An assessment of female university students& ... - Fertility and Sterility

INFERTILITY An assessment of female university students’ attitudes toward screening technologies for ovarian reserve Brindha Bavan, B.A.,a Ellen Porzig, Ph.D.,b and Valerie L. Baker, M.D.c a

School of Medicine, b Department of Developmental Biology, and University, Stanford, California

c

Department of Obstetrics and Gynecology, Stanford

Objective: To assess female university students’ attitudes toward screening technologies for ovarian reserve and their potential influence on career and family planning decisions. Design: Online survey. Setting: Not applicable. Patient(s): Respondents from 4 universities in Northern California. Intervention(s): None. Main Outcome Measure(s): Proportion with interest in screening technologies for ovarian reserve. Result(s): Of the 328 respondents, 79% were interested in learning about the current status of their ovarian reserve. Hypothetically, if informed that ovarian reserve was very low, 53% would consider oocyte cryopreservation (even when informed that it is experimental); however, only 29% would consider stopping educational or professional pursuits to focus on conceiving. Participants also demonstrated gaps in knowledge, believing that the decline in ovarian reserve starts later than it actually does, that diet and nutrition can preserve ovarian reserve, and that infertility treatments are highly effective regardless of how severe the depletion of the egg supply is. Conclusion(s): Women attending universities are interested in assessing their own ovarian reserve. Gaps in knowledge about ovarian reserve exist among these reproductive-aged women. (Fertil Steril
2011;96:1195–9. 2011 by American Society for Reproductive Medicine.) Key Words: Ovarian reserve, egg supply, screening technologies, female university students

As women age, they experience a progressive decline in fertility due to reduction in both the number of follicles and the quality of oocytes, commonly referred to in the medical literature as a decline in ovarian reserve (1–3). There is significant biologic variability in the timing of this decline, depending on the initial follicle count, proportion of follicles undergoing atresia, and rate of initiation of follicle growth (4, 5). Age-related fertility decline is a function of the germ line cells themselves, as shown by the success rates of autologous transplantation of ova into older recipients (6). A subset of women experience primary ovarian insufficiency (POI), a condition in which a woman younger than 40 years has infrequent or absent menstruation and elevated serum FSH levels due to follicle depletion or, less commonly, follicle dysfunction (7). Such a decline in egg supply may be suggested by irregularities in the menstrual cycle or may occur without any forewarning symptoms. Additionally, POI has significant effects on overall

Received June 10, 2011; revised and accepted August 12, 2011; published online September 15, 2011. B.B. has nothing to disclose. E.P. has nothing to disclose. V.L.B. has nothing to disclose. This project was supported by Stanford University Undergraduate Advising and Research Major Grant and Small Grant. Reprint requests: Brindha Bavan, B.A., Department of Obstetrics and Gynecology, Stanford University, 300 Pasteur Drive, Room HH333, c/o Valerie Baker, M.D., Stanford, California 94305 (E-mail: brindhas@ stanford.edu).

0015-0282/$36.00 doi:10.1016/j.fertnstert.2011.08.018

well-being (8). If POI is detected early, however, conception may still be possible with autologous oocytes (9, 10). Despite the abundance of information concerning age-related fertility decline and increasing literature discussing the marked variability in ovarian reserve at a given age, there is currently a general sociocultural trend among women to postpone childbearing until relatively late into female reproductive years (11–13). Many young women postpone their first pregnancies to concentrate on earning undergraduate or graduate degrees, furthering their careers, and finding stable relationships (14, 15). Thus, in what we believe is the first survey of its kind in the United States, we asked university women whether they would be interested in learning more about the current status of their ovarian reserve using screening technologies. Based on hypothetical outcomes of such tests, we then asked how they predicted this information would affect their own reproductive plans. Finally, we administered a brief quiz to assess participants’ basic knowledge of reproductive health, infertility, and potential treatments.

MATERIALS AND METHODS Female students were recruited from 4 San Francisco Bay Area universities, including University of California, Berkeley; Stanford University; University of California, Davis; and Santa Clara University, to complete a survey. An online forum (SurveyMonkey.com—professional account) was chosen to afford participants’ anonymity. Seventy-three questions were created concerning demographic information, family history related to reproductive health, current career and family goals, interest in assessing ovarian reserve via

Fertility and Sterility Vol. 96, No. 5, November 2011 Copyright ª2011 American Society for Reproductive Medicine, Published by Elsevier Inc.

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ultrasound and FSH/anti-Mullerian hormone blood tests now commonly used during a fertility evaluation (3, 16, 17), predicted behavior changes in response to hypothetical test outcomes, and basic reproductive health knowledge. A 4-point Likert scale was used for questions regarding interest in ovarian reserve testing and predicted behavior changes. All medical terms referenced were defined, and additional information was provided regarding the effectiveness of procedures mentioned (e.g., the fact that oocyte cryopreservation is still designated as experimental by the American Society for Reproductive Medicine). Institutional review board approval was obtained before study initiation. The randomized technique of ‘‘snowballing’’ was employed to accrue the participants. An e-mail was sent to personal contacts at each school encouraging women pursuing bachelor’s, master’s, and doctorate degrees between the ages of 18 and 30 years to complete the survey. These initial e-mails also requested that recipients forward them to additional university student listservs to further circulate the survey and target women from varied backgrounds over a 3-month period. Participants spent approximately 20 minutes on average completing the survey, for which they received $8 amazon.com gift cards. The data collected were analyzed using SPSS Inc. to explore descriptive statistics and frequencies concerning respondents’ interest in using medical technologies to screen for ovarian reserve, perceived impact on subsequent career and family planning decisions, and answers to the reproductive health quiz.

TABLE 1 Demographics of survey respondents. Survey respondents (N [ 328) Age 17–24 y 25–31 y Race/ethnicity American Indian or Alaska Native Asian Black or African American Hispanic or Latina Native Hawaiian or other Pacific Islander White Decline to state Mixed race Mother’s age at menopause