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Wo L, Eidelson SA, Zheng C, Mouhanna J, Bussies P, Zhang C, Möller MG. Coverage of Fertility Preservation and Treatment Among Surgical Trainees in the United States of America. JOURNAL OF SURGICAL EDUCATION 2023; 80:689-696. [PMID: 36933957 DOI: 10.1016/j.jsurg.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Surgery trainees spend their prime fertility years in training, which leads to delays in childbearing, accompanying infertility challenges, and high-risk pregnancies. Literature report of institutional support for fertility preservation (egg/sperm freezing) and treatment is lacking. The cost is particularly prohibitive while receiving a resident physician salary. This study aimed to assess availability of fertility resources and institutional coverage of fertility services to US General Surgery Residents (GSR) and Breast Fellows. METHODS We composed and distributed a 26-question survey to GS residency and fellowship program directors nationwide to survey residents and fellows. Summary and descriptive statistics were tabulated, and categorical variables were analyzed using Pearson's chi square test. RESULTS A total of 234 US surgical trainees (male n = 75, female n = 155, unreported n = 4) completed the survey. Total of 12 % of trainees reported having been counseled on family planning/fertility treatment during training, and only 5.1% were counseled on fertility preservation. Perceived lack of support from program (p = 0.027) and counseling of fertility preservation (p = 0.009) were significantly associated with female gender. A minority (12.5%) reported having insurance coverage for fertility preservation and 26% had coverage of fertility treatment. In addition, 2.6% respondents pursued fertility preservation while in training and 33% reported they would pursue fertility preservation if it was covered by insurance. CONCLUSIONS Fertility preservation is rarely discussed in US General Surgery residency programs. The large majority of GSR lacks awareness of insurance coverage of fertility preservation and treatment. Strong efforts are necessary to improve fertility education for GSR and insurance coverage to meet trainee's needs.
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Affiliation(s)
- Luccie Wo
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sarah A Eidelson
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Caiwei Zheng
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Joelle Mouhanna
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Parker Bussies
- Cleveland Clinic Foundation, Women's Health Institute, Cleveland, Ohio
| | - Chi Zhang
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida
| | - Mecker G Möller
- Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Fertility knowledge and views on egg freezing and family planning among surgical specialty trainees. AJOG GLOBAL REPORTS 2022; 2:100096. [DOI: 10.1016/j.xagr.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fertility awareness and attitudes among resident physicians across different specialties. J Assist Reprod Genet 2022; 39:655-661. [PMID: 35132531 PMCID: PMC8995230 DOI: 10.1007/s10815-022-02425-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate knowledge of age-related fertility decline and oocyte cryopreservation among resident physicians in obstetrics and gynecology (ob-gyn) compared to residents in other specialties. METHODS An online survey was sent to the US residency program directors for ob-gyn, internal medicine, emergency medicine, family medicine, general surgery, pediatrics, and psychiatry. They were asked to forward the survey to their respective residents. The survey consisted of three sections: fertility knowledge, oocyte cryopreservation knowledge, and attitudes toward family building and fertility preservation. Multivariable logistic regression models were used to compare outcomes between ob-gyn and non-ob-gyn residents. RESULTS Of the 2,828 completed surveys, 450 (15.9%) were by ob-gyn residents and 2,378 (84.1%) were by residents in other specialties. 66.3% of respondents were female. The median number of correct answers was 2 out of 5 on the fertility knowledge section and 1 out of 3 on the oocyte cryopreservation knowledge section among both ob-gyn and non-ob-gyn residents. After adjusting for covariates, residents in ob-gyn were no more likely to answer these questions correctly than residents in other specialties (fertility knowledge, adjusted OR .97, 95% CI .88-1.08; oocyte cryopreservation knowledge, adjusted OR 1.05, 95% CI .92-1.19). Ob-gyn residents were significantly more likely than non-ob-gyn residents to feel "somewhat supported" or "very supported" by their program to pursue family building goals (83.5% vs. 75.8%, OR 1.62, 95% CI 1.23-2.14). CONCLUSIONS Resident physicians, regardless of specialty, have limited knowledge of natural fertility decline and the opportunity to cryopreserve oocytes. These data suggest need for improved fertility education.
