Rethinking decision-making support in elective egg freezing: complementing counselling with decision aids.

Background:Uptake of elective egg freezing has increased globally. The decision to freeze eggs is complex, and detailed, unbiased information is needed. To address this, we developed an online Decision Aid for women considering elective egg freezing. Decision Aids are the standard of care to support complex health decisions.Objectives:This study will measure the impact of the Decision Aid on decision-making (e.g. decisional conflict, engagement in decision-making, distress, and decision delay) and decision quality (e.g. knowledge, level of informed choice, and regret).Methods and Analysis:A single-blinded two-arm parallel-group randomized controlled trial. Women considering elective egg freezing will be recruited using social media, newsletters, and fertility clinics. Data will be collected at baseline (recruitment), 6-month, and 12-month post-randomization. The primary hypothesis is that the intervention (Decision Aid plus Victorian Assisted Reproductive Technology Authority website) will reduce decisional conflict (measured using the Decisional Conflict Scale) at 12 months more than control (Victorian Assisted Reproductive Technology Authority website only). Secondary outcomes include engagement in decision-making (Perceived Involvement in Care Scale), distress (Depression, Anxiety, and Stress Scale), decision delay, knowledge, informed choice (Multi-dimensional Measure of Informed Choice), and decisional regret (Decisional Regret Scale).Ethics:The study was approved by the University of Melbourne Human Research Ethics Committee (Ethics ID: 2056457). Informed consent will be obtained from all participants prior to enrolment.Discussion:This is the first international randomized controlled trial that aims to investigate the effect of an elective egg freezing Decision Aid on decision-related outcomes (e.g. decisional conflict, informed choice, and regret). It is anticipated that participants who receive the Decision Aid will have better decision and health outcomes.Registration details:ACTRN12620001032943: Comparing different information resources on the process and quality of decision-making in women considering elective egg freezing.

<p dir="ltr">The use of elective egg freezing (EEF) has rapidly increased in recent years. Despite its popularity, scholars have documented a host of concerns in relation to the use of this technology, especially given aggressive advertising of EEF by the fertility industry as “insurance” and lack of data about success rates. Informed consent processes, and informed consent materials, are particularly important in situations like EEF where healthy people are undergoing interventions that are neither life nor health preserving. Despite these concerns necessitating a rigorous consent process, no research in Canada has explored consent processes surrounding EEF at Canadian fertility clinics to assess whether they are meeting this heightened standard. In this paper, I analyze EEF consent forms and accompanying materials collected from 11 Canadian fertility clinics. I assess the extent to which the consent forms and accompanying materials adhere to a seven-part ethical framework for minimum standards of disclosure for EEF that I argue is supported by Canadian legislation, regulations, guidelines, case law and Health Professions Appeal and Review Board (HPARB) decisions on informed consent. Ultimately, I found that consent processes for EEF rely on an unstandardized patchwork of information sources. Clinic consent forms and accompanying materials do not adhere to minimum elements of disclosure for consent for EEF and, in many cases, do not adhere to existing law, guidelines and HPARB decisions governing these consent processes in Canada. I argue that an overhaul is needed to ensure that people freezing their eggs have the basic information they need to make informed decisions and make recommendations for how to further regulate EEF consent processes.</p>

The marketing of elective egg freezing: A content, cost and quality analysis of UK fertility clinic websites

Oocyte vitrification for elective fertility preservation: a SWOT analysis

Researchers have documented the dominance of intensive mothering ideologies and their impact on mothers and their families. However, the effect of these ideologies on childless women has received little attention. I draw on interview data to examine the parenting ideologies of childless women with electively frozen eggs. I demonstrate that incorporation of and commitment to intensive mothering ideologies affect fertility decision making among these childless women. I find that concerns about the heavy burdens of intensive motherhood, coupled with unsupportive partners and workplaces, produce ambivalence toward childbearing and a strategy of fertility postponement. I extend the literatures on intensive mothering, reproductive decision making, assisted reproductive technologies (ARTs), and elective egg freezing by identifying egg freezing as an expression of the gendering of fertility risk and as a means of “doing security.” Participants view egg freezing as a means of managing risk in two primary ways: as a means of securing access to biogenetic motherhood by managing biological risks of infertility and fetal genetic abnormality, and as a means of enabling intensive parenting by managing temporal risks inherent in coordinating careers, relationships, and childbearing.

