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Maor M, Billig M. Women Who Perform Social Egg Freezing as Moral Pioneers: The Case of Ultra-Orthodox Communities in Israel. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02062-z. [PMID: 38782858 DOI: 10.1007/s10943-024-02062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Social egg freezing (SEF) is a new reproductive technology that is increasingly used within ultra-Orthodox Jewish communities, stirring tensions between tradition and modernity. Based on in-depth semi-structured interviews, this study examined how ultra-Orthodox singles who employ SEF engage in social negotiations over gender- and body-related norms. Findings show that participants successfully assimilated SEF by establishing facts on the ground and discreetly spreading information while actively avoiding tensions that may threaten religious tradition. SEF did not push participants into modern individualism or dissolve their strong connection to the community. However they did modify social boundaries and articulated social criticism.
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Affiliation(s)
- Maya Maor
- Department of Sociology and Anthropology, Ariel University, Ariel, Israel.
| | - Miriam Billig
- Department of Sociology and Anthropology, Ariel University, Ariel, Israel
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Wang H. Single women's access to egg freezing in mainland China: an ethicolegal analysis. JOURNAL OF MEDICAL ETHICS 2023; 50:50-56. [PMID: 37147115 DOI: 10.1136/jme-2023-108915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
In the name of safeguarding public interests and ethical principles, China's National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women's reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women's reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women's well-being paternalistically and partly to implement the central government's policies to boost the birthrate and maintain traditional family structures. While the government's concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women's egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority's assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children 'at a proper age', and that egg freezing by single women offends China's public moralities have not been substantiated.
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Affiliation(s)
- Hao Wang
- Shen Junru Law School, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Cascante SD, Berkeley AS, Licciardi F, McCaffrey C, Grifo JA. Planned oocyte cryopreservation: the state of the ART. Reprod Biomed Online 2023; 47:103367. [PMID: 37804606 DOI: 10.1016/j.rbmo.2023.103367] [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: 05/31/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 10/09/2023]
Abstract
The objective of this review is to provide an update on planned oocyte cryopreservation. This fertility preservation method increases reproductive autonomy by allowing women to postpone childbearing whilst maintaining the option of having a biological child. Oocyte cryopreservation is no longer considered experimental, and its use has increased dramatically in recent years as more women delay childbearing for personal, professional and financial reasons. Despite increased usage, most patients who have undergone oocyte cryopreservation have not yet warmed their oocytes. Most women who cryopreserve oocytes wait years to use them, and many never use them. Studies have demonstrated that oocyte cryopreservation results in live birth rates comparable with IVF treatment using fresh oocytes, and does not pose additional safety risks to offspring. Based on current evidence, cryopreserving ≥20 mature oocytes at <38 years of age provides a 70% chance of one live birth. However, larger studies from a variety of geographic locations and centre types are needed to confirm these findings. Additional research is also needed to determine the recommended age for oocyte cryopreservation, recommended number of oocytes to cryopreserve, return and discard/non-use rates, cost-effectiveness, and how best to distribute accurate and up-to-date information to potential patients.
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Affiliation(s)
- Sarah Druckenmiller Cascante
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA.
| | - Alan S Berkeley
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - Frederick Licciardi
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - Caroline McCaffrey
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
| | - James A Grifo
- New York University Langone Prelude Fertility Center, 159 East 53(rd) Street, 3(rd) Floor, New York, NY 10022, USA
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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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6
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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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Chin AHB, Sandhu S, Caughey L, Ahmad MF, Peate M. Systematic protocol and methodology needed for pre-procedure counselling of elective egg freezing patients in Singapore. HUM FERTIL 2023:1-13. [PMID: 37177817 DOI: 10.1080/14647273.2023.2209831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Upon legalization of social egg freezing in Singapore from 2023 onwards, compulsory pre-procedure counselling is mandated for all prospective patients to enable informed choice about whether to undergo the procedure. Being a newly introduced medical procedure in Singapore, there are currently no clear directives on what pre-procedure counselling for elective egg freezing should entail. Due to pervasive media and internet influences, prospective egg freezing patients could be misled into believing that the procedure represents a guaranteed path to future motherhood, contrary to statements by professional bodies such as the American Society for Reproductive Medicine (ASRM) and the British Fertility Society (BFS). Hence, comprehensive counselling is recommended to provide women with evidence-based information (e.g. success rates of social egg freezing for women of their age) to ensure they make informed decisions and to avoid possible decision regret. For this purpose, a systematic protocol and methodology for pre-procedure counselling of women considering elective egg freezing was developed, incorporating flowcharts and decision trees that are specifically tailored to the unique sociocultural values and legal restrictions in Singapore. Questions relating to the why, what, how, where and when of the egg freezing procedure should be addressed, which could serve as a roadmap to facilitate informed decision-making by women considering elective egg freezing.
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Affiliation(s)
| | - Sherine Sandhu
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy Caughey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Mohd Faizal Ahmad
- Advanced Reproductive Centre (ARC), Department of Obstetrics & Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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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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9
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Pérez-Hernández Y. Exploring Medical Egg Freezing as a Disease Management Strategy. Med Anthropol 2023; 42:136-148. [PMID: 36745574 DOI: 10.1080/01459740.2023.2174022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical egg freezing (MEF) allows women with fertility-threatening diseases to have their oocytes cryopreserved and stored for later use. Endometriosis is a common gynecological disease that might cause infertility. Qualitative research on endometriosis patients' experiences with MEF is minimal. I report on in-depth interviews among French endometriosis patients undertaking MEF. Their experiences are profoundly shaped by endometriosis-related pain. Egg freezing was described as a disease management strategy to cope with potential future infertility integral to their commitment to motherhood. Singlehood was a determining element for agreeing to undertake a physically and psychologically costly "additional" medical intervention.
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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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Rosenkjær D, Skytte AB, Kroløkke C. Investigation of motivations for depositing sperm during the COVID-19 pandemic. HUM FERTIL 2022:1-7. [DOI: 10.1080/14647273.2022.2142857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel Rosenkjær
- Cryos International Sperm and Egg bank, Vesterbro Torv 3, Aarhus C, Denmark
| | - Anne-Bine Skytte
- Cryos International Sperm and Egg bank, Vesterbro Torv 3, Aarhus C, Denmark
| | - Charlotte Kroløkke
- Department for the Study of Culture, University of Southern Denmark, Odense M, Denmark
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Kaplan A, Hashiloni-Dolev Y, Kroløkke C. 'My choice, my responsibility': views of Danish and Israeli female students on financing egg-freezing. CULTURE, HEALTH & SEXUALITY 2022; 24:1575-1589. [PMID: 34727003 DOI: 10.1080/13691058.2021.1981454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Over the past decade, egg freezing has evolved from being an experimental medical technology to become a commercial enterprise, accompanied by heated feminist debate. This study examined the views of Danish and Israeli female students regarding the financing of social egg freezing (SEF) (self, state, employer or family), and their correlation with country and feminist identity. A total of 569 female students (283 from Denmark and 286 from Israel) completed a questionnaire composed of closed and opened-ended questions on SEF financing under different circumstances (e.g. career advancement, lack of a partner, lack of money). The majority of female students in both countries supported SEF self-financing. They wanted to keep fertility choices in the private domain, in part by separating the bodies of women from the state and the employer. We conclude that SEF exemplifies a neoliberal and gendered responsibilisation of women's reproductive futurity, yet self-identification as a feminist was found to be correlated with stronger support for state financing. In contrast, we found no correlation between feminist identity and support for company-sponsored egg freezing. Our findings suggest a relationship between holding a feminist worldview and public policy preferences.
