte cryopreservation (OC) has become popularized with increasing numbers of reproductive-aged patients desiring to maintain fertility for future family building. OC was initially used for fertility preservation in postmenarchal patients prior to gonadotoxic therapies; however, it is now available to patients to circumvent age-related infertility and other diagnoses associated with early loss of ovarian reserve. The primary aim of this paper is to provide a narrative review of the most recent and robust data on the utilization and outcomes of OC in both patient populations. OC results in similar oocyte yield in patients facing gonadotoxic therapies and patients undergoing planned OC. Available data are insufficient to predict the live birth rates or the number of oocytes needed to result in live birth. However, oocyte yield and live birth rates are best among patients < 37.5 years old or with anti-mullerian hormone levels > 1.995 ng/dL, at the time of oocyte retrieval. There is a high 'no use' rate (58.9%) in patients using planned OC with 62.5% returning to use frozen oocytes with a spouse. The utilization rate in medical OC patients is < 10%. There is currently no data on the effects of BMI, smoking, or ethnicity on planned OC outcomes. CONCLUSION It is too early to draw any final conclusions on outcomes of OC in medical OC and planned OC; however, preliminary data supports that utilization of OC in both groups result in preservation of fertility and subsequent live births in patients who return to use their cryopreserved eggs. Higher oocyte yield, with fewer ovarian stimulation cycles, and higher live birth rates are seen in patients who seek OC at younger ages, reinforcing the importance of age on fertility preservation. More studies are needed in medical OC and planned OC to help guide counseling and decision-making in patients seeking these services.
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Affiliation(s)
- Zachary Walker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Andrea Lanes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Elizabeth Ginsburg
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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24
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Immediata V, Cirillo F, Baggiani A, Zanagnolo MF, Ronchetti C, Morenghi E, Cesana A, Specchia C, Levi-Setti PE. Why are they not coming back? A single-center follow-up study on oncological women oocyte's storing for fertility preservation. Front Endocrinol (Lausanne) 2022; 13:1054123. [PMID: 36561560 PMCID: PMC9763445 DOI: 10.3389/fendo.2022.1054123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Oocyte cryopreservation is a valid option for female cancer patients to preserve fertility. The number of patients undergoing fertility preservation (FP) cycles has increased over the past years. Nevertheless, the rates of patients returning to use their cryopreserved material have shown to be considerably low, ranging from 5-8%, but significant data regarding the reasons of such low return rates are scarce. METHODS This study is a single-center follow-up retrospective study evaluating the return rate of oncological women who underwent FP at a tertiary care Fertility Center and assessing the reasons influencing the patients who did not return. Data about patients who returned to attempt pregnancy were retrieved from internal registries. Non-returned patients were assessed with a standardized phone survey investigating health condition, marital status and family projects, spontaneous conceptions, and the reasons why they had not returned to use their gametes. A univariate analysis between returned and non-returned patients was performed. RESULTS Of the 397 patients who received counseling about FP, 171 (43.1%) underwent oocyte cryopreservation between 2001 and 2017. Nine (5%) died, and 17 (10%) were lost at follow-up. A total of 20 patients (11.7%) returned and 125 did not. In the non-returned group, 37 (29.6%) did not have a partner, 10 (8%) had a previous spontaneous conception, and 15 (12%) had recurrent malignancy at the time of follow-up. In the univariate analysis, younger age at freezing (31.8±6.2 vs. 35.2±4.7; p 0.018), lack of a partner (p 0.002), type of cancer (other than breast cancer; p 0.024) were the significant factors in the non-returned group. As for the personal reason for not coming back, patients mainly answered as follows: lack of a partner (29, 23.2%), the desire for spontaneous motherhood (24, 19.2%), previous spontaneous pregnancies after FP procedures (16, 12.8%), and still ongoing hormonal therapy for breast cancer (13, 10.4%). All patients confirmed their will to keep the storage of their oocytes. DISCUSSION The impact of a cancer diagnosis on a woman's maternal desire, sentimental status and life priorities should be studied more thoroughly. Studies investigating hormonal therapy suppression in breast cancer patients seeking pregnancy should be encouraged. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, identifier NCT05223764.
