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.
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
In a world where family planning decisions are becoming increasingly complex, elective egg freezing has emerged as a popular option for women who wish to extend their fertile years. The decision to freeze one's eggs is multifaceted and involves a range of considerations, from the financial aspects to the potential health risks. To address the need for comprehensive and accessible information, researchers have developed a Decision Aid for elective egg freezing. In this blog post, we will explore the development of this Decision Aid and the results of a phase 1 evaluation, shedding light on its acceptability and utility for women making this important decision.
Understanding the Need
The average age at which women have their first child has been steadily rising in many high-income countries. This trend, combined with various life circumstances, has led more women to consider elective egg freezing as a way to preserve their fertility. Women may choose to freeze their eggs for a variety of reasons, including the absence of a partner, concerns about their biological clock, a desire to insure against future infertility, or to avoid potential regret.
However, the decision to freeze one's eggs is not without its challenges. It involves significant financial costs, and the success rates decrease as women age. Furthermore, there are rare but serious health risks associated with the procedure. Moreover, many women who freeze their eggs may not end up using them, often due to the lack of a suitable partner for co-parenting.
Recognizing these complexities, the researchers embarked on the journey to develop a Decision Aid that would provide women with the necessary information and support to make informed choices about elective egg freezing.
Development of the Decision Aid
To create the Decision Aid, a collaborative group of experts from various fields, including psychology, gynaecology, clinical research, and public education, joined forces. They followed international patient decision aid standards and utilized the Ottawa Decision Support Framework to ensure that the content and design met the highest quality standards.
The Decision Aid, titled 'Egg Freezing,' offers comprehensive information, including the pros, cons, and implications of egg freezing, as well as alternatives to consider. It is designed with clarity and accessibility in mind, using text, infographics, and video animations. A special feature is a values clarification exercise, which helps users assess their personal preferences and concerns regarding egg freezing.
Phase 1 Evaluation: Acceptability and Utility
To evaluate the Decision Aid, researchers conducted a phase 1 study involving 26 Australian women aged 18–45 who were interested in receiving egg freezing information. Here are some key findings from the evaluation:
The development and phase 1 evaluation of the Decision Aid for elective egg freezing represent a significant step forward in empowering women to make informed decisions about their fertility. The tool's acceptability, utility, and positive impact on knowledge and decisional conflict suggest that it holds great promise as a valuable resource.
As further evaluation through a prospective randomized control trial is planned, the Decision Aid may soon become widely available to women considering elective egg freezing. With this resource at their disposal, women can navigate the complexities of this decision with greater confidence and clarity, ultimately shaping their reproductive futures on their terms.
Read more here: https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-023-02178-4
Citation: Sandhu, S., et al. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Medical Informatics and Decision Making 2023
Acknowledgements: ChatGPT was used to generate this content
Understanding the Experiences and Priorities of Women with Ovarian Cancer: Implications for Support and Care.
Post by A/Prof Michelle Peate
Ovarian cancer is the third most common gynaecological cancer among women. Despite its prevalence, ovarian cancer remains under-researched, and the supportive care needs of women with this condition are often overlooked. Our recent study aimed to shed light on the experiences and priorities of women diagnosed with ovarian cancer. The findings provide valuable insights that can inform the development of tailored support and care strategies for women facing this challenging diagnosis.
Exploring the Experiences and Priorities
The study was conducted in collaboration with Ovarian Cancer Australia (OCA), involved 288 participants recruited through a targeted social media campaign. The participants were asked to rank nine aspects of living with ovarian cancer based on their perceived level of challenge. The results showed that fear of cancer recurrence was the most commonly (51%) identified and challenging aspect – highlighting the need for interventions that address this and to alleviate the distress associated with the possibility of cancer returning.
One interesting aspect was the potential influence of age on the experiences and priorities. While the priorities did not significantly vary by age, there were notable differences in the utilization of support and information resources. Younger participants, aged 19-49, showed a higher inclination to use a mobile app version of the OCA resilience kit, indicating their preference for digital tools in managing their condition. Moreover, younger women expressed a greater interest in utilizing a fertility preservation decision aid, highlighting their specific concerns related to future parenthood and family planning.