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Affiliation(s)
- Amit Kaplan
- School of Government and Society, The Academic College of Tel Aviv-Yaffo, Yaffo, Israel
| | - Yael Hashiloni-Dolev
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beersheva, Israel
| | - Charlotte Kroløkke
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
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Planned Oocyte Cryopreservation and the Black Obstetrician Gynecologist: Utilization and Perspectives. Reprod Sci 2022; 29:2060-2066. [PMID: 35349117 DOI: 10.1007/s43032-022-00914-1] [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: 12/06/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
The objective of this study was to describe the opinions and attitudes toward planned oocyte cryopreservation (POC) among Black Obstetrician Gynecologists (BOG) and their experiences in counseling patients of color. A web-based, cross-sectional survey was distributed to BOGs. The survey consisted of questions pertaining to personal family building goals, fertility preservation, education and patient counseling experiences regarding POC. Of the 136 potential participants, the response rate was 50% (n = 68). Sixty-six percent of respondents felt the need to postpone childbearing due to medical training and 19% had already undergone POC or planned to in the future. A majority (70%) felt that all women planning to undergo medical training should consider POC, and a subgroup analysis showed this was more likely to be reported within BOG trainees (p < 0.01). Fifty-seven percent received education on POC and 25% felt "very comfortable" counseling patients on POC. Those age < 35 years were more likely to feel the need to postpone family building due to their medical training (p < 0.01). Generalist attendings who had not undergone POC were significantly more likely to report regret, compared to subspecialists (p < 0.03). Medical careers may have an unfavorable impact on family building, and our results highlight this effect in Black women. A better understanding of the mitigating factors is needed to develop culturally appropriate counseling and educational interventions for Black women and other women of color.
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Johnston M, Fuscaldo G, Gwini SM, Catt S, Richings NM. Financing future fertility: Women's views on funding egg freezing. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:32-41. [PMID: 34693043 PMCID: PMC8517713 DOI: 10.1016/j.rbms.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23-37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.
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Affiliation(s)
- Molly Johnston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Bioethics Centre, Monash University, Clayton, Australia
| | - Giuliana Fuscaldo
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Stella May Gwini
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Catt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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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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Shih LW, Schrøder TH. Enacting up: using drawing as a method/ology to explore Taiwanese pregnant women’s experiences of prenatal screening and testing. FEMINIST THEORY 2022. [DOI: 10.1177/14647001211062733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Through studying pregnant women’s experience of prenatal screening and testing in Taiwan, this article argues that the collection of participant drawings provides a valuable contribution to feminist methodology where participants are seen as knowledgeable about their own situation. Drawings offer a context that enables us to analyse how participants (pregnant women and their partners) situated themselves in relation to their foetuses, technologies and families. This approach taught us an important methodological lesson, namely that methods always embody a particular political and epistemological location. Inspired by this line of thought, we suggest the concept enacting up, which combines the idea of enacting and the expression acting up to challenge scientific objectivity and biomedical practice while simultaneously giving voice to our participants.
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Awareness, Intentions, and Attitudes Toward Planned Oocyte Cryopreservation Among Female Medical Staff. Reprod Biomed Online 2022; 44:1169-1176. [DOI: 10.1016/j.rbmo.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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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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Hashemzadeh M, Shariati M, Mohammad Nazari A, Keramat A. Childbearing intention and its associated factors: A systematic review. Nurs Open 2021; 8:2354-2368. [PMID: 33705606 PMCID: PMC8363403 DOI: 10.1002/nop2.849] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 01/29/2023] Open
Abstract
AIM This study aimed to provide comprehensive information about the core determinants of fertility intentions. DESIGN Systematic review. METHODS Ovid, MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, SCOPUS and GOOGLE SCHOLAR were searched for the relevant articles published from 1946-December 2017. We updated our records by searching three computerized databases (Ovid MEDLINE, SCOPUS and WOS) from 2018-January 2021. RESULTS 53 studies included in the qualitative synthesis. The results of some studies indicated the impact of demographic factors, physical and psychological health, happiness and child desire. The most frequent variables in a couple's mesosystem were marital status, parity, partnership satisfaction and gender role attitude. The mesosystem of childbearing intention also included family and peers network. The EXEO system of the ECSM includes certain variables, such as job characteristics, urban residence, housing condition. The macrosystem comprises cultural and societal principles with broader influences on the couple's system.
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Affiliation(s)
- Mozhgan Hashemzadeh
- Student Research CommitteeSchool of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Mohammad Shariati
- Department of Community MedicineTehran University of Medical SciencesTehranIran
| | - Ali Mohammad Nazari
- School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences ResearchShahroud University of Medical SciencesShahroudIran
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20
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Social Freezing: Pressing Pause on Fertility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158088. [PMID: 34360381 PMCID: PMC8345795 DOI: 10.3390/ijerph18158088] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
Increasing numbers of women are undergoing oocyte or tissue cryopreservation for medical or social reasons to increase their chances of having genetic children. Social egg freezing (SEF) allows women to preserve their fertility in anticipation of age-related fertility decline and ineffective fertility treatments at older ages. The purpose of this study was to summarize recent findings focusing on the challenges of elective egg freezing. We performed a systematic literature review on social egg freezing published during the last ten years. From the systematically screened literature, we identified and analyzed five main topics of interest during the last decade: (a) different fertility preservation techniques, (b) safety of freezing, (c) usage rate of frozen oocytes, (d) ethical considerations, and (e) cost-effectiveness of SEF. Fertility can be preserved for non-medical reasons through oocyte, embryos, or ovarian tissue cryopreservation, with oocyte vitrification being a new and optimal approach. Elective oocyte cryopreservation is better accepted, supports social gender equality, and enhances women's reproductive autonomy. Despite controversies, planned oocyte cryopreservation appears as a chosen strategy against age-related infertility and may allow women to feel that they are more socially, psychologically, and financially stable before motherhood.