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Affiliation(s)
- Valentina Immediata
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Federico Cirillo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Annamaria Baggiani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Maria Federica Zanagnolo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Camilla Ronchetti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Amalia Cesana
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Cristina Specchia
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- *Correspondence: Paolo Emanuele Levi-Setti,
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25
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Tsafrir A, Holzer H, Miron-Shatz T, Eldar-Geva T, Gal M, Ami IB, Dekel N, Weintruab A, Goldberg D, Schonberger O, Srebnik N, Hyman J. 'Why have women not returned to use their frozen oocytes?': a 5-year follow-up of women after planned oocyte cryopreservation. Reprod Biomed Online 2021; 43:1137-1145. [PMID: 34686418 DOI: 10.1016/j.rbmo.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION What are the reproductive choices and retrospective reflections of women at least 4 years after planned oocyte cryopreservation (POC)? DESIGN This was an internet survey, using the REDCap application, of women who underwent POC, at a single-centre university-affiliated IVF unit, 4-8 years before the survey. The questionnaire addressed reproductive choices and outcomes following POC. RESULTS Seventy-nine women who underwent POC during 2011-2014 were invited to participate, and 70 (89%) responded. Mean age at cryopreservation was 37.1 ± 2.4 (range 30-41) years, mean age at study participation 42.6 ± 2.6 (range 35-48) years, and mean time from first cryopreservation cycle to study participation 5.5 ± 1.3 (range 4-8) years. The main retrospectively reported reason for POC was not wanting to become pregnant without a partner (59, 84%). During the follow-up period, 44 women (63%) attempted to conceive either naturally or by assisted reproductive technology using fresh or cryopreserved oocytes. Of those, 28 women achieved a live birth (64% of those who tried to conceive). Fourteen respondents (20% of all respondents) reported using their cryopreserved oocytes, and three (21%) achieved a birth using those oocytes. Fifteen women (34%) of those who tried to conceive used donor spermatozoa. CONCLUSIONS The most common reasons for not using frozen oocytes were achieving pregnancy without frozen oocytes or preferring not to have a child without a partner. A considerable proportion of women who had POC and were not interested in being a single parent by choice eventually try to conceive using donor spermatozoa several years later.
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Affiliation(s)
- A Tsafrir
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel.
| | - H Holzer
- Faculty of Medicine, Hebrew University of Jerusalem, Department of Obstetrics and Gynecology, Hadassah Medical Center Jerusalem, Israel
| | - T Miron-Shatz
- Ono Academic College, Center for Medical Decision Making, Kiryat Ono, Israel; Winton Centre for Risk and Evidence Information, Cambridge University, Cambridge, UK
| | - T Eldar-Geva
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - M Gal
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - I Ben Ami
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - N Dekel
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - A Weintruab
- IVF Unit, Laniado Medical Center, Netanya, Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - D Goldberg
- Clalit Health Services, Fertility Clinic - Central district, Modi'in Illit, Israel
| | - O Schonberger
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - N Srebnik
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
| | - J Hyman
- Faculty of Medicine, Hebrew University of Jerusalem, IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center Jerusalem, Israel
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Caughey LE, Lensen S, White KM, Peate M. Disposition intentions of elective egg freezers toward their surplus frozen oocytes: a systematic review and meta-analysis. Fertil Steril 2021; 116:1601-1619. [PMID: 34452749 DOI: 10.1016/j.fertnstert.2021.07.1195] [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: 04/21/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. DESIGN A systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Actual EEFs (women with oocytes in storage), potential EEFs (women investigating elective oocyte cryopreservation or about to freeze their oocytes), and women of reproductive age (women in the community aged ≥18 years). INTERVENTION(S) A systematic review was undertaken and electronically searched MEDLINE, Embase, and PsycINFO on the Ovid platform for conference abstracts and peer-reviewed articles, published in English after January 1, 2010. A search strategy combined synonyms for oocyte, cryopreservation, donation, disposition, elective, and attitude. Eligible studies assessed disposition outcomes (how an oocyte was disposed of) and disposition intentions (how women intend to dispose of an oocyte) and/or the psychosocial determinants underlying disposition outcomes and intentions. The Joanna Briggs Institute Prevalence Tool was used to assess the risk of bias. A meta-analysis using