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Courbiere B, Le Roux E, Mathieu d'Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigne M, Chanavaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. [French clinical practice guidelines developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:211-219. [PMID: 35063688 DOI: 10.1016/j.gofs.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To provide clinical practice guidelines about fertility preservation (FP) for women with benign gynecologic disease (BGD) developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease. METHODS A steering committee composed of 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices related to FP for BGD. Then 114 key stakeholders including various healthcare professionals (n=108) and patient representatives (n=6) were asked to participate in a modified Delphi process via two online survey rounds from February to September 2020 and a final meeting. Due to the COVID-19 pandemic, this final meeting to reach consensus was held as a videoconference in November 2020. RESULTS Survey response of stakeholders was 75 % (86/114) for round 1 and 87 % (75/86) for round 2. Consensus was reached for the recommendations for 28 items, that have been distributed into five general categories: (i) Information to provide to women of reproductive age with a BGD, (ii) Technical aspects of FP for BGD, (iii) Indications for FP in endometriosis, (iv) Indications for FP for non-endometriosis BGD, (v) Indications for FP after a fortuitous diagnosis of an idiopathic diminished ovarian reserve. CONCLUSION These guidelines provide some practice advice to help health professionals better inform women about the possibilities of cryopreserving their oocytes prior to the management of a BGD that may affect their ovarian reserve and fertility. STUDY FUNDING/COMPETING INTEREST(S) The CNGOF (Collège National des Gynécologues Obstétriciens Français) funded the implementation of the Delphi process.
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Affiliation(s)
- B Courbiere
- Department of gynecology-obstetric and reproductive medicine, hôpital La Conception, AP-HM, Marseille, France; Aix-Marseille université IMBE, CNRS, IRD, Avignon université, Marseille, France.
| | - E Le Roux
- Inserm, CIC 1426, unité d'épidémiologie clinique, hôpital universitaire Robert-Debré, AP-HP Nord-université de Paris, Paris, France; Inserm, ECEVE UMR 1123, université de Paris, Paris, France
| | - E Mathieu d'Argent
- Department of gynecology-obstetric and reproductive medicine, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Torre
- Department of gynecology-obstetric and reproductive medicine, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - C Patrat
- Inserm U1016, service de biologie de la reproduction - CECOS, AP-HP centre - université de Paris, site Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Poncelet
- Department of gynecology - obstetrics/UFR SMBH Leonard de Vinci, centre hospitalier de René Dubos/université Sorbonne Paris Nord - université Paris 13, Cergy-Pontoise, France
| | - J Montagut
- Institut francophone de recherche et d'études appliquées à la reproduction, Ifreares Toulouse, Toulouse, France
| | - A-S Gremeau
- Department of gynecologic surgery and IVF, university hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - H Creux
- Department of gynecology-obstetric and reproductive medicine, clinique Saint-Roch, Montpellier, France
| | - M Peigne
- Department of reproductive medicine and fertility preservation, hôpital Jean-Verdier, université Sorbonne Paris Nord-Paris 13, AP-HP, Bondy, France
| | | | - L Dirian
- EndoFrance, Association française de lutte contre l'endométriose, Paris, France
| | - X Fritel
- Inserm CIC-P 1402, department of gynecology-obstetric and reproductive medicine, CHU Poitiers, Poitiers, France
| | - J-L Pouly
- Department of gynecology-obstetric, centre hospitalier Moulins Yzeure, Moulins, France
| | - A Fauconnier
- Department of gynecology and obstetrics/research unit 7285 risk and safety in clinical medicine for women and perinatal health, CHI Poissy-Saint-Germain-en Laye/Paris-Saclay university, Poissy, France
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Courbiere B, Le Roux E, Mathieu d’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigné M, Chanavaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process. J Clin Med 2021; 10:jcm10173810. [PMID: 34501257 PMCID: PMC8432013 DOI: 10.3390/jcm10173810] [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: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 01/28/2023] Open
Abstract
International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP.