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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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Cobo A, García-Velasco JA, Remohí J, Pellicer A. Oocyte vitrification for fertility preservation for both medical and nonmedical reasons. Fertil Steril 2021; 115:1091-1101. [DOI: 10.1016/j.fertnstert.2021.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
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23
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Pennings G. Elective egg freezing and women's emancipation. Reprod Biomed Online 2021; 42:1053-1055. [PMID: 33931374 DOI: 10.1016/j.rbmo.2021.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/01/2022]
Abstract
All studies show that the primary reason for women to consider elective egg freezing (EEF) is the lack of a partner. The first question then is where this shortage comes from and how it can be remedied. The main cause of the 'lack of partner' issue for highly educated women (the group most involved in elective egg freezing) is the reversed gender gap in education. It is concluded that EEF may increase individual reproductive autonomy but does not increase reproductive freedom for the group of highly educated women. Regardless of how many women freeze their eggs, a large number of educated women will eventually have to choose between going it alone as a single mother or looking for another life goal. Finally, some possible policy measures are proposed to reduce the gender gap and thus remove the real cause of the problem.
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Affiliation(s)
- Guido Pennings
- Bioethics Institute Ghent (BIG), Ghent University, Department of Philosophy and Moral Science, Gent, Belgium.
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24
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Birenbaum-Carmeli D, Inhorn MC, Vale MD, Patrizio P. Cryopreserving Jewish Motherhood: Egg Freezing in Israel and the United States. Med Anthropol Q 2021; 35:346-363. [PMID: 33813742 DOI: 10.1111/maq.12643] [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: 10/25/2020] [Revised: 01/16/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
Oocyte cryopreservation (i.e., egg freezing) is one of the newest forms of assisted reproduction and is increasingly being used primarily by two groups of women: (1) young cancer patients at risk of losing their fertility through cytotoxic chemotherapy (i.e., medical egg freezing); and (2) single professionals in their late 30s who are facing age-related fertility decline in the absence of reproductive partners (i.e., elective egg freezing). Based on a binational ethnographic study, this article examines the significance of egg freezing among Jewish women in Israel and the United States. As they face the Jewish maternal imperative, these women are turning to egg freezing to relieve both medical and marital uncertainties. In both secular and religious Jewish contexts, egg freezing is now becoming naturalized as acceptable and desirable precisely because it cryopreserves Jewish motherhood, keeping reproductive options open for Jewish women, and serving as a protective self-preservation technology within their pronatalist social environments.
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Affiliation(s)
| | | | - Mira D Vale
- Department of Sociology, University of Michigan
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25
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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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Gürtin ZB, Tiemann E. The marketing of elective egg freezing: A content, cost and quality analysis of UK fertility clinic websites. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 12:56-68. [PMID: 33336090 PMCID: PMC7732876 DOI: 10.1016/j.rbms.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/17/2020] [Accepted: 10/22/2020] [Indexed: 05/23/2023]
Abstract
To the authors' knowledge, this is the first UK-based study to analyse the marketing of elective egg freezing (EEF) by fertility clinics. Analyses were based on the websites of the top 15 UK clinics, which together provided 87.8% of all egg freezing cycles in the UK between 2008 and 2017 inclusive. The analyses included three phases: content analysis; systematic cost analysis and comparison; and quality analysis examining the information available on egg freezing and its adherence to the guidelines of the Human Fertilisation and Embryology Authority (HFEA). The results show that clinics frame EEF according to four main themes: as a new and exciting technology; as a solution to (a modern woman's) life circumstances; as a means to gain control, freedom and more reproductive options; and as a means to avoid the reproductive risks of ageing. This study also found that most clinics are not sufficiently clear and transparent about the 'true' cost of an EEF cycle, present an unbalanced view of EEF, and do not provide satisfactory data or information. Most importantly, none of the clinics adhere adequately to the HFEA guidelines regarding advertising and the provision of information. As the EEF market continues to grow, offered exclusively by private clinics, these findings require urgent attention. Clinics must improve the type and quality of EEF information on their websites such that potential patients can make informed choices, and this article provides 10 basic criteria which can be used as a checklist. It is suggested that the time may have come to grant greater economic regulatory powers to HFEA to avoid overcommercialization of the fertility industry.
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Affiliation(s)
- Zeynep B. Gürtin
- EGA Institute for Women’s Health, University College London, London, UK
| | - Emily Tiemann
- EGA Institute for Women’s Health, University College London, London, UK
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28
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Kostenzer J, Bos AM, Bont AD, Exel JV. Unveiling the controversy on egg freezing in The Netherlands: A Q-methodology study on women's viewpoints. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 12:32-43. [PMID: 33319082 PMCID: PMC7726258 DOI: 10.1016/j.rbms.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/17/2020] [Accepted: 09/29/2020] [Indexed: 06/01/2023]
Abstract
Preserving the option to conceive through egg freezing (oocyte cryopreservation) is surrounded by value conflicts and diverse viewpoints, particularly when non-medical or so-called 'social' reasons are involved. The debate is controversial and shaped by normative perceptions of the life course, including concepts regarding reproductive ageing, gender, motherhood and biomedicalization. To unravel the controversy and systematically identify the variety of viewpoints on egg freezing, a Q-methodology study was conducted in The Netherlands between December 2018 and October 2019. Thirty-four women of reproductive age participated in the study. They ranked 40 statements according to their level of agreement, and explained their ranking during follow-up interviews. Data were analysed using by-person factor analysis and interpreted using both quantitative and qualitative data. Four viewpoints, of which the fourth was bipolar, were identified: (1) cautious about egg freezing technology; (2) my body, my choice; (3) egg freezing is unnatural; and (4) have children and have them early. The distinct viewpoints illustrate different prioritizations of values and normative dimensions of biomedical innovations. By knowing more about the prevalent opinions on egg freezing and the surrounding controversy, policy makers and practitioners can make better informed decisions in terms of promoting and providing patient-centred infertility care. The findings furthermore stimulate continuing scholarly work on egg freezing and other innovations in reproductive medicine which may continue to disrupt normative standards.