random effects was applied to pool proportions of women with similar disposition intentions toward their oocytes. MAIN OUTCOME MEASURE(S) Disposition outcomes and intentions toward surplus frozen oocytes: donate to research; donate to others; discard; unsure. Psychosocial determinants (beliefs, attitudes, barriers, and facilitators) of disposition outcomes and intentions. RESULT(S) A total of 3,560 records were identified, of which 22 (17 studies) met the inclusion criteria (8 studies from Europe, 7 from North America, and 2 from Asia). No studies reported on past oocyte disposition outcomes. Seventeen studies reported on the future disposition intentions of 5,446 women. Only 2 of the 17 studies reported on the psychosocial determinants of oocyte disposition intentions. There was substantial heterogeneity in the pooled results, which was likely a result of the significant variation in methodology. Actual EEFs were included in eight studies (n = 873), of whom 53% (95% confidence interval [CI], 44-63; I2, 87%) would donate surplus oocytes to research, 31% (95% CI, 23-40; I2, 72%) were unsure, 26% (95% CI, 17-38; I2, 92%) would donate to others, and 12% (95% CI, 6-21; I2, 88%) would discard their eggs. Psychosocial determinants: One study reported that 50% of these women were aware of friends and/or family having difficulty conceiving, which may have contributed to their willingness to donate to others. Potential EEFs were included in 4 studies (n = 645), of whom 38% (95% CI, 28-50; I2, 84%) would donate to research, 32% (95% CI, 17-51; I2, 91%) would donate to others, 29% (95% CI, 17-44; I2, 89%) would discard, and 7% (95% CI, 1-27; I2, 77%) were unsure. Psychosocial determinants: No studies. Women of reproductive age were included in 5 studies (n = 3,933), of whom 59% (95% CI, 48-70; I2, 97%) would donate to research and 46% (95% CI, 35-57; I2, 98%) would donate to others. "Unsure" and "discard" were not provided as response options. Psychosocial determinants: One study reported that the facilitators for donation to others included a family member or friend in need, to help others create a family, financial gain, to further science, and control or input over the selection of recipients. Barriers for donation included fear of having a biological child they do not know or who is raised by someone they know. CONCLUSION(S) No studies reported on the disposition outcomes of past EEFs. Disposition intentions varied across the three groups; however, "donating to research" was the most common disposition preference. Notably, the second disposition preference for one-third of actual EEFs was "unsure" and for one-third of potential EEFs was "donate to others." There were limited studies for actual and potential EEFs, and only two studies that explored the psychosocial determinants of oocyte disposition intentions. Additionally, these data suggest that disposition decisions change as women progress on their egg freezing journey, highlighting the importance of ongoing contact with the fertility team as intentions may change over time. More research is needed to understand the psychosocial determinants of oocyte disposition decisions so fertility clinics can provide EEFs with the support and information they need to make informed decisions about their stored eggs and reduce the level of uncertainty reported among EEFs and the potential risk of psychological distress and regret. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO 2020: CRD42020202733.
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Affiliation(s)
- Lucy E Caughey
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia.
| | - Sarah Lensen
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
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27
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Gurbuz A, Cil AP, Karakis LS, Abali R, Ceyhan M, Aksakal E, Kilic A, Bahceci M, Urman B. Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline. J Assist Reprod Genet 2021; 38:1469-1479. [PMID: 33797008 PMCID: PMC8266947 DOI: 10.1007/s10815-021-02164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the prevalence and factors associated with decision regret following oocyte cryopreservation (OC) in women with diminished ovarian reserve (DOR) and/or age-related fertility decline (ARFD). METHODS A cross-sectional survey study was conducted to five hundred fifty-two women with DOR and/or ARFD who underwent OC between 2014 and 2019 in two private-assisted reproductive units in Istanbul, Turkey. Decision regret was measured using the validated Decision Regret Scale (DRS). RESULTS The median and mean DRS scores were 10 (interquartile range: 25) and 13.4 (SD: 13.2, range 0-70), respectively. Eighty-five (52.5%) women reported mild regret and 26 (16%) had moderate to severe regret. Decision regret was inversely associated with the belief in fate regarding childbearing and trust in the efficacy of OC. CONCLUSIONS The prevalence of severe decision regret among patients with DOR and/or ARFD undergoing OC is low. Women who had belief in fate and trusted in the efficacy of oocyte cryopreservation had significantly lower decisional regret.
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Affiliation(s)
- Aysen Gurbuz
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Aylin Pelin Cil
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey.