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Affiliation(s)
- Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, 13005 Marseille, France
- Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-38-37-11
| | - Enora Le Roux
- Unité d’Epidémiologie Clinique, Hôpital Universitaire Robert Debré, AP-HP Nord-Université de Paris, Inserm, CIC 1426, 75019 Paris, France;
- ECEVE UMR 1123, Université de Paris, Inserm, 75019 Paris, France
| | - Emmanuelle Mathieu d’Argent
- Department of Gynecology-Obstetric and Reproductive Medicine, GRC6-UPMC, Centre Expert en Endométriose (C3E), Université Pierre-et-Marie-Curie Paris 6, Hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France;
| | - Antoine Torre
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Rouen, 37 bd Gambetta, 76000 Rouen, France;
| | - Catherine Patrat
- Service de Biologie de la Reproduction—CECOS, APHP Centre—Université de Paris, Site Cochin, Inserm U1016, 75014 Paris, France;
| | - Christophe Poncelet
- Department of Gynecology-Obstetric, UFR SMBH Leonard de Vinci, CH René Dubos, 95000 Cergy-Pontoise, France;
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
| | - Jacques Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, 31000 Toulouse, France;
| | - Anne-Sophie Gremeau
- Department of Gynecologic Surgery and IVF, Clermont-Ferrand, University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Hélène Creux
- Clinique Saint Roch, Department of Gynecology-Obstetric and Reproductive Medicine, 34000 Montpellier, France;
| | - Maëliss Peigné
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
- Department of Reproductive Medicine and Fertility Preservation, AP-HP Hôpital Jean Verdier, 93143 Bondy, France
| | | | - Lara Dirian
- EndoFrance, Association Française de lutte contre l’Endométriose, 70190 Tresilley, France;
| | - Xavier Fritel
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Poitiers, 86000 Poitiers, France;
- Inserm CIC-P 1402, 86021 Poitiers, France
| | - Jean-Luc Pouly
- Department of Gynecology-Obstetric, CH Moulins Yzeure, 03000 Moulins, France;
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain-en Laye, 78300 Poissy, France;
- Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Paris-Saclay University, 78300 Poissy, France
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Caughey LE, Lensen S, White KM, Peate M. Disposition intentions of elective egg freezers toward their surplus frozen oocytes: a systematic review and meta-analysis. Fertil Steril 2021; 116:1601-1619. [PMID: 34452749 DOI: 10.1016/j.fertnstert.2021.07.1195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. DESIGN A systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Actual EEFs (women with oocytes in storage), potential EEFs (women investigating elective oocyte cryopreservation or about to freeze their oocytes), and women of reproductive age (women in the community aged ≥18 years). INTERVENTION(S) A systematic review was undertaken and electronically searched MEDLINE, Embase, and PsycINFO on the Ovid platform for conference abstracts and peer-reviewed articles, published in English after January 1, 2010. A search strategy combined synonyms for oocyte, cryopreservation, donation, disposition, elective, and attitude. Eligible studies assessed disposition outcomes (how an oocyte was disposed of) and disposition intentions (how women intend to dispose of an oocyte) and/or the psychosocial determinants underlying disposition outcomes and intentions. The Joanna Briggs Institute Prevalence Tool was used to assess the risk of bias. A meta-analysis using random effects was applied to pool proportions of women with similar disposition intentions toward their oocytes. MAIN OUTCOME MEASURE(S) Disposition outcomes and intentions toward surplus frozen oocytes: donate to research; donate to others; discard; unsure. Psychosocial determinants (beliefs, attitudes, barriers, and facilitators) of disposition outcomes and intentions. RESULT(S) A total of 3,560 records were identified, of which 22 (17 studies) met the inclusion criteria (8 studies from Europe, 7 from North America, and 2 from Asia). No studies reported on past oocyte disposition outcomes. Seventeen studies reported on the future disposition intentions of 5,446 women. Only 2 of the 17 studies reported on the psychosocial determinants of oocyte disposition intentions. There was substantial heterogeneity in the pooled results, which was likely a result of the significant variation in methodology. Actual EEFs were included in eight studies (n = 873), of whom 53% (95% confidence interval [CI], 44-63; I2, 87%) would donate surplus oocytes to research, 31% (95% CI, 23-40; I2, 72%) were unsure, 26% (95% CI, 17-38; I2, 92%) would donate to others, and 12% (95% CI, 6-21; I2, 88%) would discard their eggs. Psychosocial determinants: One study reported that 50% of these women were aware of