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Affiliation(s)
- Johanna Kostenzer
- Erasmus University Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Annelies M.E. Bos
- University Medical Centre Utrecht, Department of Reproductive Medicine and Gynaecology, Utrecht, the Netherlands
| | - Antoinette de Bont
- Erasmus University Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Job van Exel
- Erasmus University Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, the Netherlands
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29
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Kostenzer J, de Bont A, van Exel J. Women's viewpoints on egg freezing in Austria: an online Q-methodology study. BMC Med Ethics 2021; 22:4. [PMID: 33407392 PMCID: PMC7789674 DOI: 10.1186/s12910-020-00571-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background Egg freezing has emerged as a technology of assisted reproductive medicine that allows women to plan for the anticipated loss of fertility and hence to preserve the option to conceive with their own eggs. The technology is surrounded by value-conflicts and is subject to ongoing discussions. This study aims at contributing to the empirical-ethical debate by exploring women’s viewpoints on egg freezing in Austria,
where egg freezing for social reasons is currently not allowed. Methods Q-methodology was used to identify prevailing viewpoints on egg freezing. 46 female participants ranked a set of 40 statements onto a 9-column forced choice ranking grid according to the level of agreement. Participants were asked to explain their ranking in a follow-up survey. By-person factor analysis was used to identify distinct viewpoints which were interpreted using both the quantitative and the qualitative data. Results Three distinct viewpoints were identified: (1) “women should decide for themselves”, (2) “we should accept nature but change policy”, and (3) “we need an informed societal debate”. These viewpoints provide insights into how biomedical innovations such as egg freezing are perceived by women in Austria and illustrate the normative tensions regarding such innovations. Conclusions Acknowledging the different prioritizations of values regarding assisted reproductive technologies is important to better understand the underlying normative tensions in a country where egg freezing for social reasons is currently not allowed. The study adds new empirical insights to the ongoing debate by outlining and discussing viewpoints of those directly affected: women. Following up on the lay persons perspective is particularly important in the context of future biomedical innovations that may challenge established norms and create new tensions. It therefore also adds to the societal debate and supports evidence-informed policy making in that regard.
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Affiliation(s)
- Johanna Kostenzer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Antoinette de Bont
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Johnston M, Fuscaldo G, Richings NM, Gwini S, Catt S. Cracked open: exploring attitudes on access to egg freezing. Sex Reprod Health Matters 2020; 28:1758441. [PMID: 32458753 PMCID: PMC7887973 DOI: 10.1080/26410397.2020.1758441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Egg freezing (EF) technology has improved significantly over the last decade, giving women more choice over their reproductive futures. Despite this advance, EF brings forth contentious ethical and regulatory issues. Policies controlling access to EF vary around the world and there is a lack of consensus about who should have access and what criteria are relevant in making these decisions. This study aimed to identify views of women about access to EF for both "medical" and "non-medical" risks to infertility. An online survey was administered to women aged between 18 and 60 years in Victoria, Australia between April and May 2018. A total of 1,066 individuals initiated the survey. The median age of the participants was 28 years and 81% were <40 years old. Almost all participants (98%) supported access to medical EF in situations where treatments (e.g. chemotherapy) or illnesses threaten fertility. Support for access to EF for non-medical indications was lower; 75% supported EF for "lack of suitable partner", followed by "financial insecurity to raise a child" (72%) and "career/educational advancement" (65%). Older respondents (aged ≥40 years) were less likely than their younger counterparts to support all indications for non-medical EF. Our findings indicate broad support for EF. However, the variation in support between indications for non-medical EF suggests that individuals do not think about access to EF simply in terms of medical necessity. To reflect public views, future policy may need to consider access to EF beyond the medical/non-medical distinction.
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Affiliation(s)
- Molly Johnston
- PhD candidate, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia, 3168
| | - Giuliana Fuscaldo
- Associate Professor, Eastern Health Clinical School, Monash University, Box Hill, Australia; University Hospital Geelong, Australia
| | - Nadine Maree Richings
- Teaching Associate, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - StellaMay Gwini
- Adjunct Lecturer, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; University Hospital Geelong, Australia; Centre for Innovation in Mental and Physical Health and Clinical Treatment (IMPACT), School of Medicine, Deakin University, Geelong, Australia
| | - Sally Catt
- Senior Lecturer, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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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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Inhorn MC. Reprint: Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:110-121. [PMID: 34136666 PMCID: PMC8178439 DOI: 10.1016/j.rbms.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/10/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Inhorn MC, Yu R, Patrizio P. Upholding Success: Asian Americans, Egg Freezing, and the Fertility Paradox. Med Anthropol 2020; 40:3-19. [PMID: 33074721 DOI: 10.1080/01459740.2020.1825415] [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
Asian American women are turning to oocyte cryopreservation (egg freezing) at rates higher than would be expected, given that Asian Americans make up less than six percent of the total United States population. Based on ethnographic interviews with 23 women of East, Southeast, and South Asian ancestry, we examine the "fertility paradox" faced by highly educated Asian American professional women. Despite achieving multiple "pillars of success," these women have difficulty finding educated partners with whom to pursue childbearing. Egg freezing offers feelings of empowerment and relief from pressure for Asian American women, holding open the possibility of future biogenetic motherhood.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology and MacMillan Center for International and Area Studies, Yale University
| | - Ruoxi Yu
- School of Medicine, Johns Hopkins University
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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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Miner SA, Miller WK, Grady C, Berkman BE. "It's Just Another Added Benefit": Women's Experiences with Employment-Based Egg Freezing Programs. AJOB Empir Bioeth 2020; 12:41-52. [PMID: 32990510 DOI: 10.1080/23294515.2020.1823908] [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: 01/20/2023]
Abstract
BACKGROUND In 2014, companies began covering the costs of egg freezing for their employees. The adoption of this benefit was highly contentious. Some argued that it offered women more reproductive autonomy, buying time to succeed in their careers and postpone childbearing. Others suggested this benefit might place inappropriate pressure on women, unduly influencing them to freeze their eggs to prioritize their career over reproduction. Although ethical problems with this benefit have been explored, there has not been research analyzing the perspectives of women working for companies that offer employer-based egg freezing. Furthermore, existing empirical studies often focus on the experiences of egg freezers rather than the young women thinking about, but not yet using, this technology. Methods: Through in-depth semi-structured interviews, we explore the perceptions and attitudes of 25 women employees of companies with employer-based egg freezing. Results: These women describe delaying childbearing for a multitude of reasons, including not having a partner, and the desire to achieve social and career goals. Many women did not know that their employers covered egg freezing before the interview (44%; 11/24), suggesting this benefit is not essential to their career and family-building decisions. While women did not describe pressure to use this technology, they did describe how this benefit would not solve the difficulties of becoming a mother while excelling in their careers. Conclusion: Although women may not feel pressure to freeze their eggs and delay childbearing, they still feel constricted in their reproductive options. While employer programs may offer women the ability to delay childbearing, many saw this delay as postponing problems with work-life balance rather than solving them. We suggest that sociocultural shifts, such as workplace daycare, flexible workplace hours, and acceptability of non-biological parenthood, might allow women to feel more empowered about their reproduction choices.