| | | | - Remzi Abali
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Mehmet Ceyhan
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Ece Aksakal
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
| | - Azer Kilic
- Department of Sociology, Istanbul Bilgi University, 34060, Istanbul, Turkey
| | - Mustafa Bahceci
- Fulya IVF Center, Bahçeci Health Group, 34394, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, Assisted Reproduction Unit, American Hospital, Guzelbahce Sokak, No: 20 Nisantasi, 34365, Istanbul, Turkey
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28
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Johnston M, Richings NM, Leung A, Sakkas D, Catt S. A major increase in oocyte cryopreservation cycles in the USA, Australia and New Zealand since 2010 is highlighted by younger women but a need for standardized data collection. Hum Reprod 2021; 36:624-635. [PMID: 33367704 DOI: 10.1093/humrep/deaa320] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Indexed: 02/03/2023] Open
Abstract
STUDY QUESTION What are the cohort trends of women undergoing oocyte cryopreservation (OC)? SUMMARY ANSWER There has been a dramatic increase in OC cycles undertaken each year since 2010, and the demographics of women accessing OC has shifted to a younger age group, but so far very few women have returned to use their cryopreserved oocytes in treatments. WHAT IS KNOWN ALREADY Although OC, as a method of fertility preservation, is offered around the world, global data are lacking on who is accessing OC, who is returning to thaw oocytes and whether these trends are changing. STUDY DESIGN, SIZE, DURATION A trinational retrospective cohort study was performed of 31 191 OC cycles and 972 oocyte thaw (OT) cycles undertaken in the USA (2010-2016) and 3673 OC and 517 OT cycles undertaken in Australia/New Zealand (Aus/NZ; 2010-2015). PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the USA Society for Assisted Reproductive Technology (SART) national registry and the Australian and New Zealand Assisted Reproduction Database (ANZARD). De-identified data were requested on all autologous oocyte freeze-all cycles and all cycles where autologous oocytes were thawed to be used in a treatment cycle for the time periods of interest. MAIN RESULTS AND THE ROLE OF CHANCE In both the USA and Aus/NZ, there has been a dramatic rise in the number of OC cycles performed each year (+880% in the USA from 2010 to 2016 and +311% in Aus/NZ from 2010 to 2015). Across both regions, most women undergoing OC were aged in their late 30s, but the average age decreased over time (USA: 36.7 years vs 34.7 years in 2010 and 2016, respectively). The number of women returning for thaw cycles was low (USA: 413 in 2016, Aus/NZ: 141 in 2015) and most thaw cycles (47%) across both regions involved oocytes that were frozen for <6 months. In the USA, a higher proportion of cycles resulted in a live birth when only thawed oocytes were used, compared to cycles that combined thawed oocytes with fresh oocytes (25% vs 11%, respectively; P < 0.001). Age at retrieval influenced live birth rate in the USA; 38% of thaw cycles started in women who stored oocytes when aged ≤35 years resulted in a live birth, whereas only 16% resulted in a live birth for women who stored oocytes when aged ≥36 years. Similar data were unobtainable from Aus/NZ. LIMITATIONS, REASONS FOR CAUTION There were limitations associated with both the SART and ANZARD data outputs received. The format in which the ANZARD data were provided, and the inconsistencies seen amongst cycle reporting in the SART dataset, restricted data interpretation. For example, both datasets did not provide a clear indication as to why women were undergoing OC and it was not possible to accurately calculate duration of storage for thaw cycles in the USA. We also did not obtain details on embryo quality from either database and acknowledge that embryo quality and subsequent outcome (embryo freezing or discard) would be of interest, especially when considering the efficacy of OC. WIDER IMPLICATIONS OF THE FINDINGS The data show that there is widespread demand for OC, and it is increasingly undertaken by younger women; however, the limitations encountered in the dataset support the need for a shift to a more uniform approach to data collection and presentation by large databases, worldwide. STUDY FUNDING/COMPETING INTEREST(S) This study received funding from the Fertility Society of Australia to support the ANZARD data extraction. M.J. is supported by an Australian Government Research Training Program Scholarship stipend. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Nadine M Richings
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | | | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Yee S, Lipton NJ, Fu V, Goodman CV, Librach C. Planned Oocyte Cryopreservation: Outcomes, Motivations, and Involvement of Primary Health Care Providers. J Womens Health (Larchmt) 2021; 31:285-292. [PMID: 34030468 DOI: 10.1089/jwh.2020.8888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: With improvements in oocyte cryopreservation and widespread delays in childbearing, planned oocyte cryopreservation (POC) has become an increasingly attractive option. This study aimed to (1) review POC cycle outcomes at an academic in vitro fertilization (IVF) center and (2) examine POC users' motivations for pursuing POC, fertility knowledge, and the involvement of their primary health care providers (PHP). Materials and Methods: POC cycle outcomes were collected from IVF records of the 224 women who underwent ≥1 cycle from 2012 to 2018. The 198 who were reachable by e-mail were invited to complete an online survey. The study was approved by the University of Toronto Research Ethics Board (No. 32951). Results: Mean age of the 224 women at first cycle was 36.4 (range: 25-42), with a significant decrease in anti-Müllerian hormone level (p = 0.001) and mean number of oocytes retrieved (p = 0.006) and cryopreserved per cycle (p = 0.042) with increasing age. From those invited for survey participation, 98 (49.5%) questionnaires were returned, with 86 evaluable. Majority of respondents were Caucasian (66%), single (93%), and earned a gross annual income of >$70,000 (74%). Strongest motivation for pursuing POC was concern about age-related fertility decline in the absence of a partner. Respondents' annual income was positively correlated with the number of completed cycles (p = 0.032). Half the respondents correctly identified age of onset of marked fertility decline as ≥35 years. In only 19% of cases was the conversation PHP initiated, and 29% never discussed POC with their PHP. Conclusions: More than 50% of women underwent POC at an age when fertility has begun to markedly decline. It is important for PHPs to identify and discuss POC with appropriate patients and offer accurate preliminary information and timely referrals for those interested in exploring this option.