Advancing Patient-Centered Tailored Support and Care
Patient-centered care, which places the individual's needs and preferences at the forefront of healthcare delivery, is crucial for improving the quality of life of women with ovarian cancer. By identifying the priorities and experiences of these women, healthcare providers can develop tailored interventions and resources that better address their unique challenges. The study highlights the importance of considering age-specific differences and utilizing technology-based solutions to reach and engage a wider audience, including older individuals who may face barriers in accessing relevant health information online. By adopting patient-centered approaches, healthcare providers and support organizations can make significant strides in improving the well-being and quality of life for women living with ovarian cancer.
Read more here: https://link.springer.com/article/10.1007/s00520-023-07903-3
Citation: Pasvanis M, et al. Exploring the experiences and priorities of women with a diagnosis of ovarian cancer. Supportive Care in Cancer 2023.
Acknowledgements: ChatGPT was used to generate this content
Understanding the Role of Family and Partner Support in Fertility Decision-Making Among Adolescents and Young Adults with Cancer: Insights from a National Australian Study
Post by A/Prof Michelle Peate
Getting diagnosed with cancer as a young person can be overwhelming. It not only affects your health but also brings up worries about the future, including the ability to have children. We aimed to understand how young people with cancer and their families make decisions about preserving their fertility. By exploring their experiences, we hope to improve the support and care available to these individuals.
Understanding Fertility Concerns
Cancer treatments can sometimes affect fertility, making it harder to become pregnant or have biological children later on. Fertility preservation offers options to protect fertility, but it comes with its own risks and considerations. The decision to pursue fertility preservation is complex, as young patients must weigh their desire for children against the costs and chances of success, all while dealing with the stress of a cancer diagnosis.
The Importance of Family and Partner Support
Family and partners play a crucial role in the lives of young people with cancer. They help navigate the challenges of treatment and provide emotional support. In this study, researchers wanted to understand how family members and partners contribute to the decision-making process regarding fertility preservation.
The study involved 196 young cancer patients in Australia.
In summary, this Australian study sheds light on the experiences of young cancer patients when it comes to making decisions about preserving their fertility. It highlights the importance of involving parents, especially mothers and fathers, in these discussions. Their support is valuable in helping young patients make informed choices about fertility preservation. The study also emphasizes the need to explore how partners and siblings can contribute to these decisions. By understanding the dynamics of family and partner support, healthcare providers can improve the care and support available to young cancer patients, ultimately enhancing their quality of life and well-being as they continue their cancer journey.
Read more here: https://www.liebertpub.com/doi/full/10.1089/jayao.2023.0037
Citation: Marino JL et al. Experiences of Family and Partner Support in Fertility Decision-Making Among Adolescents and Young Adults with Cancer: A National Australian Study. JAYAO 2023.
Acknowledgements: ChatGPT was used to generate this content
Post by Lucy Caughey
Elective egg freezing is an option women choose to preserve their fertility to have a genetically linked child in the future, for reasons such as not having met a suitable partner to have a child with. Elective egg freezing became available in Australian in December 2012, when the procedure was no longer labelled experimental. Since then egg freezing has grown exponentially and in 2020 there were 2900 freeze all egg cycles in Australia and New Zealand. On average women freeze approximately 9 eggs per cycle depending on their age (9 eggs if they are under 35, 9 eggs if they are 35-39, and 6 eggs if they are aged 40 plus).
Therefore, many women are choosing to freeze their eggs, however research tells us most women (68% to 94%) do not return to use their eggs, resulting in an abundant but unquantified number of eggs in storage. Women do not return to use their eggs for many reasons such as, conceiving naturally, reaching an upper age-limit of willingness to become mothers, and not wanting to be a single parent (having not met a suitable partner and choosing not to use donor sperm). Despite the low usage rates of stored eggs, the majority of women do not regret freezing their eggs, because a principal reason of women freezing their eggs is having no regrets or as much choice as possible for their parenting future. This is a concept many people, not faced with this situation, seem to have difficulty grasping, as they view the only successful outcome of freezing eggs is to have a child. However, women who freeze their eggs, like women who naturally conceive, prefer to bring a child into the world in an ideal situation, financially, emotionally and providing enough time and support for a child.
