Emotional experience and decision satisfaction in women undergoing elective oocyte cryopreservation

Abstract

To explore emotional experiences and decision satisfaction in women undergoing egg freeze for delayed reproduction. Retrospective survey. 180 healthy women age 25-44 underwent elective oocyte cryopreservation cycles at an academic center from 2012 - 2016, and subsequently completed a survey. The survey interrogated the following: emotional responses, perceived adequacy of information and emotional support, patient-estimated likelihood of returning to use their eggs to achieve pregnancy and predicted probability of having a baby with the banked eggs. Visual analog scales were used to indicate levels of anxiety and depression related to reproductive future, before, during and after the egg freezing process, with scores of 0-100 indicating no to extreme anxiety/depression. We utilized a validated Decision Regret Scale, with scores from 0-100 indicating decision regret to decision satisfaction. Linear regression models assessed predictors of decision satisfaction. Paired t-tests assessed changes in depression and anxiety scores over time. Average age at treatment was 36.4 (SD 3.0), time since treatment was 2.0 years (SD 1.3, range 0.32-5.66), and mean oocytes frozen was 18 (SD 10, range 1-58). 13% of women reported inadequate information; 13% inadequate emotional support. 36% reported feeling lonelier during the process, and 16% felt more hopeless about future family building. 36% agreed their experience “would have been improved by a chance to meet with a mental health professional.” Ratings of depression related to reproductive future were highest before cycling, lower during, and lowest after treatment (47 [SD 29] vs 38 [SD 27] vs 35 [SD 27]; p<0.0001 for before vs during and before vs after). Anxiety ratings also declined (61 [SD 27] vs 59 [SD 24] vs 44 [SD 28] , p<0.0001 for before vs after and during vs after). Mean decision satisfaction score was 90.3 (SD 14), indicating high levels of satisfaction. In univariate regression, factors associated with decision satisfaction included: number of eggs frozen, perceived reduction in anxiety, adequate emotional support, adequate information, patient-predicted probability of using the eggs, and of achieving a live birth. Age and time since treatment were not associated with satisfaction. In a multivariate regression model, estimated likelihood of returning to use the eggs, estimated chance of having a baby, and perceived reduction in anxiety remained associated with decision satisfaction. Women undergoing elective egg freezing for delayed reproduction report considerable anxiety and depression related to their reproductive future. Decision satisfaction is associated with number of eggs frozen, expectations about future use of eggs, and reduction in anxiety. Women electively freezing eggs could benefit from the opportunity to meet with a psychologist.