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Affiliation(s)
- Samantha Yee
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Nechama J Lipton
- Research Department, CReATe Fertility Centre, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vivian Fu
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Carly V Goodman
- Research Department, CReATe Fertility Centre, Toronto, Canada
| | - Clifford Librach
- Research Department, CReATe Fertility Centre, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
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Chronopoulou E, Raperport C, Sfakianakis A, Srivastava G, Homburg R. Elective oocyte cryopreservation for age-related fertility decline. J Assist Reprod Genet 2021; 38:1177-1186. [PMID: 33608838 PMCID: PMC7894970 DOI: 10.1007/s10815-021-02072-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/11/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation. This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counselling. METHODS A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives. RESULTS Clinician-led counselling regarding reproductive aging and fertility preservation is often overlooked. Elective oocyte cryopreservation is not a guarantee of live birth, and the answer regarding cost-effectiveness needs to be individualized. The existing studies on obstetric and perinatal outcomes following the use of egg freezing are, until now, reassuring. Constant monitoring of short-term and long-term outcomes, uniform regulation and evidence-based, individualized counselling is of paramount importance. CONCLUSIONS Elective oocyte cryopreservation is one of the most controversial aspects of the world of assisted reproduction, and a lot of questions remain unanswered. However, women today do have this option which was not available in the past. Elective oocyte cryopreservation for age-related fertility decline should be incorporated in women's reproductive options to ensure informed decisions and reproductive autonomy.
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Affiliation(s)
- E Chronopoulou
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK.
| | - C Raperport
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
- Queen Mary University of London, Mile End Road, Bethnal Green, London, E1 4NS, UK
| | - A Sfakianakis
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - G Srivastava
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - R Homburg
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
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Yee S, Goodman CV, Fu V, Lipton NJ, Dviri M, Mashiach J, Librach CL. Assessing the quality of decision-making for planned oocyte cryopreservation. J Assist Reprod Genet 2021; 38:907-916. [PMID: 33575856 PMCID: PMC8079493 DOI: 10.1007/s10815-021-02103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This survey study aims to examine the quality of planned oocyte cryopreservation (POC) decision-making in the domains of decision change, decision difficulty, decision regret and informed choice. METHODS Of the 224 women who completed at least one POC cycle between 2012 and 2018 at a Canadian academic IVF centre, 198 were reachable by email for anonymous survey participation. RESULTS Ninety-eight questionnaires were returned (response rate 49.5%). Of these, 86 fully completed questionnaires were analyzed for this study. Eighty-eight percent of respondents stated that it was a 'good decision' to cryopreserve oocytes, in retrospect. Despite this, 31% found the decision-making process to be 'difficult'. Three in five (61%) would have made 'exactly the same' decision without any change, yet slightly over a third (35%) would have made a 'similar' decision, but with option-related changes and process-related changes. A negative correlation between 'decision regret' and 'informed choice' was found (p < .005). Those who stated that they would have made exactly the 'same' POC decision were found to have a significantly higher 'informed choice' score compared to others who would have made a 'similar' or 'completely different' decision, in retrospect (p < .001). Respondents with lesser 'decision regret' were significantly more likely to appraise their decision as a well-informed choice (p < .001). CONCLUSIONS Our findings show that high-quality POC decision-making is accompanied by the perception of being able to make an informed choice, which can be achieved by providing patients with adequate information and individualized counselling to help patients set realistic expectations of cycle outcomes.
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Affiliation(s)
- Samantha Yee
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada.