friends and/or family having difficulty conceiving, which may have contributed to their willingness to donate to others. Potential EEFs were included in 4 studies (n = 645), of whom 38% (95% CI, 28-50; I2, 84%) would donate to research, 32% (95% CI, 17-51; I2, 91%) would donate to others, 29% (95% CI, 17-44; I2, 89%) would discard, and 7% (95% CI, 1-27; I2, 77%) were unsure. Psychosocial determinants: No studies. Women of reproductive age were included in 5 studies (n = 3,933), of whom 59% (95% CI, 48-70; I2, 97%) would donate to research and 46% (95% CI, 35-57; I2, 98%) would donate to others. "Unsure" and "discard" were not provided as response options. Psychosocial determinants: One study reported that the facilitators for donation to others included a family member or friend in need, to help others create a family, financial gain, to further science, and control or input over the selection of recipients. Barriers for donation included fear of having a biological child they do not know or who is raised by someone they know. CONCLUSION(S) No studies reported on the disposition outcomes of past EEFs. Disposition intentions varied across the three groups; however, "donating to research" was the most common disposition preference. Notably, the second disposition preference for one-third of actual EEFs was "unsure" and for one-third of potential EEFs was "donate to others." There were limited studies for actual and potential EEFs, and only two studies that explored the psychosocial determinants of oocyte disposition intentions. Additionally, these data suggest that disposition decisions change as women progress on their egg freezing journey, highlighting the importance of ongoing contact with the fertility team as intentions may change over time. More research is needed to understand the psychosocial determinants of oocyte disposition decisions so fertility clinics can provide EEFs with the support and information they need to make informed decisions about their stored eggs and reduce the level of uncertainty reported among EEFs and the potential risk of psychological distress and regret. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO 2020: CRD42020202733.
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Affiliation(s)
- Lucy E Caughey
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia.
| | - Sarah Lensen
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, University of Melbourne, Level 7, Royal Women's Hospital, Victoria, Australia
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Bracewell-Milnes T, Holland JC, Jones BP, Saso S, Almeida P, Maclaran K, Norman-Taylor J, Nikolaou D, Shah NM, Johnson M, Thum MY. Exploring the knowledge and attitudes of women of reproductive age from the general public towards egg donation and egg sharing: a UK-based study. Hum Reprod 2021; 36:2189-2201. [PMID: 34227667 PMCID: PMC8648294 DOI: 10.1093/humrep/deab157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the knowledge and views of UK-based women towards egg donation (ED) and egg sharing (ES)? SUMMARY ANSWER Lacking knowledge of the practices of ED and ES could be an influential factor in donor egg shortages, rather than negative perceptions or lack of donor anonymity and financial incentives. WHAT IS KNOWN ALREADY The increasing age of women trying to conceive has led to donor egg shortages, with ED and ES failing to meet demand. Indeed, in recent years in the UK, ES numbers have fallen. This results in long waiting lists, forcing patients abroad for fertility treatment to take up cross border reproductive care. Previous research suggests a lack of knowledge of ED among members of the general public; however, no study has yet assessed knowledge or views of ES in the general public. STUDY DESIGN, SIZE, DURATION Six hundred and thirty-five UK-based women over 18 years were voluntarily recruited from social media community groups by convenience sampling. The recruitment period was from February to April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants completed a previously validated questionnaire regarding female fertility, ED and ES, including knowledge, perceptions and approval of the practices and relevant legislation. This included ranking key benefits and issues regarding egg sharing. The questionnaire was completed using the online Qualtrics survey software. Statistical analysis was conducted using SPSS. MAIN RESULTS AND THE ROLE OF CHANCE Regarding knowledge of ED and ES, 56.3% and 79.8%, respectively had little or no prior knowledge. Upon explanation, most approved of ED (85.8%) and ES (70.4%). A greater proportion of respondents would donate to a family member/friend (49.75%) than to an anonymous recipient (35.80%). Overall, ES was viewed less favourably than ED, with ethical and practical concerns highlighted. Women aged 18-30 years were significantly more likely to approve