Prospective survey exploring decision-making among patients pursuing oocyte and/or embryo cryopreservation prior to gonadotoxic therapy: Seeking certainty or harboring hope?

PURPOSE: To assess the extent to which patients pursuing medically-indicated fertility preservation (FP) prioritize reproductive certainty vs. hope, and to correlate specific FP strategies with post-cycle satisfaction, anxiety, and optimism.

METHODS

Prospective survey of patients with ovaries 18-45y requiring fertility-compromising therapy having completed a FP consult at an academic fertility center from 10/2021-2/2023.

RESULTS

Among 136 eligible patients, 70 completed the survey. Of those planning FP, 35 planned egg freezing (57.4%), 16 embryo freezing (26.2%), and 10 both (16.4%). Those freezing eggs were younger (29.7 ± 6.5y) vs. those freezing embryos (35.8 ± 4.5y) or both (30.9 ± 6.1y) (p = 0.01). While those freezing embryos were more likely to be married (12/16, 75%), 33% of married individuals froze at least some eggs. Of those freezing embryos, 88.5% said they would want to know if their embryos were abnormal; however, only 46.2% planned pre-implantation genetic testing (PGT). Fifty-three patients ultimately completed ≥ 1 cycle: 64.1% eggs, 30.2% embryos, and 5.7% both. Among those completing the post-cycle survey (n = 42), cycle satisfaction varied by FP strategy, from 62% for embryos to 96% for eggs and 100% for both (p = 0.013). Anxiety measure scores were higher pre- vs. post-cycle (median [IQR] = 8 [6-12] vs. 6 [0-8], p < 0.001), whereas optimism measure scores were similar throughout.

CONCLUSIONS

FP decisions are nuanced and individualized. Notably, patients freezing eggs who therefore had less concrete information about reproductive potential endorsed higher cycle satisfaction. More thorough understanding of this complex decision-making may help optimize counseling and support.