| | - Carly V Goodman
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
| | - Vivian Fu
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
| | - Nechama J Lipton
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Michal Dviri
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jordana Mashiach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Clifford L Librach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Gynecology, Women's College Hospital, Toronto, ON, Canada
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Blakemore JK, Grifo JA, DeVore SM, Hodes-Wertz B, Berkeley AS. Planned oocyte cryopreservation-10-15-year follow-up: return rates and cycle outcomes. Fertil Steril 2021; 115:1511-1520. [PMID: 33712289 DOI: 10.1016/j.fertnstert.2021.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the outcomes of planned oocyte cryopreservation patients most likely to have a final disposition. DESIGN Retrospective cohort study of all patients who underwent at least 1 cycle of planned oocyte cryopreservation between Jan 2005 and December 2009. SETTING Large urban University-affiliated fertility center PATIENT(S): All patients who underwent ≥1 cycle of planned oocyte cryopreservation in the study period. INTERVENTION(S) None MAIN OUTCOME MEASURE(S): Primary outcome was the disposition of oocytes at 10-15 years. Secondary outcomes included thaw/warming types, laboratory outcomes, and live birth rates. Outcomes and variables treated per patient. RESULT(S) A total of 231 patients with 280 cycles were included. The mean age at the first retrieval was 38.2 years (range 23-45). A total of 3,250 oocytes were retrieved, with an average of 10 metaphase II frozen/retrieval. To date, the oocytes of 88 patients (38.1%) have been thawed/warmed, 109 (47.2%) remain in storage, 27 (11.7%) have been discarded, and 7 (3.0%) have been transported elsewhere. The return rate (patients who thawed/warmed oocytes) was similar by Society for Assisted Reproductive Technology age group. The mean age of patients discarding oocytes was 47.4 years (range, 40-57). Of the 88 patients who thawed/warmed oocytes, the mean age at the time of thaw/warming was 43.9 years (range, 38-50) with a mean of 5.9 years frozen (range, 1-12). Nine patients (10.2%) thawed/warmed for secondary infertility. A total of 62.5% of patients created embryos with a partner, and 37.5% used donor sperm. On average, 14.3 oocytes were thawed/warmed per patient, with 74.2% survival (range, 0%-100%) and a mean fertilization rate of 68.8% of surviving oocytes. Of 88 patients, 39 (44.3%) planned a fresh embryo transfer (ET); 36 of 39 patients had at least 1 embryo for fresh ET, and 11 had a total of 14 infants. Forty-nine of 88 patients (55.7%) planned for preimplantation genetic testing for aneuploidy, with a mean of 4.2 embryos biopsied (range, 0-14) and a euploidy rate of 28.9%. Of the 49 patients, 17 (34.7%) had all aneuploidy or no embryos biopsied. Twenty-four patients underwent a total of 36 single euploid ET with 18 live births from 16 patients. Notably, 8 PGT-A patients had a euploid embryo but no ET, affecting the future cumulative pregnancy rate. Overall, 80 patients with thaw/warming embryos had a final outcome. Of these, 20 had nothing for ET (arrested/aneuploid), and of the 60 who had ≥1 ET, 27 had a total of 32 infants, with a live birth rate of 33.8% (27/80). CONCLUSION(S) We report the final outcomes of patients most likely to have returned, which is useful for patient counseling: a utilization rate of 38.1% and a no-use rate of 58.9%, similar across age groups. Further studies with larger cohorts as well as epidemiologic comparisons to patients currently cryopreserving are needed.
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Affiliation(s)
| | - James A Grifo
- New York University Langone Fertility Center, New York, New York
| | - Shannon M DeVore
- New York University Langone Fertility Center, New York, New York
| | | | - Alan S Berkeley
- New York University Langone Fertility Center, New York, New York
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Caughey LE, White KM. Psychosocial determinants of women's intentions and willingness to freeze their eggs. Fertil Steril 2021; 115:742-752. [PMID: 33478776 DOI: 10.1016/j.fertnstert.2020.09.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the psychosocial factors that influence Australian women's intentions to freeze their eggs. DESIGN Initially, a qualitative elicitation study followed by a larger-scale quantitative study. SETTING Both studies were conducted online. PATIENTS A total of 234 Australian women 25-43 years of age, who identifed as heterosexual, had no children, were open to the idea of having children, were currently not pregnant, and did not have a diagnosis of medical infertility. INTERVENTION None. MAIN OUTCOME MEASURE(S) Intentions and willingness of women to freeze their eggs. RESULT(S) Hierarchical multiple regression analyses showed that after accounting for demographic variables, there was strong support for the psychosocial predictors of attitude, pressure from others, and control perceptions as predictors of women's intentions to freeze their eggs. Of the additional variables, cognitive bias (influence of the media) was significant, and the final model accounted for 52.7% of variance in women's intentions to freeze their eggs. CONCLUSION(S) This study was the first to predict women's intentions to freeze their eggs using a well-established decision-making model, the theory of planned behavior. Messages designed to develop a positive attitude toward egg freezing, and to encourage an increased perception of personal control of the egg freezing process, as well as approval from others, could support women to investigate egg freezing, in consultation with appropriate medical advice, as an option when faced with possible future infertility. Effective strategies broaden fertility options for women faced with age-related fertility decline, maximize women's chances of a successful pregnancy, and, critically, prevent the often substantial psychological distress associated with involuntary childlessness.
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Affiliation(s)
- Lucy E Caughey
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, Queensland, Australia.