Therefore, we now have many eggs in storage in Australia and because most jurisdictions of Australia have a 10-year storage limit for gametes, most elective egg freezers now and in the future will have to decide what to do with their surplus frozen eggs. This is called a disposition decision. In Australia women can choose to
Oocyte disposition decision outcomes and the factors influencing the decision have been explored for the first time in the study Elective egg freezers' disposition decisions: a qualitative study.
This study found that the disposition decisions are dynamic and often women’s preferences at the beginning of the process of freezing their eggs is not their preference at the time they have to make their final decision depending on a number of factors. One of these factors was whether women achieve motherhood or not. When women first achieve motherhood they are in an emotional state of happiness and want to share the joy of motherhood, therefore they are open to donating their eggs to others. The wish of wanting to share the joy of motherhood are driven by feelings of empathy for others who have faced similar fertility challenges, reciprocity for those women who have received donor sperm and now feel they would also like to reciprocate by donating to others and altruism , the feeling of just wanting to give to others in need. However, when these women are actually faced with making their final decision their focus changes to the child. The child being the child or children they are raising and the impacts on that child. For instance, the concern their child may have too many half-siblings so the child feels overwhelmed or has too many half-siblings to have real relationships with. The potential egg donors are also concerned about the child resulting from their egg donation, will they have family identity issues or not feel they fit in to their family. These are serious concerns women have.
For those women who did not achieve motherhood, they are in a grieving process and feel isolated and misunderstood. They feel misunderstood as their loss is not tangible like a miscarriage but conceptual, the loss of a dream of being a mother. These women are unlikely to be able to consider donating to others as their dream has not come true, so they move on to deciding whether to donate their eggs to research, to discard them or to reclaim them. Reclaiming their eggs to take them home to have a closure ceremony helps some women in their grieving process.
Post by Anastasia Vakkas
In a world where information is available in seconds, it is no doubt frustrating that when it comes to our own bodies, the answers we seek are often the hardest to find.
Despite significant advancements in the field of reproductive medicine, fertility remains shrouded in mystery. Century old myths and misconceptions about what is good and bad for one’s fertility continue to spread, now repackaged and propagated through social media and influencer culture. Sadly, these ideas continue to make infertility a mostly ‘female’ issue and place the responsibility of childbearing on women. Almost a third of couples that struggle to conceive are told they have ‘unexplained’ infertility. It is therefore no surprise that as more and more women choose to start their families later in life, they may be interested in understanding their future fertility.
Anti-Müllerian Hormone (AMH) is a test that is increasingly being spruiked as a measure of fertility in the medical sphere. Many women have anxieties when it comes to fertility. Clare Stephens (Editor in Chief of Mamamia) stated in an article that when it comes to fertility, ‘knowledge is power’. She wrote, “despite my immediate uncertainty, having my AMH tested has given me some piece of mind, even if it's not exactly logical”. The idea of things being ‘not exactly logical’ is a vital part of the story when it comes to AMH- while performing the test is simple (a blood test), the information it yields is not.
AMH needs to be interpreted with nuance and careful consideration, alongside other factors. There are many factors involved in conceiving a baby that an AMH test does not consider. Whilst AMH can help plan fertility treatment, it doesn’t give any information about your fertility (i.e. the quality of the eggs or any other fertility-related conditions you might have). Without a proper consultation with a fertility consultant, the results can be misleading.
Even though AMH test results alone cannot give an accurate prediction of future fertility some providers market AMH as a way to this. This is concerning as women may change their reproductive plans based on these results - such as becoming pregnant earlier or later than originally planned or opting to use costly reproductive technologies such as IVF and elective egg freezing.
