P-562 Elective egg freezers’ disposition decisions: A qualitative study
Authors: Caughey L , White K M , Lensen S , Peate M 
Published: June 2023

Abstract

Study question
What are the factors that influence elective egg freezers’ (EEF) disposition decisions towards their surplus frozen oocytes?

Summary answer
Achieving motherhood or dealing with grief if motherhood was not achieved, the complexities of donating to others, and a lack of information and professional advice.

What is known already
Most women who undergo EEF do not use their oocytes. Consequently, there is an abundant, but unquantified, number of women with surplus oocytes in storage globally. Many women are deciding about the disposition of their surplus oocytes due to storage limits in countries such as Australia, Belgium, Finland, and Taiwan. However, no studies have examined the factors that influence EEF oocyte disposition decisions. Research exploring factors relevant to embryo disposition and planned oocyte donation may not be relevant. Consequently, women are making the challenging and stressful decision regarding the fate of their oocytes with limited research available to support them.

Study design, size, duration
Thirty-one structured interviews took place in Australia between October 2021 and March 2022. Recruitment was via: Facebook (paid advertising, posts on relevant groups and organisation sites), newsletters and emails from universities and professional organizations, emails to eligible patients from an IVF clinic, and snowballing. A reflexive thematic approach was planned; data collection and analysis occurred concurrently. Recruitment occurred until the process of analysis did not identify any new themes and saturation have been reached.

Participants/materials, setting, methods
Eligible participants (EEF with surplus frozen eggs, 18+, living in Australia) were interviewed and included women who had previously made a disposition decision (n = 7), were currently deciding (n = 6), or who not yet considered the decision (n = 18). Interviews took place on recorded teleconference, were transcribed verbatim and anonymised. Transcripts were iteratively coded via NVivo and analysed, and themes developed inductively. The researcher reflected on their subjectivity with co-authors to ensure accuracy and clarity of data interpretation.

Main results and the role of chance
Six inter-related themes were identified related to the decision-making process: ‘decisions are dynamic’; ‘triggers for the final decision’; ‘achieving or not achieving motherhood’; ‘conceptualisation of oocytes’; ‘the impacts of egg donation on others’; and ‘external factors affecting the final disposition outcome’. All women reported a type of trigger ‘event’ for making a final decision (e.g. completing their family). Women who achieved motherhood were more open to donating their oocytes to others, wanting to share the joy of motherhood, but were concerned about the implications for their child (e.g. donor-conceived half-siblings) and also felt responsibility for potential donor children. Women who did not achieve motherhood were less likely to donate to others due to the grief of not becoming a mother, often feeling alone, misunderstood, and unsupported. Reclaiming oocytes (e.g. taking them home) and closure ceremonies helped some women process their grief. Donating to research was viewed as an altruistic option as oocytes would not be wasted and did not have the “complication” of a genetically linked child. Decisions were often made based on misinformation and a lack of knowledge of the available disposition options and their consequences, with few women seeking professional advice on their decision.

Limitations, reasons for caution
Most participants had not considered the decision and their stated intentions may not reflect their final decision. Women who had previously made disposition decisions were difficult to recruit despite comprehensive study advertising. Other limitations were the use of convenience sampling and conduct of interviews via teleconference (due to COVID).

Wider implications of the findings
Due to a lack of understanding of the disposition options, their impacts, and women not seeking professional advice, decision support (e.g. counselling, decision aids) is suggested. Counselling should occur at least at the beginning and end of the process, address disposition options, impacts, grief, and gaining support from others.

Trial registration number
Not applicable