Elective egg freezing is a treatment to help patients increase their chance of pregnancy at a later, more advanced age Elective egg freezing, or oocyte cryopreservation, involves controlled ovarian stimulation, followed by an egg retrieval procedure. Patients considering this treatment are

Does the use of an online decision aid (DA) about fertility preservation (FP), in addition to standard counselling by a specialist in reproductive medicine, reduce decisional conflict compared to standard counselling alone? Female cancer patients who could make use of the online DA had a significantly lower short-term decisional conflict score. Nowadays, female cancer patients have several options for preserving fertility, but having to decide whether to opt for FP within a short time frame after cancer diagnosis and before the start of treatment is challenging. According to previous studies focussing mainly on breast cancer patients, decisional conflict among these women is high, and they have expressed the need for additional support. The study was a randomized controlled trial including female cancer patients who were referred by their treating oncologist to a specialist in reproductive medicine for fertility counselling. Participants were randomly assigned to the control group (counselling only) or to the intervention group (counselling and additional use of the online DA immediately after counselling). Recruitment was ongoing from July 2016 to December 2017 at eight fertility centres in Switzerland and Germany. The online DA was developed by an interdisciplinary team of specialists in reproductive medicine, gynaecologists, oncologists and psychologists. Of 79 recruited participants, 59 completed the first assessment and could therefore be enrolled in the study. They were asked to complete an online questionnaire at three time points: at T1, after counselling (control group, n = 27) or after counselling and the additional use of the DA (intervention group, n = 24); at T2, 1month later (N = 41: control group, n = 23; intervention group, n = 18); and at T3, 12months later (N = 37: control group, n = 20; intervention group, n = 17). The survey comprised questions about fertility-related knowledge, attitude towards FP, willingness to undergo FP and socio-demographic data, as well as the decisional conflict and decisional regret scales. All participants showed low decisional conflict scores. Women who used the online DA in addition to counselling (intervention group) showed a significantly lower total score on the Decisional Conflict Scale (DCS) compared to the control group at T1 (P = 0.008; M = 12.15, SD = 4.38; 95% CI, 3.35-20.95) and at T2 (P = 0.043; M = 9.35, SD = 4.48; 95% CI, 0.31-18.38). At T3, the mean total score of the DCS was still lower in the intervention group compared to the control group; however, this group difference was no longer significant (P = 0.199, M = 6.86, SD = 5.24; 95% CI, -3.78 to 17.51). The majority of participants had already made a decision regarding FP (yes or no) at T1 (72.5%): 91.7% in the intervention group compared to 55.6% in the control group (P = 0.014). Those who had decided already at T1 showed significantly lower decisional conflict (P = 0.007; M = 13.69, SD = 4.89; 95% CI, 3.86-23.52). The average number of DA sessions per user was 2.23, and 80.8% of the participants completed the DA's value clarification exercises. Participants in the intervention group were satisfied with the DA and would recommend it to other patients. The recruitment of participants was challenging because of the emotionally difficult situation patients were in. This led to the limited sample size for final analysis. Education levels were high in two-thirds of the participants. It is difficult to say whether the DA would be equally effective in women with a lower educational background. There is evidence that the DA served as a helpful complement to the decision-making process for young female cancer patients qualifying for FP. This is, to our knowledge, the first randomized controlled trial evaluating a DA targeted at patients with several cancer types and in a language other than English (i.e. German). This study contributes to extending the range of the still limited number of DAs in the context of FP. The study was supported by a research grant of the Swiss Cancer Research. The authors declare that no competing interests exist. Clinicaltrials.gov, trial no. NCT02404883. 19 March 2015. 4 July 2016.

Evidence suggests that curative treatment for low-risk prostate cancer (LRPC) has no survival benefits over active surveillance (AS); thus, treatment choice becomes a value-sensitive decision. Decision aids (DAs) have the potential to facilitate this process, yet no DA has been tailored to the Australian health care system or population. This study aims to evaluate the impact of an online DA (Navigate) on the uptake of AS, quality of life, and decision-making in Australia. This parallel-group, prospective, randomised controlled trial recruited men (from May 2017 to May 2021) from participating cancer centres, via self-referral, or via clinician referral. The inclusion criteria were the following: a recent LRPC diagnosis, no decision on treatment, and clinical suitability for AS. Partners could also enrol. Assessments were undertaken at baseline (before decision) and after baseline (1, 2, and 6 mo). Participants were randomised 1:1 to Navigate (online DA, intervention) or a national prostate cancer website (usual care), stratified by the site/recruitment method. Partners were allocated to the group matching their respective partners. The primary outcome was self-reported uptake of AS for first-line treatment at 1 mo. The secondary outcomes included decision-making preparedness; decisional conflict, regret, and satisfaction; illness communication; and prostate cancer-specific quality of life. Intention-to-treat analyses were conducted. Of the 619 patients referred, those eligible (n=302) were randomised to either Navigate (n=153) or usual care (n=149), with no significant between-group differences at baseline. The proportion of men self-reporting AS versus another treatment was 90.6% (Navigate) versus 79.0% (usual care; p=0.008). Navigate participants also reported greater decision-making preparedness (p<0.001). Partners were allocated to Navigate (n=70) or usual care (n=49); no significant between-group differences were found. Longer-term outcomes were not measured. Providing men with an online DA resulted in higher uptake of AS for LRPC than standard resources and in increased decision-making preparedness. By increasing the uptake of AS, DAs may help reduce treatment-related morbidity. Implementation research assessing the possibility of integrating Navigate into standard care is needed.

