Motivations and perceived barrier to care in women seeking information regarding elective oocyte cryopreservation (EOC)

Abstract

Interest in EOC is growing amongst reproductive-aged women. Limited data exists on why women consider EOC and what prevents them from pursuing EOC. The primary objective of this study is to evaluate and characterize stated motivations and barriers to care in women seeking information on EOC. Retrospective Cohort. From December 2016 - March 2018, Extend Fertility Medical Practice, a large single-center oocyte cryopreservation program offering a cost-conscious EOC model, hosted monthly public educational sessions on EOC. Following the session, attendees were given an optional feedback form. Respondents were asked for session feedback, plans regarding EOC, motivation for considering EOC, and primary concern holding them back from EOC. Free text responses were collected and characterized. Associations were compared using X2 and student's t-test. 253 women attended the information sessions, of which 174 (68.7%) completed the form. Mean age of respondents was 34.1±5.1. 35.1% (61/174) reported increasing age as their primary motivation for interest in EOC, 33 (19.0%) reported interest in EOC specifically to delay childbearing, 32 (18.4%) reported they did not want to delay fertility but were doing so as a result of their relationship status, and 21 (12.1%) reported they did not desire children but wanted to have the option in the future. There was no significant difference in mean age between these groups (p=0.33). The high cost of EOC was the leading stated barrier with 73.0% (127/174) reporting that it was the primary concern holding them back from pursuing EOC. Other stated barriers were a lack of knowledge about EOC, perceived disruption to daily life, and fear of side effects. Mean age was significantly higher in women who stated that cost was their primary concern compared to those who reported other concerns (34.6±4.7 vs. 32.6±6.0, p=0.02). 66.7% (114/174) reported they would like to proceed with EOC in the next 12 months. 80.5% (140/174) reported they wanted to schedule a complimentary fertility assessment, consisting of serum AMH and antral follicle count. Mean age was not significantly different between those that did and did not want to schedule a complementary fertility assessment (34.1±5.4 vs. 34.0±3.7; p=0.92). There was no significant difference desired fertility assessment amongst women who stated that cost was their primary barrier and those who did not (p=0.29). To date, of the 253 women who presented to these sessions, 101 (39.9%) scheduled fertility assessments and 83 (32.8%) completed EOC cycles. Consistent with prior studies, purposeful delay of childbearing is not the primary motivation for the majority of women at our education sessions. The high cost of EOC was reported as the greatest barrier to pursuing treatment even in this highly motivated cohort. Age may be a factor in cost considerations. Additional studies are needed to evaluate the potential role of a cost conscious EOC model to increase access to care.