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 ... -  《-》

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 ... -  《-》

An unconventional path to conventional motherhood: A qualitative study of women's motivations and experiences regarding social egg freezing in the Netherlands.

What are women's motivations for social egg freezing and what are their experience regarding the egg freezing process in the Netherlands? Women who engage in social egg freezing are driven by feelings of fear, including the fear of not finding the suitable partner and fear of declining fecundity. They aim to fulfil their desire for having children with a partner. Alternative ways to achieve parenthood are considered if the conventional way of motherhood cannot be achieved. The reasons for social egg freezing are multi-fold, including amongst others economic, social, health, educational and career factors. The lack of a (stable) partnership, and a strong desire for a genetically related child with a committed partner are considered main reasons. A qualitative interview study, including 20 women, was conducted in the Netherlands between October 2018 and August 2019. Women between 32 and 42 years of age, who had completed the egg freezing trajectory for social reasons at three different medical centres in the Netherlands participated in the study. Semi-structured interviews were conducted face-to-face or via a teleconference tool and were recorded and transcribed verbatim. The interviews lasted between 30 and 90 minutes. Data were analysed using thematic content analysis. This study identified one overall theme: "an unconventional path to conventional motherhood" and five interpretive theme's: "fear of not becoming a mother, peace of mind, an unconventional path to motherhood, conventional perspectives, and financial discrimination". Women were afraid of not becoming a mother in the future. Despite the fact that all kinds of alternatives were available, conventional motherhood was preferred. Women chose a non-conventional path to reach this goal and they had to let go of traditional perspectives. Although they had the feeling of being discriminated financially, it gave them 'peace of mind'. The preserved oocytes gave them the sense of a fertility insurance for the future. The demographic profile displays a high degree of homogeneity, which may impact generalisability. This study contributes to a better understanding of women who cryopreserve their oocytes for social reasons. Healthcare professionals need to be aware of these motivations and perspectives. Understanding the underlying factors and emotional considerations in the decision-making process is crucial to provide proper counselling and optimal patient-centered infertility care. Furthermore, it is important to raise awareness about the possibilities of pursuing (alternative) motherhood to support effective policy making. However, social egg freezing remains closest to women's preferences of conventional motherhood, even in a country like the Netherlands, which is known for its progressiveness and focus on gender equality. Last, policy makers need to stimulate cost-effectivity and prevent younger women of pursuing social egg freezing as kind of a prevention method.

Kanters NTJ ，Brokke KE ，Bos AME ，Benneheij SH ，Kostenzer J ，Ockhuijsen HDL ... -  《Journal of Gynecology Obstetrics and Human Reproduction》

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 ... -  《-》

Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients.

Can a counseling tool be developed for women desiring elective oocyte cryopreservation to predict the likelihood of live birth based on age and number of oocytes frozen? Using data from ICSI cycles of a population of women with uncompromised ovarian reserve, an evidence-based counseling tool was created to guide women and their physicians regarding the number of oocytes needed to freeze for future family-building goals. Elective oocyte cryopreservation is increasing in popularity as more women delay family building. By undertaking elective oocyte freezing at a younger age, women hope to optimize their likelihood of successful live birth(s) using their thawed oocytes at a future date. Questions often arise in clinical practice regarding the number of cryopreserved oocytes sufficient to achieve live birth(s) and whether or not additional stimulation cycles are likely to result in a meaningful increase in the likelihood of live birth. As relatively few women who have electively cryopreserved oocytes have returned to use them, available data for counseling patients wishing to undergo fertility preservation are limited. A model was developed to determine the proportion of mature oocytes that fertilize and then form blastocysts as a function of age, using women with presumably normal ovarian reserve based on standard testing who underwent ICSI cycles in our program from January, 2011 through March, 2015 (n = 520). These included couples diagnosed exclusively with male-factor and/or tubal-factor infertility, as well as cycles utilizing egg donation. Age-specific probabilities of euploidy were estimated from 14 500 PGS embryo results from an external testing laboratory. Assuming survival of thawed oocytes at 95% for women <36 y and for egg donors, and 85% for women ≥36 y, and 60% live birth rate per transferred euploid blastocyst, probabilities of having at least one, two or three live birth(s) were calculated. First fresh male-factor and/or tubal-factor only autologous ICSI cycles (n = 466) were analyzed using Poisson regression to calculate the probability that a mature oocyte will become a blastocyst based on age. Egg donation cycles (n = 54) were analyzed and incorporated into the model separately. The proportion of blastocysts expected to be euploid was determined using PGS results of embryos analyzed via array comparative genomic hybridization. A counseling tool was developed to predict the likelihood of live birth, based on individual patient age and number of mature oocytes. This study provides an evidence-based model to predict the probability of a woman having at least one, two or three live birth(s) based on her age at egg retrieval and the number of mature oocytes frozen. The model is derived from a surrogate population of ICSI patients with uncompromised ovarian reserve. A user-friendly counseling tool was designed using the model to help guide physicians and patients. The data used to develop the prediction model are, of necessity, retrospective and not based on patients who have returned to use their cryopreserved oocytes. The assumptions used to create the model, albeit reasonable and data-driven, vary by study and will likely vary by center. Centers are therefore encouraged to consider their own blastocyst formation and thaw survival rates when counseling patients. Our model will provide a counseling resource that may help inform women desiring elective fertility preservation regarding their likelihood of live birth(s), how many cycles to undergo, and when additional cycles would bring diminishing returns. None. Not applicable.

Goldman RH ，Racowsky C ，Farland LV ，Munné S ，Ribustello L ，Fox JH ... -  《-》