Evolution of Knowledge and Attitudes Regarding Fertility Service Utilization

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