Title: Fertility Knowledge, Childbearing Intentions and Attitudes Towards Social Egg Freezing:
a Study of Female Students of a Private University in Kumasi, Ghana
Version: 1 Date: 25 Jun 2024
Reviewer's report:
This is an interesting study on a topic that is not so much researched in Ghana. It is unfortunate
the sample size was quite small and hence the authors could only run descriptive analysis. Below,
I provide a number of comments, especially in the Methods and Results sections, that the authors
should address to revise their manuscript.
Introduction
Although there may be a paucity of data on social egg freezing in Ghana, there are a number of
studies on ART. The authors can discuss some of the literature on this. Also, statistics on the
growing number of older ages at first birth could be useful to document and discuss.
Either in the Introduction or Methods, the authors should include a bit of information about
Kumasi, the study setting, and a rationale for their choice of a private (instead of public)
university and older (levels 300 and 400) undergraduate nursing/midwifery student. There does
not seem to be much information as to why they selected the study setting and the types of
students that they targeted.
The third research question can be rephrased as: What are the attitudes of Ghanaian students to
childbearing with donor or frozen eggs?
Methods
More information needed about when data were collected – over what period and in what year?
How did the authors ascertain that only level 300 and 400 nursing/midwifery students
participated in the survey. The link could have been shared to others outside the WhatsApp
groups.
The authors should provide a rationale for the convenience sampling approach used instead of
attempting a representative sample, even if within the selected group of nursing students. A
sampling frame could have been generated from nursing/midwifery student ID numbers with
students subsequently sampled.
Provide a reference for the Slovin sample size formula used.
Provide references for the papers that used the study instruments which were adopted for the
study.
It would have been ideal to report on all the variables in the study and how they were measured.
However, since there are so many variables listed. The authors need to think through how they
can represent this.
Results
What is the theoretical reason for the selected age groupings of the respondents. In addition,
from the description about the choice of undergraduate university students, it would suggest the
authors wanted a younger sample, however, the ages of respondents range from 18 to 42. The
author’s choices and justification need to align.
The frequency distributions of the respondents by their demographic characteristics have cells
with very few people. These categories will have to be recoded into theoretically sound
categories so that the analysis is possible. For example, None and Traditional religious
affiliations have very few respondents and will need to be merged with the Muslim category so
that the variable is dichotomous. Relationship status is also quite problematic.
Categories for a number of ordinal variables need to be reordered. For instance, knowledge of
fertility and infertility issues – should be ordered from least knowledge to most knowledge -  No
knowledge, adequate knowledge, some knowledge, good knowledge, very good knowledge. It
is not clear among the ‘some’ and ‘adequate’ knowledge which indicates a greater amount of
knowledge. The same re-ordering is required for variables – ‘how important is/was it for you to
have children?’ and ‘how confident are you that you will have your desired number of children?’
All graphs should be changes to 2D graphs and should only indicate percentages and not the
frequencies. X-axis labels should also be written in full.
Regarding awareness about social egg freezing, the number of respondents that responded to
that question was 76, and yet the contingency question on where they heard about social egg
freezing from has all 135 respondents. This is not possible.
Some of the write up should be included between tables 4A and 4B to separate the tables or they
should be joined as one table.
Table 4B should only include the percentages and not the frequencies as well since the tables
look crowded with information. As the percentages are indicated, there should be a column at
the end with the total frequency for each of the categories for each variable.
The results in Table 5 need to be revised. The demographic variables require re-categorization
before being cross-tabulated with the dependent variable. Also, the likelihood of social egg
freezing variable has two categories – ‘uncertain and don’t know’ which can be merged.
Due to the small sample size, the Fischer’s Exact test or other variations of the test for smaller
samples could be used instead of the Pearson Chi-square test. However, this would require the
authors recoding variables into dichotomous variables or variables with fewer categories.
Why was bivariate analysis only restricted to the one variable on likelihood of social egg
freezing? I suggest the authors think through what variables matter for the study and only present
those, while including additional bivariate tables to help explain associations.
Discussion
The Discussion does not require a summary of the results on the demographic characteristics
of respondents.
A qualitative study could have provided more insights. I suggest the authors recommend for
further studies with larger samples or a qualitative study to fully understand young women's
perceptions about social egg freezing.
Limitations
Include as a limitation that the small sample size did not allow for rigorous analysis to help
understand the subject in more depth.
Other comments
The authors should check that the in-text citations are being properly included, especially how
they have carried out the bracketing of references.