An unconventional path to conventional motherhood: A qualitative study of women's motivations and experiences regarding social egg freezing in the Netherlands.

STUDY QUESTION: What are women's motivations for social egg freezing and what are their experience regarding the egg freezing process in the Netherlands? SUMMARY ANSWER: Women who engage in social egg freezing are driven by feelings of fear, including the fear of not finding the suitable partner and fear of declining fecundity. They aim to fulfil their desire for having children with a partner. Alternative ways to achieve parenthood are considered if the conventional way of motherhood cannot be achieved. WHAT IS ALREADY KNOWN: The reasons for social egg freezing are multi-fold, including amongst others economic, social, health, educational and career factors. The lack of a (stable) partnership, and a strong desire for a genetically related child with a committed partner are considered main reasons. STUDY DESIGN, SIZE, DURATION: A qualitative interview study, including 20 women, was conducted in the Netherlands between October 2018 and August 2019. MATERIAL & METHODS: Women between 32 and 42 years of age, who had completed the egg freezing trajectory for social reasons at three different medical centres in the Netherlands participated in the study. Semi-structured interviews were conducted face-to-face or via a teleconference tool and were recorded and transcribed verbatim. The interviews lasted between 30 and 90 minutes. Data were analysed using thematic content analysis. MAIN RESULTS AND THE ROLE OF CHANCE: This study identified one overall theme: "an unconventional path to conventional motherhood" and five interpretive theme's: "fear of not becoming a mother, peace of mind, an unconventional path to motherhood, conventional perspectives, and financial discrimination". Women were afraid of not becoming a mother in the future. Despite the fact that all kinds of alternatives were available, conventional motherhood was preferred. Women chose a non-conventional path to reach this goal and they had to let go of traditional perspectives. Although they had the feeling of being discriminated financially, it gave them 'peace of mind'. The preserved oocytes gave them the sense of a fertility insurance for the future. LIMITATIONS, REASONS FOR CAUTION: The demographic profile displays a high degree of homogeneity, which may impact generalisability. WIDER IMPLICATIONS OF THE FINDINGS: This study contributes to a better understanding of women who cryopreserve their oocytes for social reasons. Healthcare professionals need to be aware of these motivations and perspectives. Understanding the underlying factors and emotional considerations in the decision-making process is crucial to provide proper counselling and optimal patient-centered infertility care. Furthermore, it is important to raise awareness about the possibilities of pursuing (alternative) motherhood to support effective policy making. However, social egg freezing remains closest to women's preferences of conventional motherhood, even in a country like the Netherlands, which is known for its progressiveness and focus on gender equality. Last, policy makers need to stimulate cost-effectivity and prevent younger women of pursuing social egg freezing as kind of a prevention method.

Intrafamilial oocyte donation in classic galactosemia: ethical and societal aspects.

Classic galactosemia is a rare inherited disorder of galactose metabolism. Primary ovarian insufficiency (POI) with subfertility affects > 80% of female patients and is an important concern for patients and their parents. Healthcare providers are often consulted for subfertility treatment possibilities. An option brought up by the families is intrafamilial oocyte donation (mother-to-daughter or sister-to-sister). In addition to POI, galactosemia patients can also present varying cognitive and neurological impairments, which may not be fully clear at the time when mother-to-daughter oocyte donation is considered. Ethical and societal aspects arise when exploring this option. This study aimed to provide guidance in aspects to consider based on the views of different groups involved in the oocyte donation process. A qualitative study using in-depth semi-structured interviews with > 50 participants (patients, family members, and healthcare providers) was conducted. From these interviews, themes of concern emerged, which are illustrated and reviewed: (1) family relations, (2) medical impact, (3) patients' cognitive level, (4) agreements to be made in advance and organization of counseling, (5) disclosure to the child, and (6) need for follow-up. We conclude that discussing and carrying out intrafamilial oocyte donation in galactosemia patients requires carefully addressing these themes. This study adds value to the already existing recommendations on intrafamilial oocyte donation in general, since it highlights important additional aspects from the perspectives of patients and their families.

A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): a protocol for a randomized controlled trial.

BACKGROUND: Obesity in women with polycystic ovary syndrome (PCOS) negatively affects all clinical features, and a 5 to 10% weight loss has shown promising results on reproductive, metabolic and psychological level. Incorporating a healthy diet, increasing physical activity and changing dysfunctional thought patterns in women with PCOS are key points in losing weight. The biggest challenge in weight management programs is to achieve a reasonable and sustainable weight loss. The aim of this study is to explore whether Cognitive Behavioural Therapy (CBT) by a mental health professional, working in a multidisciplinary team with a dietician and a physical therapist (a three-component intervention), is more effective for weight loss in the long term, within 12 months. We will also explore whether mobile phone applications are effective in supporting behavioural change and sustainable weight loss. METHODS: The present study is a longitudinal randomized controlled trial (RCT) to study the effectiveness of a three-component 1-year cognitive-behavioural lifestyle intervention in overweight/obese women with PCOS. A total of 210 participants are randomly assigned to three groups: 1) CBT provided by the multidisciplinary team or; 2) CBT provided by the multidisciplinary team and Short Message Service (SMS) or; 3) usual care: encourage weight loss through publicly available services (control group). The primary aim of the 12-month intervention is to explore whether a three-component 1-year cognitive-behavioural lifestyle intervention is effective to decrease weight, when compared to usual care. Secondary outcomes include: the effect of the intervention on the PCOS phenotype, waist circumference, waist to hip ratio, ovulation rates, total testosterone, SHBG, free androgen index (FAI), AMH, hirsutism, acne, fasting glucose, blood pressure and all psychological parameters. Additionally, we assessed time to pregnancy, ongoing pregnancies, clinical pregnancies, miscarriages and birth weight. All outcome variables are measured at the start of the study, and again at 3 months, 6 months, nine months and 12 months. DISCUSSION: We expect that CBT provided by a multidisciplinary team, especially combined with SMS, is effective in developing a healthy lifestyle and achieving a long-term weight loss in women with PCOS. Losing 5- 10% body weight improves various PCOS characteristics. Consequently, we expect to show that CBT provided by a multidisciplinary team improves reproductive and metabolic outcomes, as well as quality of life, while at the same time being cost-effective. TRIAL REGISTRATION: Registered at the Netherlands National Trial Register with number NTR2450 on August 2nd, 2010.