Disposition intentions of elective egg freezers toward their surplus frozen oocytes: a systematic review and meta-analysis.

To examine the disposition outcomes and disposition intentions of elective egg freezers (EEFs) toward their surplus frozen oocytes and the psychosocial determinants underlying these. A systematic review and meta-analysis. Not applicable. 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). 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. 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. 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. 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. PROSPERO 2020: CRD42020202733.

Caughey LE ，Lensen S ，White KM ，Peate M ... -  《-》

Elective egg freezers' disposition decisions: a qualitative study.

To explore the factors that influence elective egg freezers' disposition decisions toward their surplus-frozen oocytes. Qualitative. Not applicable. Thirty-one participants: 7 past; 6 current; and 18 future oocyte disposition decision-makers. Not applicable. Qualitative thematic analysis of interview transcripts. Six inter-related themes were identified related to the decision-making process which are as follows: decisions are dynamic; triggers for the final decision; achieving motherhood; conceptualization of oocytes; the impacts of egg donation on others; and external factors affecting the final disposition outcome. All women reported a type of trigger event for making a final decision (e.g., completing their family). Women who achieved motherhood were more open to donating their oocytes to others but were concerned about the implications for their child and felt responsibility for potential donor children. Women who did not achieve motherhood were unlikely to donate to others due to the grief of not becoming a mother, often feeling alone, misunderstood, and unsupported. Reclaiming oocytes (e.g., taking them home) and closure ceremonies helped some women process their grief. Donating to research was viewed as an altruistic option as oocytes would not be wasted and did not have the "complication" of a genetically-linked child. There was a general lack of knowledge around disposition options at all stages of the process. Oocyte disposition decisions are dynamic and complex for women, exacerbated by a general lack of understanding of these options. The final decision is framed by: whether women achieved motherhood, dealing with grief if they did not achieve motherhood, and considering the complexities of donating to others. Additional decision support through counseling, decision aids, and early consideration of disposition when eggs are initially stored may help women make informed decisions.

Caughey LE ，White KM ，Lensen S ，Peate M ... -  《-》

Women Electing Oocyte Cryopreservation: Characteristics, Information Sources, and Oocyte Disposition: A Systematic Review.

Recently, there is a growing interest in cryopreservation for nonmedical reasons, widely known as planned oocyte cryopreservation. This review aims to summarize and understand the characteristics of women who undergo or consider planned oocyte cryopreservation, identify their initial sources of information, and describe the oocyte disposition. This information should assist health professionals with shared decision-making. A systematic review was performed and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. PubMed, Scopus, and Web of Science were searched from inception to January 2021 without any limitation on publication date. Studies were included if they were in English and examined the characteristics of users or potential users of planned oocyte cryopreservation, initial information sources, and the oocyte disposition. Extracted data were analyzed using thematic analysis. The methodological quality of the recruited studies was assessed with the QualSyst criteria. Of 1074 initially retrieved records, 29 met the inclusion criteria, including 12 qualitative and 17 quantitative studies. Response rates of surveys ranged between 38% and 85%. Most of the users or potential users of planned oocyte cryopreservation were single, highly educated, and employed and had a mean age of 37 years. Media and friends were the most common sources of initial knowledge about planned oocyte cryopreservation, and health professionals were a less common source. The majority of planned oocyte cryopreservation users did not attempt pregnancy with their frozen oocytes, yet they did not regret having undergone the procedure. The results regarding the disposition intentions of unused frozen oocytes are inconsistent. Most of the users or potential users of planned oocyte cryopreservation have specific demographic characteristics and do not ultimately use their cryopreserved oocytes. Unused oocytes can be discarded or donated to other women or to research. By understanding the main characteristics of potential users of planned oocyte cryopreservation, health professionals can provide proper counseling and support effective decision-making.

Giannopapa M ，Sakellaridi A ，Pana A ，Velonaki VS ... -  《-》

Is employer coverage of elective egg freezing coercive?: a survey of medical students' knowledge, intentions, and attitudes towards elective egg freezing and employer coverage.

Ikhena-Abel DE ，Confino R ，Shah NJ ，Lawson AK ，Klock SC ，Robins JC ，Pavone ME ... -  《-》

Examining willingness to donate frozen oocytes among women of reproductive age.

What are the predictors of willingness to donate frozen oocytes among women of reproductive age in Australia? An online survey involving 303 women of reproductive age (18-49 years) in Australia who had not frozen their oocytes or planned to freeze their oocytes in the next 12 months. The survey assessed demographic variables, prototype willingness model variables (attitude, subjective norm, prototype similarity and prototype favourability) and additional variables (altruism, empathy and infertility awareness) as predictors of hypothetical scenarios of willingness to donate frozen oocytes. A multivariate repeated measures analysis of variance explored differences in willingness to donate frozen oocytes. Hierarchical multiple regression analysis examined predictors of donor willingness. Women's willingness to donate their frozen oocytes was higher for donating to a friend or family member and to research compared with an egg bank or fertility clinic, or a couple advertising online for an egg donor (all P < 0.001). The prototype willingness model variables were significant predictors of willingness to donate showing slightly varied patterns across four scenarios. After accounting for demographics, regression models including prototype willingness model variables and additional variables accounted for 45-64% of variance in donor willingness. Frozen oocyte donation may be facilitated by improving attitudes towards donation and establishing positive images of donors. Professionals requiring frozen oocytes for research could focus on creating a sense of social approval for donating in this context. Encouraging frozen oocyte donation could increase access to oocytes for IVF treatment and aid in reducing the psychological burdens associated with involuntary childlessness.

Duncan JP ，Caughey LE ，White KM 《-》