What’s more, there is very little data about what women understand about AMH testing and what a test result may mean for them, prior to undergoing the test. There is even less data on how receiving an AMH test result may affect a woman’s emotional and psychological wellbeing. Knowledge may be power, but what are the broader consequences of this knowledge? In fact. is all knowledge, good or bad, empowering?
A joint research project between the the University of Melbourne and the Royal Women’s Hospital seeks to explore how AMH test results are shared with women, how this impacts women’s wellbeing, and how it may influence their choices and behaviours around family planning. Researchers are aiming to investigate whether AMH test results change women’s plans to become pregnant or lead to use of assisted reproductive technologies such as IVF and elective egg freezing.
The project hopes to survey more than 300 women who had an AMH test in the past five years. Ultimately, the results of this study will seek to improve communication around AMH test results- so that women can understand what an AMH test result might mean for them and are empowered to make informed and contextualised reproductive decisions.
Researchers would love to hear from you if you are:
- Aged 18-55
- Have had an AMH test in the past 5 years
- Have not had difficulty conceiving for more than 12 months (if you are trying/or have tried to become pregnant); and
- Have 15-20 minutes to this survey
Interested? Find out more: go.unimelb.edu.au/x6di
Below is a Blog Post by Dr. Michelle Peate originally published on the Cancer Knowledge Network website which has been copied here:
The idea that we can have a child when we choose to is an important part of human identity, and having this taken away from us can be really upsetting. Unfortunately, many young women who are diagnosed with breast cancer face this issue. Treatments for their cancer such as chemotherapy, may mean sacrificing their chances for future children.
My research has shown that young women who are diagnosed with breast cancer worry about infertility as a result of their cancer treatment. Around two thirds of them told us that they want (more) children in the future and that this is really important to them.
The great news is that there is hope for these women. Many women in this situation can access options that can maximise their future opportunities to become parents. The most common options are to freeze eggs or to create and freeze embryos before starting cancer treatment. There are also some other experimental options, such as freezing ovarian tissue that can be considered.
However, the decision to preserve fertility is a difficult one.
Ultimately, a good fertility preservation decision will weigh up the benefits and consequences of the decision, and women will make a choice that is consistent with their personal values. In an attempt to support this process, we developed a decision support tool (called a decision aid) to help young women faced with this issue. The decision aid booklet was designed by a team of experts, using evidence to present information about breast cancer and fertility and the relationship between the two. It also presented women with values clarification exercises to facilitate the weighing up of the benefits and consequences for each fertility preservation option.
We evaluated the decision aid (read the paper here) amongst 120 young women who were newly diagnosed with early breast cancer across Australia. We found that the decision aid improved the quality of decision-making. Women who received the decision aid had more knowledge about fertility preservation and experienced greater satisfaction with the decision they made. They also were more certain about their decision and felt less regret than those who did not get the booklet.
It is very exciting to have an effective and useful tool that can now be used as part of clinical care. The decision aid has just been updated in light of new technologies and can be accessed here. Although we encourage you to use this tool if you are a young woman with early breast cancer considering your options or a clinician of a patient who is in this position, please keep in mind that this was designed for an Australian audience so there may be some differences around what is accessible in your location.
Now that we have done this, you might ask: where to next?
Well, our group is now working on a website which presents this information in an easily accessible way so that people who would prefer not to have to read a whole lot of information in a booklet can still get hold of it online – where information will be presented through simple English, videos and animations. Ultimately, this decision aid will be specifically designed for those who find health information difficult to understand and process. This decision aid will be formally evaluated in a randomised controlled trial and be made available to the public following completion of the trial.
As mentioned above, one of the challenges in this field is calculating a woman’s chance of infertility. Current ‘calculators’, don’t tend to take into account a woman’s fertility before her cancer AND her recommended treatment. So our team is also in the process of developing a fertility predictor that will be used by health care practitioners to work out a woman’s risk of infertility. This tool will use personal factors, clinical data (such as blood biomarkers) and the recommended cancer treatment to predict a personalised risk of infertility. We will also evaluate this in a clinical trial and will be available following completion of the trial.