of egg donation practice compared to those aged >30 years (P < 0.0001). Those against ES found fears of financial coercion or negative psychological wellbeing the most concerning. About 35.8% and 49.7% would personally consider anonymous and known ED, respectively, whilst 56.7% would consider ES. Those answering in favour of egg sharing were significantly more likely to give higher benefit ratings compared to those against the practice (P < 0.001). Most agreed (55.8%) with and were not deterred to donate (60.1%) by the 'Disclosure of Donor Identity' legislation. Only 31.6% agreed with the compensatory cap; however, 52.7% would not be more motivated to donate by an increased cap. LIMITATIONS, REASONS FOR CAUTION There were several limitations of the study, including the use of convenience sampling and the voluntary nature of participation opening the study up to sampling and participation bias. Finally, closed questions were predominantly used to allow the generation of quantitative data and statistical analysis. However, this approach prevented opinion justification and qualitative analysis, limiting the depth of conclusions drawn. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the first study to survey the general public's knowledge and views of ED/ES using a previously validated questionnaire. The conclusion that lack of knowledge could be contributing to the current donor shortfall in the UK demonstrates that campaigns to inform women of the practices are necessary to alleviate donor oocyte shortages. STUDY FUNDING/COMPETING INTEREST(S) No external funds were used for this study. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Timothy Bracewell-Milnes
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK.,Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - James C Holland
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paula Almeida
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK
| | - Kate Maclaran
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK
| | | | | | - Nishel M Shah
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Mark Johnson
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK.,The Lister Hospital, The Lister Fertility Clinic, London, UK
| | - Meen-Yau Thum
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK.,The Lister Hospital, The Lister Fertility Clinic, London, UK
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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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Fuchs Weizman N, Baram S, Montbriand J, Librach CL. Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective. BJOG 2020; 128:950-962. [PMID: 33021076 DOI: 10.1111/1471-0528.16555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advances in vitrification techniques have enabled planned oocyte cryopreservation ('Planned OC'). OBJECTIVES To explore the cost-efficiency and utilisation of planned OC, as well as patients' perspectives on the process. SEARCH STRATEGY A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019. SELECTION CRITERIA The protocol followed PRISMA guidelines in PECO format, and was registered with PROSPERO. DATA COLLECTION AND ANALYSIS Two independent reviewers evaluated all manuscripts for inclusion eligibility. Authors were contacted for missing data. Included studies were assessed for risk of bias and for heterogeneity. Weighted effects were measured and plotted. MAIN RESULTS The search yielded 12 545 records, of which 43 were included. Planned OC is cost-efficient at 35, assuming 60% utilisation; and at 37 assuming utilising donor sperm when necessary. At 38 it is cost-efficient to defer planned OC in favour of undergoing 2 IVF cycles. Currently, utilisation of banked-oocytes within 22-58 months, is up to 15%. Nine percent of warmed banked oocytes result in life births. Online resources and treating physicians are equally important sources of information regarding planned OC. Most patients think planned OC is ideal before age 35 and are not fully aware of what the process entails and tend to overestimate the success rates. The main barrier to wider endorsement of planned OC is being wary of potential health implications or of limited success. CONCLUSION Planned OC is an adequate method for preserving fertility. However, knowledge gaps result in under-utilisation leading to reduced cost-efficiency. TWEETABLE ABSTRACT Identifying facilitators and barriers for wider adoption of banking oocytes can enhance the cost-efficiency of this modality.
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Affiliation(s)
| | - S Baram
- CReATe Fertility Centre, Toronto, ON, Canada
| | - J Montbriand
- Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C L Librach
- CReATe Fertility Centre, Toronto, ON, Canada.,Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
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