Attitude towards ovarian tissue and oocyte cryopreservation for non-medical reasons: a cross-sectional study

Acceptance rates and reasons for social oocyte cryopreservation among women: systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to determine the acceptance rates and reasons for social oocyte cryopreservation (SOC) in the general population (subgroup 1) and healthcare professionals/students (subgroup 2) according to the current literature. Relevant studies published between 2007 and Sept 2023 were identified from electronic databases, including PubMed, EBSCO MEDLINE Complete, Web of Science, Science Direct, Scopus, and CINAHL. Quantitative studies reporting women's acceptance rates and reasons for social oocyte cryopreservation were eligible. A total of 20 quantitative studies were included in this process. Meta-analyses were conducted using random-effects models to evaluate study effect sizes. A total of 20 articles were analyzed. While the acceptance rate of SOC women in the general population was 56.5% (95% CI = 47.8-64.9%; τ2 = 0.98, df = 20; p < 0.001), this rate was between 42 and 66% in female healthcare professionals/students (p > 0.05; I2 = 98.46%; df = 20; p < 0.001). Among the acceptable reasons for SOC, cost-recovery (67.9%, 95% CI = 58-76%, I2 = 97.88%, τ2 = 0.95, df = 6; p < 0.001) and inability to find a suitable partner (45.7%, 95% CI = 32.6-59.5%; I2 = 97.96%, df = 10; p < 0.001) stand out. Acceptance rates did not differ significantly between the general population and healthcare professionals/students' inability to find a suitable partner (p > 0.05). The meta-analysis shows that more than half of women accept SOC, with the acceptance rate increasing in the absence of a partner and if the cost is affordable.Trial registration CRD42023455656.

Who freezes her eggs and why? psychological predictors, reasons, and outcomes of social egg freezing

BACKGROUND

Despite the growing use of social egg freezing (SEF), research focusing on its psychological aspects is lacking. This study aimed to investigate possible psychological predictors, reasons, and outcomes of SEF in German-speaking countries.

METHODS

The cross-sectional study included 1,131 women (average age 31 years) who had never used medical egg freezing. The participants were at different stages of SEF decision-making: women who cannot imagine using SEF (SEF-non-use), women who can imagine using SEF (SEF-possible-use), women who plan to use SEF (SEF-planned-use), women who have used SEF (SEF-use), and women who have used their oocytes frozen during SEF for assisted reproduction (SEF + ART-use). Data on sociodemographic and psychological characteristics, attitudes towards motherhood, well-being, and reasons for SEF were assessed. We used multinomial logistic regression to identify predictors of SEF decision-making stages, principal components analysis to examine motives for SEF, and multiple linear regression to analyze associations between motives and psychological variables.

RESULTS

The probability of belonging to the SEF-use group rather than SEF-non-use was higher among childless single women with tertiary education, high levels of employment, and high importance placed on the genetic relationship to the child, and rose with increasing age and importance of motherhood. The probability of belonging to the SEF-use group rather than SEF-planned-use was higher among childless women with a high importance placed on the genetic relationship to the child, and increased with age. The probability of belonging to the SEF + ART-use group rather than SEF-use depended mainly on the presence of infertility. The women froze eggs mainly to gain time to fulfill their desire for conventional parenthood (59%), including finding the right partner and enabling a genetic relationship to the child. Using SEF to actively shape one's life and family planning was rather associated with positive psychological outcomes, whereas relying on SEF in the hope of personal and societal changes (e.g. improving fertility) was associated with negative outcomes.

CONCLUSION

SEF users might be characterized as mainly single, career-oriented, and greatly valuing genetic motherhood. As the motives for SEF, rather than its use per se, might be linked to psychological variables, these should be considered when counseling and supporting women.

Awareness and attitude toward oocyte cryopreservation for non-medical reasons: a study on women candidates for social egg freezing

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.

Exploring women's attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review

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.

Oocyte or ovarian tissue banking: decision-making in women aged 35 years or older facing age-related fertility decline

RESEARCH QUESTION

Women who face age-related fertility decline have the option to safeguard future reproductive potential by banking oocytes or ovarian tissue. What are the methods that women prefer and what factors are important in their decision-making?

DESIGN

Qualitative interview study, participants were recruited through monthly information sessions at a university hospital on oocyte banking, postings on social media, websites and newsletters and snowball sampling. Women had to be aged 35 years or older, single, childless and with a possible future desire for motherhood. Key concepts of the Health Belief Model were used as framework for the analyses.

RESULTS

In total, 15 women participated in this qualitative study. For oocyte banking, they mentioned chances of success, extra time and faith in the technique and healthcare professionals as benefits. Risks for themselves or future children and costs were considered to be barriers in decision making. For ovarian tissue banking, the chances of success, the possibility of natural conception, the time investment and effect on menopausal symptoms were seen as benefits, and lack of experience and lack of information were considered barriers for themselves or their future children. Overall, they considered the procedures involved in oocyte banking as relatively 'easy', whereas ovarian tissue banking was seen as a more invasive procedure.

CONCLUSION

Most women preferred oocyte banking over ovarian tissue banking because of its relative convenience. Future quantitative research in a larger cohort is necessary to confirm the findings and provide more insight into the relative importance of the different factors influencing women's decision.

Stepped vitrification technique for human ovarian tissue cryopreservation

The advantage of stepped vitrification (SV) is avoiding ice crystal nucleation, while decreasing the toxic effects of high cryoprotectant concentrations. We aimed to test this method for human ovarian tissue cryopreservation. Ovarian cortex was taken from 7 fertile adult women. Samples were subjected to an SV protocol performed in an automatic freezer, which allowed sample transfer to ever higher concentrations of dimethyl sulfoxide (DMSO) as the temperature was reduced. Histological evaluation of the vitrified-warmed tissue showed large numbers of degenerated follicles after 24 hours of in vitro culture. We therefore evaluated DMSO perfusion rates by X-ray computed tomography, ice crystal formation by freeze-substitution, and cell toxicity by transmission electron microscopy, seeking possible reasons why follicles degenerated. Although cryoprotectant perfusion was considered normal and no ice crystals were formed in the tissue, ultrastructural analysis detected typical signs of DMSO toxicity, such as mitochondria degeneration, alterations in chromatin condensation, cell vacuolization and extracellular matrix swelling in both stromal and follicular cells. The findings indicated that the method failed to preserve follicles due to the high concentrations of DMSO used. However, adaptations can be made to avoid toxicity to follicles caused by elevated levels of cryoprotectants.