ABSTRACT
Objective: To evaluate the temporal evolution of knowledge and attitudes regarding fertility service utilization in the United States. Material(s) and Method(s): 1000 women (21-45 years, stratified by age </= or > 35 years) were surveyed using an 82-item Internet-based questionnaire in April 2021. 50% had at least one child and 50% had interest in future childbearing. This cohort was compared to historical controls from a similar survey administered in 2016 (n=1000) using parametric tests. Multivariable linear regression was performed to evaluate differences in accepted costs. Result(s): Compared to historical controls, this cohort had a greater proportion of Hispanic and Black participants and those who reported lower-level education status, use of government-subsidized insurance, and being single. Despite consideration of the impact of the COVID-19 pandemic, likelihood to consider planned oocyte cryopreservation (OC) was similar between 2021 and 2016 (21.3% vs. 21.6%, p=0.87). In 2021, there was increased awareness of OC (92.3% vs. 87.2%), what the process entails (41.9% vs. 29.8%), and objectively assessed knowledge of associated costs (1.06/2 points vs. 0.68/2 points) despite decreased knowledge of OC efficacy (0.91/2 points vs. 0.99/2 points) and reproductive health (1.71/5 points vs. 2.40/5 points) (all p<0.01). Fewer participants cited relationship stability, completed education, and age as factors important in deciding when to pursue childbearing (82.1% vs. 91.7%;56.8% vs. 70.7%;69.2% vs. 79.6%;respectively;all p<0.01). If unable to conceive, women were less likely than previously reported to seek help from a specialist (74.2% vs. 82.0%) or adopt children (63.7% vs. 72.2%) and were more likely to use donor gametes (sperm: 32.7% vs. 25.4%;oocyte: 30.7% vs. 24.3%) (all p<0.01). When asked about the minimum success rate of achieving a pregnancy if OC cost $10,000, 77.5% of the cohort accepted a minimum 50% chance of success compared to 91.1% in 2016, with 44.1% of the cohort accepting a minimum of 80% success compared to 55.9% in 2016 (both p<0.01). A success rate less than 80% was more likely to be acceptable to those likely to consider OC (COC) compared to those unlikely to consider (NOC) (65.9% vs. 53.0%, p<0.01). A success rate less than 50% was not considered more acceptable by COC compared to NOC (25.5% vs. 21.7%, p=0.25), despite this being the case in 2016. COC were overall accepting of a lower minimum success rate compared to NOC (p<0.01). In a model considering demographic and knowledge differences, participants in 2021 reported an acceptable minimum success rate that was on average 11.1% less than historical controls (p<0.01). Conclusion(s): Likelihood to consider OC has remained constant, while third-party reproduction options have become more accepted. Despite improved awareness of the OC process, a disconnect exists between willingness to pay for OC and realistic success rates. Impact Statement: Understanding of and willingness to pay for OC has evolved in the decade since the experimental label on OC was removed, highlighting opportunities to provide more cost-effective and efficient fertility services. Support: Financial support for survey distribution was provided by Pennsylvania Hospital Resident Research Funding. Copyright © 2022