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, Queensland, Australia
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Ben-Nagi J, Kasaven LS, Jones BP, Saso S, Norris G, Green J, Petrie A, Odia R, Serhal P, Yasmin E. Oocyte yield in social, medical and donor oocyte cryopreservation cycles. HUM FERTIL 2020; 25:508-515. [PMID: 33272064 DOI: 10.1080/14647273.2020.1855369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To determine if oocyte yield in women undergoing cryopreservation for social (SOC), medical (MOC) and oocyte donation (OD) cycles is comparable when matched for age. 315 oocyte retrievals were performed for SOC, 116 for MOC and 392 for OD. Non-parametric Kruskal-Wallis tests and Poisson regression were used to assess the impact of age stratification. The median ages of women undergoing SOC, MOC, and OD were 38, 31 and 26 years respectively. The median (IQR) number of oocytes in the three categories was 7, 10, and 12. The oocyte yield was significantly higher in women aged 30-34 years undergoing SOC, compared to the MOC group. For the SOC group, age in years, oestradiol levels per 1000 pmol/and follicle count >12mm on the day of trigger were significant predictors of oocyte yield. Women embarking on SOC are significantly older than those undergoing MOC and OD, and thus oocyte yield is reduced when stratified for age. This study highlights the significant predictors of oocyte yield amongst women undergoing oocyte cryopreservation for specific indications. The findings can be used to optimise the yield and overall chance of successful livebirth.
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Affiliation(s)
- Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, London, UK
| | | | | | | | - Guy Norris
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College Hospital, London, UK
| | | | - Aviva Petrie
- Eastman Dental Institute, University College London, London, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, London, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, London, UK
| | - Ephia Yasmin
- Centre for Reproductive and Genetic Health, London, UK.,Reproductive Medicine Unit, University College Hospital, London, UK
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Chronopoulou E, Raperport C, Serhal P, Saab W, Seshadri S. Preconception tests at advanced maternal age. Best Pract Res Clin Obstet Gynaecol 2020; 70:28-50. [PMID: 33358154 DOI: 10.1016/j.bpobgyn.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
Pregnancies at an advanced reproductive age are increasingly common. However, the safety of pregnancy remains a concern as maternal age is a recognized independent factor for various obstetric complications. Also, age is a risk factor for most systematic health problems and older women are more likely to enter into pregnancy with pre-existing conditions. At the moment there is no separate, structured guidance on preconception tests at advanced maternal age. However, the preconceptual period offers an ideal window to recognize and address underlying health issues, social issues and harmful lifestyle behaviours in order to optimize maternal health ultimately reducing infertility, perinatal morbidity and mortality. Preconception tests should be clinically relevant aiming to identify risk factors and address them to predict and prevent infertility and pregnancy complications. The importance of preconception care is magnified for women of advanced age for whom the risks are higher and the potential benefits greater.
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Affiliation(s)
- Elpiniki Chronopoulou
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK.
| | - Claudia Raperport
- Homerton Fertility Centre, Homerton University Hospital, Homerton Row, Clapton, London, E9 6SR, UK
| | - Paul Serhal
- The Centre for Reproductive and Genetic Health (CRGH), 230-232 Great Portland St, Fitzrovia, London, W1W 5QS, UK
| | - Wael Saab
- The Centre for Reproductive and Genetic Health (CRGH), 230-232 Great Portland St, Fitzrovia, London, W1W 5QS, UK
| | - Srividya Seshadri
- The Centre for Reproductive and Genetic Health (CRGH), 230-232 Great Portland St, Fitzrovia, London, W1W 5QS, UK
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36
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Platts S, Trigg B, Bracewell-Milnes T, Jones BP, Saso S, Parikh J, Nicopoullos J, Almeida P, Norman-Taylor J, Nikolaou D, Johnson M, Thum MY. Exploring women's attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review. Acta Obstet Gynecol Scand 2020; 100:383-393. [PMID: 33078391 DOI: 10.1111/aogs.14030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/31/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Women are postponing childbearing and preventing age-related fertility decline with oocyte freezing for non-medical reasons (OFNMR). The objective of this systematic evaluation was to gain an understanding of women's attitudes and knowledge of, and intentions to use OFNMR among users of OFNMR and the general public. MATERIAL AND METHODS A systematic search of MEDLINE, EMBASE, and PyschINFO databases was undertaken, for studies that examined the psychosocial attitudes among women toward OFNMR. The search was limited to English language and no time restriction was set for publications. Extracted data were analyzed using thematic analysis and the study was performed according to PRISMA guidelines with prospective PROSPERO registration (CRD4201912578). RESULTS Overall, 35 studies met the inclusion criteria. Studies were broadly categorized into studies investigating users or potential users of OFNMR, and studies examining the views of members of the general public. Users of OFNMR have good knowledge of age-related fertility decline and awareness of the OFNMR procedure. Lack of partner was identified as the most common motivating factor to undertake OFNMR, with cost as a predominant concern. Knowledge among the general public of OFNMR is highly variable. Underestimation of age-related fertility decline is common among the general public. Intentions of women to use OFNMR also varied drastically between studies. CONCLUSIONS Women are predominantly motivated to freeze eggs by the lack of a suitable partner, but cost is a significant barrier. Increasing the number of women pursuing OFNMR at an earlier stage may positively impact upon the risk of future involuntary childlessness. Better information should be made available to both women and men about their fertility and options to inform their reproductive decision-making.