Background: Non-medical oocyte cryopreservation (NMOC), also known as elective egg freezing, has become an established reproductive option that enables women to preserve fertility for social or personal reasons. Assessing women’s knowledge and attitudes toward NMOC is critical for enhancing awareness, supporting informed decision-making, and refining counseling practices. Objective: This literature review synthesizes current evidence regarding women’s knowledge, attitudes, and influencing factors related to NMOC, with particular emphasis on gaps identified among Saudi women. Methods: A systematic search was performed in PubMed, Medline Plus, Web of Science, and Google Scholar for studies published from 2020 to 2024. Of the 260 articles initially identified, 23 met the inclusion criteria. Each study was analysed based on its aim, setting, sample size, and key findings. Thematic synthesis was used to organize results into four main areas: knowledge and attitudes toward NMOC, factors influencing women’s decision-making, factors affecting attitudes, and sources of information. Results: The findings indicate that most women possess limited knowledge of NMOC, particularly concerning optimal age, success rates, and medical procedures. However, attitudes toward NMOC are generally positive, especially among highly educated, employed, and medically trained women. Variables such as age, marital status, education, income, fertility awareness, and cultural or religious beliefs significantly influence both knowledge and attitudes. Online resources and healthcare professionals are the primary sources of information shaping women’s understanding. Conclusion: Although global awareness of NMOC is increasing, significant gaps remain, particularly among Saudi women. Future research and culturally tailored educational initiatives are necessary to improve women’s reproductive literacy, facilitate informed choices, and support equitable access to fertility preservation counselling.

The 2022 White Paper on Singapore Women’s Development, which aimed at a fair and inclusive society where both women and men can pursue their aspirations fully, announced the option for elective egg freezing (EEF) and that the age limit for EEF was planned to be set at 35 years. The limit has been set at 37 years following recent review of success rates of EEF up to this age.2 This was implemented on 1 July 2023, presenting a conundrum among health professionals and women alike. While this is an exciting long-overdue progress in women’s reproductive autonomy, elective egg freezing needs adequate counselling and critical appraisal before a woman embarks on this journey. In this issue of the Annals, Ong et al.3 have presented a comprehensive overview on the key clinical aspects of EEF that a clinician should consider, while empowering women in this complicated decision-making. This review is a foundation for the consideration of EEF for young Singaporean women who intend to navigate newly charted waters in EEF in the context of a still rather conservative society.

Elective egg freezing and male support: a qualitative study of men’s hidden roles in women’s fertility preservation

This chapter charts the ways in which assisted reproduction (AR) has challenged long-held views about the boundaries of reproduction. It examines the recent redefinition of infertility itself, to show that AR has permitted families to be imagined and created by clients such as gay men, lesbians and single people. Uses of AR that defy former temporal barriers to reproduction, such as elective egg freezing, older women giving birth and posthumous reproduction, have also raised questions about the limits of AR. A consideration of the importance of male infertility to gender roles is followed by a discussion of the use of intracytoplasmic sperm injection (ICSI). Addressing controversies over treatment ‘add-ons’, the chapter points to the industry’s own concerns about the question of when to cease unsuccessful treatment.

African-American men have an elevated risk of developing and dying from prostate cancer. Shared decision-making (SDM) about prostate cancer screening is recommended but does not always occur. We pilot-tested an online decision aid (DA) in primary care settings using a pre/postevaluation design among African-American men ages 45 to 70 years. Men completed surveys before and after using the DA, which had interactive segments (e.g., values clarification) and provided individualized assessment of prostate cancer risk. Primary outcomes included prostate cancer knowledge, confidence in ability to make informed decisions, decisional conflict, and satisfaction with the decision. Immediately after the clinical visit, patients reported the degree to which they were engaged by their provider in SDM. Among this sample of men (n = 49), use of the DA was associated with increased knowledge about prostate cancer [mean = 55.3% vs. 71.2%; 95% confidence interval (CI), 9.8-22.1; P < 0.001], reduced decisional conflict (mean = 33.4 vs. 23.6; 95% CI, -18.1 to -1.6; P = 0.002) on a scale from 0 to 100, and a decreased preference to be screened (88% vs. 69%; 95% CI, 0.09-0.64; P = 0.01). Most (89%) reported that the DA prepared them well/very well for SDM with their provider. Following the clinical visit with providers, scores on perceived involvement in SDM were 68.1 (SD 29.1) on a 0 to 100 scale. The DA improved men's knowledge, reduced decisional conflict, and promoted the perception of being prepared for SDM. Findings suggest that use of an online DA to improve SDM outcomes warrants further testing in a future trial.

Effects of an online tailored decision aid to promote informed decision making about maternal pertussis vaccination in the Netherlands: A randomized controlled trial

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.