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Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - W K Miller
- Doximity, San Francisco, California, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Inhorn MC. Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 10:46-57. [PMID: 32760816 PMCID: PMC7393315 DOI: 10.1016/j.rbms.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/29/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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37
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Maslow BSL, Guarnaccia MM, Ramirez L, Klein JU. Likelihood of achieving a 50%, 60%, or 70% estimated live birth rate threshold with 1 or 2 cycles of planned oocyte cryopreservation. J Assist Reprod Genet 2020; 37:1637-1643. [PMID: 32418136 DOI: 10.1007/s10815-020-01791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/22/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To characterize the likelihood of cryopreserving enough oocytes for 50%, 60%, or 70% estimated live birth rate (eLBR) with 1-2 planned oocyte cryopreservation (Pl-OC) cycles. METHODS We performed a retrospective cohort study utilizing all patients completing ≥ 1 Pl-OC cycle from 2016 to 2018 at a large single-center OC program. Subjects were categorized by age at retrieval and number of cycles. We extrapolated age-based oocyte thresholds for 50%, 60%, or 70% eLBR from previously published data. We calculated the proportion of subjects overall, and for each age group, whose number of frozen oocytes was greater than or equal to their age-based threshold for a 50%, 60%, or 70% eLBR after 1 and 2 cycles. OR for 60% eLBR with one cycle was calculated for age and AMH cutoff values and corroborated with logistic regression. RESULTS A total of 1241 subjects, completing 1799 Pl-OC cycles, were included. With one cycle, 66% (819/1241) achieved ≥ 50% eLBR and 51% (634/1241) achieved 70% eLBR. With two cycles, 79.6% (988/1241) attained ≥ 50% eLBR and 65.5% (813/1241) achieved 70% eLBR. Achieving 50%, 60%, or 70% eLBR with 1-2 cycles was significantly associated with both age (p < 0.001) and AMH (p < 0.001). Age < 37.5 and AMH > 1.995 were independently associated with attaining 60% eLBR with one cycle (age: OR 13.73; 95%CI 9.16-20.57, p < 0.001; AMH: OR 7.32; 95% CI 5.50-9.76, p < 0.001). CONCLUSIONS Younger age and higher AMH were associated with achieving 50%, 60%, or 70% eLBR thresholds with Pl-OC. Nevertheless, almost all subjects were successfully able to preserve enough oocytes for ≥ 50% eLBR in 1-2 cycles.
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Affiliation(s)
- Bat-Sheva L Maslow
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA.
| | - Michael M Guarnaccia
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
| | - Leslie Ramirez
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
| | - Joshua U Klein
- Extend Fertility Medical Practice - Center for Fertility Research and Education, 200 West 57th Street - Suite 1101, New York, NY, 10019, USA
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Yeung SY, Ng EYL, Lao TTH, Li TC, Chung JPW. Fertility preservation in Hong Kong Chinese society: awareness, knowledge and acceptance. BMC WOMENS HEALTH 2020; 20:86. [PMID: 32349724 PMCID: PMC7189503 DOI: 10.1186/s12905-020-00953-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Background Fertility preservation for both medical and non-medical reasons are gaining increasing attention world-wide. This study aimed to evaluate the awareness, knowledge and acceptance on fertility preservation in Hong Kong Chinese. Methods This was a cross-sectional study carried out between June 2016 to March 2017. A self-administered questionnaire was distributed by convenience sampling. Results Forty two percent of subjects returned the questionnaire (n = 296/697). Among them, only 54.3% were aware of any means of fertility preservation. Tertiary educated individuals are more aware than less educated individuals (73.6% versus 46.6%, p < 0.001). The most commonly known method is oocyte cryopreservation (94.3%). Most of the respondents (80%) were interested to know about fertility preservation, 84.1% considered fertility preservation counselling necessary and 83.3% would consider undergoing fertility preservation if a treatment has a high chance of causing infertility despite the possibility of delay in cancer treatment. Up to 93.9% agreed to set up a dedicated referral centre with government funding and 73.4% agreed that fertility preservation for medical indication should be provided as a government funded service. In terms of fertility preservation for non-medical reason, 65.5 and 70.4% agreed that fertility preservation should be offered to single men and women without partner respectively, while only 53.3 and 50% agreed that fertility preservation is acceptable for delay in childbearing for career development in female and male respectively. Conclusion There was a low awareness but positive attitude towards fertility preservation among Hong Kong Chinese. Acceptance towards medically indicated fertility preservation is high while a considerable number also accepts it for non-medical reasons. Educational campaigns are required to arouse awareness of fertility preservation to prevent individuals being deprived of the option due to lack of knowledge. Dedicated referral centre with established efficient patient referral pathways and financial support should be provided to improve the provision and uptake of fertility preservation service to enhance the reproductive potential and life options of women.
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Affiliation(s)
- Suet Ying Yeung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Prince of Wales Hospital, Shatin, N.T, Hong Kong SAR
| | - Elaine Yee Lee Ng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Prince of Wales Hospital, Shatin, N.T, Hong Kong SAR
| | - Terence Tzu Hsi Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Prince of Wales Hospital, Shatin, N.T, Hong Kong SAR
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Prince of Wales Hospital, Shatin, N.T, Hong Kong SAR
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 1/F, Block E, Special Block, Prince of Wales Hospital, Shatin, N.T, Hong Kong SAR.
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Inhorn MC, Birenbaum-Carmeli D, Vale MD, Patrizio P. Abrahamic traditions and egg freezing: Religious Women's experiences in local moral worlds. Soc Sci Med 2020; 253:112976. [PMID: 32278236 DOI: 10.1016/j.socscimed.2020.112976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
In this article, we elucidate how elective egg freezing (EEF) has been received within the three Abrahamic traditions-Judaism, Christianity, and Islam-and how these religion-specific standpoints have affected the EEF experiences of women who self-identify as religiously observant. Through an analysis of religious women's narratives, the study explores the "local moral worlds" of religious women who chose to freeze their eggs for non-medical reasons. It draws on ethnographic interviews with 14 women in the United States and Israel who had completed at least one EEF cycle, and who were part of a large, binational study that interviewed, between 2014 and 2016, 150 women who pursued EEF. These religious women, who were all highly educated, faced a particular challenge in finding appropriate marriage partners. Feeling pressured but still hopeful to marry and create large families, the women used EEF to extend their reproductive timelines and reduce their anxieties. As the study showed, the women reinterpreted or reconciled religious restrictions on the use of EEF in various ways, believing that their ultimate pursuit of religiously sanctioned reproduction justified the means. This study, which is the first to compare Jewish, Christian, and Muslim women's experiences of EEF, illustrates how this novel technology is now shaping the local moral worlds of religious women.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT, 06511, USA.
| | | | - Mira D Vale
- Department of Sociology, University of Michigan, 500 S. State Street, Ann Arbor, MI, 48019, USA.
| | - Pasquale Patrizio
- Yale Fertility Center, 150 Sargent Drive, New Haven, CT, 06511, USA.
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Abstract
Aim The interest in oocyte cryopreservation (OC) for nonmedically indicated reasons is increasing. Knowing women's beliefs and knowledge from various geographic regions could help providers to understand the similarities and differences that could facilitate proper counseling. Materials & methods Articles about social egg freezing published over the past 18 years were extracted from the literature. Results We demonstrated that there are common rationales toward OC among women in the USA and other countries. The ultimate goal was to prolong fertility. The most commonly reported reasons were aging, lack of partner, career and financial status. Conclusion The beliefs and rationales toward elective OC among women in the USA and other countries are consistent.