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Affiliation(s)
- Sophie Platts
- Women's Health Department, University College Hospital, London, UK
| | | | | | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
| | | | | | - Paula Almeida
- Chelsea and Westminster Hospital, Assisted Conception Unit, London, UK
| | | | | | - Mark Johnson
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
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Yee S, Goodman CV, Fu V, Lipton NJ, Librach CL. Parenthood desire, childbearing plans and oocyte utilization among women who previously underwent planned oocyte cryopreservation. Reprod Biomed Online 2020; 42:442-450. [PMID: 33246804 DOI: 10.1016/j.rbmo.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION To examine the motivations, life circumstances and parenthood aspirations of a cohort of women who underwent planned oocyte cryopreservation (POC) at a Canadian academic IVF centre. DESIGN A single-site, cross-sectional, anonymous quantitative study using a study-specific questionnaire administrated via SurveyMonkey®. Of the 224 women who completed at least one POC cycle between 2012 and 2018, 198 were reached by email and invited to participate. RESULTS Of the 98 (49.5%) questionnaires returned, 86 were fully completed and were analysed. Mean age at first POC cycle was 35.7 ± 2.4 (range 27-43) and at survey was 37.7 ± 2.5 years. At POC, 77% were single and 97.7% childless. At survey, 96% had not attempted to use their cryopreserved oocytes, yet 26 (30%) had tried natural conception or fertility treatments. Of these, three conceived naturally and two by assisted reproduction. Eighty-five per cent expressed a strong motherhood desire and 67.1% indicated that usage of their cryopreserved oocytes was mostly contingent on relationship status. Many expressed a desire for shared genetic parenthood within a committed relationship. Forty-seven per cent did not want to carry a pregnancy beyond the age of 46. CONCLUSION The findings of this study confirm the central role of age and relationship status in influencing women's POC decisions and oocyte utilization plans. The late age at POC could be explained by women using it toward the end of their peak reproductive years to leverage their remaining chances of genetic motherhood. Surveying women at later points following POC would help to gain a more comprehensive picture of their oocyte utilization and disposition plans.
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Affiliation(s)
| | | | - Vivian Fu
- CReATe Fertility Centre, Toronto, Canada
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, Canada
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Jones B, Rajamanoharan A, Kasaven L, Jalmbrant M, Green J, Mahmoud M, Odia R, Saso S, Serhal P, Ben Nagi J. The novel use of fertility quality of life (FertiQoL) treatment subscale to assess treatment acceptability in social egg freezing. HUM FERTIL 2020; 25:447-455. [PMID: 32883118 DOI: 10.1080/14647273.2020.1815242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This is the first study to assess the impact of social egg freezing (SEF) on quality of life. This cross-sectional survey utilised the FertiQoL treatment module in women who underwent SEF between January 2008 and October 2019 (n = 94). The mean treatment score was 65.5, whereas the tolerability and environment scores were 62.4 and 68 respectively. Being married or in a relationship was associated with higher, albeit not statistically significant, scores (69.2) when compared to single women (66.3; p = 0.49). However, being separated or divorced was associated with significantly worse scores compared to married women, women in a relationship and single women (43.3 vs. 67.0; p = 0.001). There were no significant differences in scores between younger and older women, low and high number of oocytes stored, duration of stimulation cycles, or in those who had single or multiple cycles. These data suggest SEF is largely tolerable, with favourable FertiQoL scores compared to infertile women undergoing IVF. However, whilst such women are physiologically fertile, their situation renders them socially infertile. As such, women undergoing SEF should be identified as a population that requires additional support, who should be offered extensive counselling, active monitoring throughout the process and additional support if required.
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Affiliation(s)
- Benjamin Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abirami Rajamanoharan
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Lorraine Kasaven
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Maria Jalmbrant
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Joy Green
- Centre for Reproductive and Genetic Health, London, UK
| | - Makki Mahmoud
- Centre for Reproductive and Genetic Health, London, UK
| | - Rabi Odia
- Centre for Reproductive and Genetic Health, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, London, UK
| | - Jara Ben Nagi
- Centre for Reproductive and Genetic Health, London, UK
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