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

Abstract

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.

Keywords: Cancer; Decision-making; Embryo cryopreservation; Fertility preservation; Oocyte cryopreservation.