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Campo-Engelstein L. Reproductive technologies are not the cure for social problems. JOURNAL OF MEDICAL ETHICS 2020; 46:85-86. [PMID: 31974292 DOI: 10.1136/medethics-2019-105981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 06/10/2023]
Abstract
Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women's inequality. While these advancements and technologies can benefit women, I argue medicine is not the best tool to 'cure' social problems and should not be co-opted as an agent of social change. Systemic social changes, not just technomedical approaches, are needed to address the root of gender inequality, which is social in nature, not medical.
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Inhorn MC, Birenbaum-Carmeli D, Patrizio P. Elective egg freezing and male support: a qualitative study of men's roles in women's fertility preservation. HUM FERTIL 2020; 25:99-106. [PMID: 31920127 DOI: 10.1080/14647273.2019.1702222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
How do men participate in women's fertility preservation decisions and procedures? This binational, qualitative study assessed whether men play supportive roles either before, during or after women's elective egg freezing (EEF) cycles. From June 2014 to August 2016, 150 women (114 in the USA and 36 in Israel) who had completed at least one cycle of EEF were interviewed by two medical anthropologists, one in each country. The majority (85%) of women in the study identified the lack of a male partner as their main reason for pursuing EEF. However, nearly two-thirds (63%) of women relied on some form of male support during their EEF decision making processes and procedures. Five categories of men, in order of support, included: (i) fathers (or other male father figures), (ii) male partners (past or present), (iii) male friends, (iv) brothers and (v) male judges (some of whom supported EEF in divorce settlements). More than a dozen different forms of assistance were offered by men in four major categories: (i) instrumental, (ii) financial, (iii) physical and (iv) psychological. Although one-third (37%) of women went through EEF alone or with only female support, this study reveals the 'hidden' roles men play in supporting the reproductive aspirations of women.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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Pralat R. Parenthood as intended: Reproductive responsibility, moral judgements and having children 'by accident'. THE SOCIOLOGICAL REVIEW 2020; 68:161-176. [PMID: 32903979 PMCID: PMC7449378 DOI: 10.1177/0038026119868643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
What does it mean to have a child 'by accident'? And why is parenthood so often described as happening 'accidentally', even when it is likely to involve at least some degree of intention? Drawing on interviews conducted in England and Wales with lesbians and gay men who do not have children but may have them in the future, this article explores the meanings of the notion that, as a same-sex couple, 'you can't have a child by accident' - a comment that interviewees frequently made unprompted when they were asked about the possibility of becoming parents. My data show that referring to 'accidental parenthood' is a common way of distinguishing one's experience of early adulthood from that of heterosexual people, especially among white, middle-class lesbians. As a closer reading of the data also suggests, parenthood that arguably happens by accident is often neither unforeseen nor unfortunate, and its currency as a point of reference reveals a powerful cultural narrative. When a wide range of reproductive behaviours are often deemed irresponsible because of their broadly defined timing, describing a pregnancy as an accident obscures responsibility. I argue that, to a certain extent, the discourse of accidental parenthood can serve to prevent moral judgements about reproductive decisions. Consequently, however, the 'inability' to have a child by accident makes the prospect of creating a family not only more complicated but also subject to greater scrutiny.
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Affiliation(s)
- Robert Pralat
- Robert Pralat, Department of Sociology, University of Cambridge, 16 Mill Lane, Cambridge, CB2 1SB, UK.
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A follow-up survey on the reproductive intentions and experiences of women undergoing planned oocyte cryopreservation. Reprod Biomed Online 2019; 40:207-214. [PMID: 31983546 DOI: 10.1016/j.rbmo.2019.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/10/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
RESEARCH QUESTION What are the current reproductive attitudes and experiences of women who have previously undergone planned oocyte cryopreservation (OoC)? DESIGN Retrospective questionnaire-based cohort study involving women who had previously undergone planned OoC between January 2009 and September 2016 at a single centre. Eligible women were contacted via e-mail and invited to complete an anonymous standardized questionnaire that had been developed to evaluate their current relationship status and reproductive situation, their attitudes towards planned OoC and their future reproductive intentions. RESULTS Of 460 women who had completed at least one OoC cycle, questionnaires were obtained from 138 women. After a mean (± SD) follow-up of 4.5 ± 2.4 years, two-thirds of respondents (65%) anticipated using their oocytes at some point in the future. The respondents reported an overwhelmingly positive attitude towards planned OoC, with 98% indicating they would recommend this intervention to others. Overall, 83% of respondents were single at the time they requested OoC but only 44% were single at the time they completed the survey. While 43/62 (69%) of women became pregnant after undergoing OoC, the majority 30/43 (70%) of these pregnancies were achieved without using their vitrified oocytes. Finally, 13/28 (46%) who used their cryopreserved oocytes stated that they had achieved a live birth. CONCLUSIONS The majority of women who undergo OoC do not regret their experience and many have found a partner in subsequent years. Twenty-one per cent of respondents who attempted to conceive after OoC had a live birth using their cryopreserved oocytes.
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Baram S, Myers SA, Yee S, Librach CL. Fertility preservation for transgender adolescents and young adults: a systematic review. Hum Reprod Update 2019; 25:694-716. [DOI: 10.1093/humupd/dmz026] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
BACKGROUND
Many transgender individuals choose to undergo gender-affirming hormone treatment (GAHT) and/or sex reassignment surgery (SRS) to alleviate the distress that is associated with gender dysphoria. Although these treatment options often succeed in alleviating such symptoms, they can also negatively impact future reproductive potential.
OBJECTIVE AND RATIONALE
The purpose of this systematic review was to synthesize the available psychosocial and medical literature on fertility preservation (FP) for transgender adolescents and young adults (TAYAs), to identify gaps in the current research and provide suggestions for future research directions.
SEARCH METHODS
A systematic review of English peer-reviewed papers published from 2001 onwards, using the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines, was conducted. Four journal databases (Ovid MEDLINE, PubMed Medline, Ovid Embase and Ovid PsychINFO) were used to identify all relevant studies exploring psychosocial or medical aspects of FP in TAYAs. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Bibliographies of the selected articles were also hand searched and cross-checked to ensure comprehensive coverage. All selected papers were independently reviewed by the co-authors. Characteristics of the studies, objectives and key findings were extracted, and a systematic review was conducted.
