Navigating the Maze of Planned Oocyte Cryopreservation: A Closer Look at Women’s Decision-Making

Introduction
The landscape of planned oocyte cryopreservation (POC) is rapidly evolving, with increasing numbers of women in high-income countries opting for this fertility preservation method. In the United States alone, the annual number of POC cycles has surged from around 2,700 in 2012 to a staggering 13,800 in 2018. Notably, the COVID-19 pandemic has further fueled interest in POC, revealing a growing trend in women considering this option.
 
Initially designed for fertility preservation in cancer patients, POC has transcended its experimental label, becoming an accessible choice for women concerned about age-related infertility. However, the decision to pursue POC is multifaceted, involving considerations such as age, success rates, costs, and potential health risks. This blog post delves into the findings of a survey exploring the information and decision support needs of women intrigued by the prospect of planned oocyte cryopreservation.
 
Decoding the Decision-Making Process
The decision to undergo POC is not a simple one; rather, it involves a myriad of factors. Age emerges as a pivotal predictor of success, with live birth rates per thawed-oocyte-derived embryo transfer decreasing significantly with advancing age. The financial implications of POC, including retrieval costs, storage fees, and future utilization expenses, create a substantial barrier for many women.
 
Moreover, the physical aspects of ovarian stimulation and oocyte collection introduce small yet noteworthy health risks. While complications are rare, they remain a concern for potential POC users. Additionally, the risk of severe maternal morbidity from pregnancy increases with age, adding another layer of complexity to the decision-making process.
 
Unraveling the Information Gap
The limited available evidence on POC decisions suggests that women crave more information and support to navigate this complex terrain. Studies indicate that inadequate information and emotional support contribute to regret among women who have undergone POC. The sources of information are diverse, ranging from media and online platforms to fertility clinics and primary care physicians.
 
However, these sources present their own challenges. Media information is often oversimplified, lacking depth and completeness. Fertility clinic information may carry commercial biases, and primary care physicians may feel ill-equipped to provide comprehensive guidance. This highlights a critical need for balanced and accessible information.
 
Surveying the Information Landscape
To shed light on the information and decision support needs of women considering POC, an online cross-sectional survey was conducted in Australia. Women aged 18-45 years, proficient in English, and interested in POC information were eligible to participate. The survey covered various aspects, including participant characteristics, information sources, preferences for information delivery, knowledge, decisional conflict, and time to decision.
 
Results and Reflections
The survey, conducted from June to December 2018, garnered responses from 332 women who met the eligibility criteria. Key findings include:
 
1. Demographics: Participants were predominantly aged ≤30 years, single, university-educated, and working in professional occupations.
 
2. Consideration of POC: The majority had contemplated POC, with various reasons such as single relationship status, a desire to invest in future reproductive potential, and health conditions driving interest.
 
3. Information Sources: Over half of the participants had actively searched for POC information, mainly relying on fertility clinic websites. Consultation with primary care physicians and fertility specialists was less common.
 
4. Preferences for Information Delivery: Participants favored receiving POC information between ages 19-30 years, primarily from healthcare professionals or through online resources.
 
5. Knowledge Gaps: Despite interest, participants exhibited knowledge gaps, particularly regarding POC procedure-related health risks, success rates, and the impact of time on oocyte quality in storage.
 
6. Decisional Conflict: Women who had considered POC often experienced high decisional conflict, emphasizing the need for additional decision support. Consulting an IVF specialist was associated with lower decisional conflict.
 
7. Time to Decision: The median time spent contemplating POC was around two years, with implications for the potential success of POC.
 
Closing Thoughts
The survey outcomes underscore the complexity of the POC decision-making process and the information gaps women face. Addressing these gaps is crucial for empowering women to make informed choices aligned with their reproductive goals. Primary care physicians and online resources emerge as key players in disseminating comprehensive and unbiased information. Additionally, the findings emphasize the potential value of decision aids in reducing decisional conflict.
 
As POC continues to gain prominence, the healthcare community must collaborate to provide accessible, transparent, and evidence-based information. By doing so, we can empower women to navigate the intricate landscape of planned oocyte cryopreservation and make decisions that align with their individual needs and aspirations.

Read more here: https://link.springer.com/article/10.1007/s10815-023-02796-x
 
Citation: Sandhu, S., Hickey, M., Braat, S., Hammarberg, K., Lew, R., Fisher, J., ... & Eggsurance Collaborative Group Agresta F Lieberman D Anderson R Norman R Hart R Johnson L Michelmore J Parle A Summers F Allingham C. (2023). Information and decision support needs: a survey of women interested in receiving planned oocyte cryopreservation information. Journal of Assisted Reproduction and Genetics, 40(6), 1265-1280.

Acknowledgements: ChatGPT was used to generate this content