OUTCOMES
Included in the study were 19 psychosocial-based research papers and 21 medical-based research papers that explore fertility-related aspects specific for this population. Key psychosocial themes included the desire to have children for TAYAs; FP discussions, counselling and referrals provided by healthcare providers (HCPs); FP utilization; the attitudes, knowledge and beliefs of TAYAs, HCPs and the parents/guardians of TAYAs; and barriers to accessing FP. Key medical themes included fertility-related effects of GAHT, FP options and outcomes. From a synthesis of the literature, we conclude that there are many barriers preventing TAYAs from pursuing FP, including a lack of awareness of FP options, high costs, invasiveness of the available procedures and the potential psychological impact of the FP process. The available medical data on the reproductive effects of GAHT are diverse, and while detrimental effects are anticipated, the extent to which these effects are reversible is unknown.
WIDER IMPLICATIONS
FP counselling should begin as early as possible as a standard of care before GAHT to allow time for informed decisions. The current lack of high-quality medical data specific to FP counselling practice for this population means there is a reliance on expert opinion and extrapolation from studies in the cisgender population. Future research should include large-scale cohort studies (preferably multi-centered), longitudinal studies of TAYAs across the FP process, qualitative studies of the parents/guardians of TAYAs and studies evaluating the effectiveness of different strategies to improve the attitudes, knowledge and beliefs of HCPs.
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Affiliation(s)
- Shira Baram
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
| | - Samantha A Myers
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Samantha Yee
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, 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, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Physiology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Institute of Medical Science, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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Nasab S, Shah JS, Nurudeen K, Jooya ND, Abdallah ME, Sibai BM. Physicians' attitudes towards using elective oocyte cryopreservation to accommodate the demands of their career. J Assist Reprod Genet 2019; 36:1935-1947. [PMID: 31376103 DOI: 10.1007/s10815-019-01541-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Among medical professionals, there appears to be a significant lack of knowledge about oocyte cryopreservation. Medical professionals may be potential candidates for elective oocyte cryopreservation due to the demands and commitments of medical training. There is a paucity of data on this topic among medical professionals. The aim of this study was to assess knowledge, understanding, and beliefs towards elective egg freezing among medical professionals to assess whether they are potential candidates for elective egg freezing. METHODS This is a cross-sectional descriptive study in a university-based training program. All medical students, residents, fellows, and faculty were included. An online survey was emailed to potential participants. It included demographic questions regarding childbearing decision-making factors, fertility knowledge, and attitudes towards using elective oocyte cryopreservation. RESULTS A total of 1000 emails were sent. Of those, 350 completed surveys were received. On average, 33% of responders provided a correct answer to each fertility knowledge question. The duration of training and the heavy workload with long duty hours were the most common influencing factors when deciding the timing of childbearing. Overall, 65% of the male and female responders were concerned about their future fertility. Among those women who had future fertility concerns, 8% were not aware of egg freezing as a fertility option and wished they had had an opportunity to freeze their eggs at an earlier time. CONCLUSIONS Physicians' childbearing decisions can be affected by the demands of their careers. Elective oocyte cryopreservation could be considered an option for family planning. Educational sessions and awareness programs are needed to provide information about available fertility preservation options, which can potentially decrease the rate of regret.
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Affiliation(s)
- Susan Nasab
- McGovern Medical School, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.214, Houston, TX, 77030, USA.
| | - Jaimin S Shah
- McGovern Medical School, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.214, Houston, TX, 77030, USA
| | - Kemi Nurudeen
- Houston Fertility Institute, 6400 Fannin Street, Suite 2000, Houston, TX, 77030, USA
| | - Neda D Jooya
- McGovern Medical School, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.214, Houston, TX, 77030, USA
| | - Mazen E Abdallah
- Houston Fertility Institute, 6400 Fannin Street, Suite 2000, Houston, TX, 77030, USA
| | - Baha M Sibai
- McGovern Medical School, Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3.214, Houston, TX, 77030, USA
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Lew R, Foo J, Kroon B, Boothroyd C, Chapman M. ANZSREI consensus statement on elective oocyte cryopreservation. Aust N Z J Obstet Gynaecol 2019; 59:616-626. [PMID: 31332788 DOI: 10.1111/ajo.13028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND One in six Australian women and couples suffer infertility. A rising proportion relates to advanced maternal age, associated with poorer oocyte quality and in vitro fertilisation (IVF) outcomes. Internationally, oocyte cryopreservation technology applied to oocytes vitrified before 35 years provides similar live-birth statistics compared to IVF treatment using fresh oocytes. Oocyte cryopreservation is accessible in Australasian settings and elective uptake is increasing. For women accessing treatment, oocyte cryopreservation may expand future family building options. AIMS To develop the first Australasian Certification in Reproductive Endocrinology and Infertility (CREI) subspecialist-led consensus guideline on oocyte cryopreservation. METHODS The ANZSREI ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence group) met in 2017 and 2018 and identified clinical aspects of care for inclusion and review. Review of the available evidence was conducted and consensus statements prepared. Areas of dissent of expert opinion and for further research were noted. RESULTS Consensus was reached on definition and best practice in oocyte cryopreservation for freeze method, controlled ovarian stimulation, medical risk reduction and treatment and outcomes counselling. The term 'social egg freezing' may marginalise, stigmatise or attribute social blame to women, and there is a need to revise this to a neutral and non-judgemental term such as elective or planned oocyte cryopreservation. CONCLUSION Oocyte cryopreservation has the potential to improve cumulative live birth outcomes for women. Implementation of this guideline should facilitate an optimal approach for providing care.
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Affiliation(s)
- Raelia Lew
- Royal Women's Hospital Melbourne, Melbourne, Victoria, Australia.,Melbourne IVF, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Australia and New Zealand Society of Reproductive Endocrinology and Infertility, Sydney, Australia
| | - Jinny Foo
- Australia and New Zealand Society of Reproductive Endocrinology and Infertility, Sydney, Australia
| | - Ben Kroon
- Australia and New Zealand Society of Reproductive Endocrinology and Infertility, Sydney, Australia
| | - Clare Boothroyd
- Australia and New Zealand Society of Reproductive Endocrinology and Infertility, Sydney, Australia
| | - Michael Chapman
- Australia and New Zealand Society of Reproductive Endocrinology and Infertility, Sydney, Australia
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Gürtin ZB, Morgan L, O’Rourke D, Wang J, Ahuja K. For whom the egg thaws: insights from an analysis of 10 years of frozen egg thaw data from two UK clinics, 2008-2017. J Assist Reprod Genet 2019; 36:1069-1080. [PMID: 31119440 PMCID: PMC6603120 DOI: 10.1007/s10815-019-01429-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/27/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To better understand the characteristics of patients who returned to thaw their frozen eggs to attempt conception and their outcomes. METHODS A retrospective analysis of clinical records for all own egg thaw patients in two UK fertility clinics across 10 years, 2008-2017. RESULTS There were 129 patients who returned to thaw their eggs, of which 46 had originally frozen their eggs for social reasons and 83 for a variety of clinical, incidental, and ethical reasons (which we have called "non-social"). Women who had frozen their eggs for social reasons were single at time of freeze, with an average age of 37.7. They kept their eggs in storage for just under 5 years, returning to use them at the average age of 42.5. 43.5% were single at time of thaw, and 47.8% used donor sperm to fertilise their eggs. Women whose eggs were frozen for non-social reasons were almost all (97.6%) in a relationship at both time of freeze and thaw. They had an average age of 37.2 at first freeze and 37.6 at thaw, having kept their eggs in storage for an average of 0.4 years. Overall, there was a 20.9% success rate among women attempting conception with frozen-thawed eggs. CONCLUSIONS Despite widespread assumptions, many women attempting conception with thawed eggs had not initially frozen them for social reasons. Women who froze their eggs for social reasons presented distinctly and statistically different characteristics at both time of freeze and thaw to women whose eggs were frozen for non-social reasons.
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Affiliation(s)
- Zeynep B. Gürtin
- Institute for Women’s Health, UCL, 84-96 Chenies Mews, London, WC1E 6HU UK
| | - Lucy Morgan
- Sociology Department, University of Cambridge, 16 Mill Lane, Cambridge, CB2 1SB UK
| | | | - Jinjun Wang
- London Women’s Clinic, 113-115 Harley Street, London, W1PG 6AP UK
| | - Kamal Ahuja
- London Women’s Clinic, 113-115 Harley Street, London, W1PG 6AP UK
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Patient-centered elective egg freezing: a binational qualitative study of best practices for women's quality of care. J Assist Reprod Genet 2019; 36:1081-1090. [PMID: 31104290 PMCID: PMC6603102 DOI: 10.1007/s10815-019-01481-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE How can elective egg freezing (EEF) be made patient centered? This study asked women to reflect on their experiences of EEF, which included their insights and recommendations on the optimal delivery of patient-centered care. METHODS In this binational, qualitative study, 150 women (114 in the USA, 36 in Israel) who had completed at least one cycle of EEF were recruited from four American IVF clinics (two academic, two private) and three in Israel (one academic, two private) over a two-year period (June 2014-August 2016). Women who volunteered for the study were interviewed by two medical anthropologists. Interviews were audio recorded, transcribed, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS The majority (85%) of women were without partners at the time of EEF, and thus were undertaking EEF alone in mostly couples-oriented IVF clinics. Following the conceptual framework known as "patient-centered infertility care," we identified two broad categories and eleven specific dimensions of patient-centered EEF care, including (1) system factors: information, competence of clinic and staff, coordination and integration, accessibility, physical comfort, continuity and transition, and cost and (2) human factors: attitude and relationship with staff, communication, patient involvement and privacy, and emotional support. Cost was a unique factor of importance in both countries, despite their different healthcare delivery systems. CONCLUSIONS Single women who are pursuing EEF alone in the mostly couples-oriented world of IVF have distinct and multifaceted needs. IVF clinics should strive to make best practices for patient-centered EEF care a high priority.
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Affiliation(s)
- Marcia C. Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520 USA
| | | | - Lynn M. Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University, 1195 W. Fremont Ave, Sunnyvale, CA 94087 USA
| | - Joseph Doyle
- Shady Grove Fertility, 9600 Blackwell Road, Rockville, MD 20850 USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY 10021 USA
| | - Dror Meirow
- Division Reproductive Endocrinology-IVF, Department of Obstetrics & Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, 3436212 Haifa, Israel
| | - Martha Dirnfeld
- Clinical Center for Fertility Preservation and Fertility Preservation Research Laboratory, Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Daniel Seidman
- Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha’ella St, 52621 Ramat Gan, Israel
| | - Arik Kahane
- Assuta Medical Center, 13 Eliezer Mazal, 75653 Rishoon Lezion, Israel
| | - Pasquale Patrizio
- Yale Fertility Center, Yale University, 150 Sargent Drive, New Haven, CT 06511 USA
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Inhorn MC, Birenbaum-Carmeli D, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Ten pathways to elective egg freezing: a binational analysis. J Assist Reprod Genet 2018; 35:2003-2011. [PMID: 30074130 DOI: 10.1007/s10815-018-1277-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE What are the specific pathways that lead women to freeze their eggs? In this binational study, women were asked directly about the life circumstances that led them on the path to elective egg freezing (EEF). METHODS From June 2014 to August 2016, 150 women (114 in the USA, 36 in Israel) who had completed at least 1 cycle of EEF were interviewed by two medical anthropologists. Study participants were recruited through four American IVF clinics (two academic, two private) and three in Israel (one academic, two private). Interviews were audio-recorded, transcribed verbatim, and entered into a qualitative data management program (Dedoose) for analysis. RESULTS The majority (85%) of women in the study were without partners, while 15% had partners at the time of EEF. Six pathways to EEF were found among women without partners (being single, divorced, broken up, deployed overseas, single mother, career planner), with career planning being the least common pathway to EEF. Among women with partners, four pathways to EEF were found (relationship too new or uncertain, partner not ready to have children, partner refusing to have children, or partner having multiple partners). With only one exception, the pathways and their frequencies were similar in both countries. CONCLUSIONS Partnership problems, not career planning, lead most women on pathways to EEF. These pathways should be studied in a variety of national settings, and fertility clinics should offer patient-centered care for single women pursuing EEF in the couples-oriented world of IVF.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT, 06511, USA.
| | | | - Lynn M Westphal
- Stanford Fertility and Reproductive Medicine Center, Stanford University Medical Center, 1195 W. Fremont Ave., Sunnyvale, CA, 94087, USA
| | - Joseph Doyle
- Shady Grove Fertility, 9601 Blackwell Road, Rockville, MD, 20850, USA
| | - Norbert Gleicher
- Center for Human Reproduction, 21 E. 69th Street, New York, NY, 10021, USA
| | - Dror Meirow
- Clinical Center for Fertility Preservation and Fertility Preservation Research Laboratory, Sheba Medical Center, Department of Obstetrics and Gynecology, IVF and Fertility Unit, 1 Emek Ha'ella St., 52621, Ramat Gan, Israel
| | - Martha Dirnfeld
- Israeli Fertility Society, Division Reproductive Endocrinology-IVF, Department of Obstetrics & Gynecology, Carmel Medical Center, Ruth & Bruce Faculty of Medicine, Technion, 343621, Haifa, Israel
| | - Daniel Seidman
- Department of Obstetrics and Gynecology, Sheba Medical Center, IVF and Fertility Unit, 1 Emek Ha'ella St., 52621, Ramat Gan, Israel
| | - Arik Kahane
- Assuta Medical Center, 13 Eliezer Mazal, 75653, Rishon LeZion, Israel
| | - Pasquale Patrizio
- Yale Fertility Center and Fertility Preservation Program, 150 Sargent Drive, New Haven, CT, 06511, USA
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