Journal of Assisted Reproduction and Genetics

, Volume 35, Issue 9, pp 1613–1621 | Cite as

Counseling patients on reproductive aging and elective fertility preservation—a survey of obstetricians and gynecologists’ experience, approach, and knowledge

  • Rani Fritz
  • Susan Klugman
  • Harry Lieman
  • Jay Schulkin
  • Laura Taouk
  • Neko Castleberry
  • Erkan BuyukEmail author
Fertility Preservation



What are the experience, approach, and knowledge of US Obstetricians and Gynecologists’ (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP).


A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP.


Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18–34 years old, compared to 75.8% aged 35–44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP.


In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.


Reproductive aging Fertility preservation Counseling Obstetricians/gynecologists Oocyte cryopreservation 



This work was supported by the Maternal and Child Health Bureau (Grant UA6MC19010).

Supplementary material

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  1. 1.
    Block E. Quantitative morphological investigations of the follicular system in women; variations at different ages. Acta Anat (Basel). 1952;14(1–2):108–23.CrossRefGoogle Scholar
  2. 2.
    Baker TG. A quantitative and cytological study of germ cells in human ovaries. Proc R Soc Lond B Biol Sci. 1963;158:417–33.CrossRefPubMedGoogle Scholar
  3. 3.
    Pellestor F, Andreo B, Arnal F, Humeau C, Demaille J. Maternal aging and chromosomal abnormalities: new data drawn from in vitro unfertilized human oocytes. Hum Genet. 2003;112(2):195–203. Scholar
  4. 4.
    Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep. 2017;66(1):1.PubMedGoogle Scholar
  5. 5.
    Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril. 2013;100(5):1343–9. Scholar
  6. 6.
    Heck KE, Schoendorf KC, Ventura SJ, Kiely JL. Delayed childbearing by education level in the United States, 1969-1994. Matern Child Health J. 1997;1(2):81–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Hammarberg K, Clarke VE. Reasons for delaying childbearing--a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician. 2005;34(3):187–8. 206PubMedGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention. 2016. Accessed 3/13/2017 2017.
  9. 9.
    Centers for Disease Control and Prevention. Accessed 3/13/2017 2017.
  10. 10.
    Chen C. Pregnancy after human oocyte cryopreservation. Lancet. 1986;1(8486):884–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Grifo JA, Noyes N. Delivery rate using cryopreserved oocytes is comparable to conventional in vitro fertilization using fresh oocytes: potential fertility preservation for female cancer patients. Fertil Steril. 2010;93(2):391–6. Scholar
  12. 12.
    Trokoudes KM, Pavlides C, Zhang X. Comparison outcome of fresh and vitrified donor oocytes in an egg-sharing donation program. Fertil Steril. 2011;95(6):1996–2000. Scholar
  13. 13.
    Cobo A, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011;96(2):277–85. Scholar
  14. 14.
    Rienzi L, Romano S, Albricci L, Maggiulli R, Capalbo A, Baroni E, et al. Embryo development of fresh 'versus' vitrified metaphase II oocytes after ICSI: a prospective randomized sibling-oocyte study. Hum Reprod. 2010;25(1):66–73. Scholar
  15. 15.
    Cobo A, Meseguer M, Remohi J, Pellicer A. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod. 2010;25(9):2239–46. Scholar
  16. 16.
    Cobo A, Rubio C, Gerli S, Ruiz A, Pellicer A, Remohi J. Use of fluorescence in situ hybridization to assess the chromosomal status of embryos obtained from cryopreserved oocytes. Fertil Steril. 2001;75(2):354–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Noyes N, Porcu E, Borini A. Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies. Reprod BioMed Online. 2009;18(6):769–76.CrossRefPubMedGoogle Scholar
  18. 18.
    Goldman KN, Kramer Y, Hodes-Wertz B, Noyes N, McCaffrey C, Grifo JA. Long-term cryopreservation of human oocytes does not increase embryonic aneuploidy. Fertil Steril. 2015;103(3):662–8. Scholar
  19. 19.
    Cobo A, Serra V, Garrido N, Olmo I, Pellicer A, Remohi J. Obstetric and perinatal outcome of babies born from vitrified oocytes. Fertil Steril. 2014;102(4):1006–15 e4. Scholar
  20. 20.
    Chian RC, Huang JY, Tan SL, Lucena E, Saa A, Rojas A, et al. Obstetric and perinatal outcome in 200 infants conceived from vitrified oocytes. Reprod BioMed Online. 2008;16(5):608–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Practice Committees of American Society for Reproductive M, Society for Assisted Reproductive T. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013;99(1):37–43. Scholar
  22. 22.
    Peterson BD, Pirritano M, Tucker L, Lampic C. Fertility awareness and parenting attitudes among American male and female undergraduate university students. Hum Reprod. 2012;27(5):1375–82. Scholar
  23. 23.
    Virtala A, Vilska S, Huttunen T, Kunttu K. Childbearing, the desire to have children, and awareness about the impact of age on female fertility among Finnish university students. Eur J Contracept Reprod Health Care. 2011;16(2):108–15. Scholar
  24. 24.
    Hashiloni-Dolev Y, Kaplan A, Shkedi-Rafid S. The fertility myth: Israeli students' knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology. Hum Reprod. 2011;26(11):3045–53. Scholar
  25. 25.
    Chan CH, Chan TH, Peterson BD, Lampic C, Tam MY. Intentions and attitudes towards parenthood and fertility awareness among Chinese university students in Hong Kong: a comparison with Western samples. Hum Reprod. 2015;30(2):364–72. Scholar
  26. 26.
    Bretherick KL, Fairbrother N, Avila L, Harbord SH, Robinson WP. Fertility and aging: do reproductive-aged Canadian women know what they need to know? Fertil Steril. 2010;93(7):2162–8. Scholar
  27. 27.
    Yu L, Peterson B, Inhorn MC, Boehm JK, Patrizio P. Knowledge, attitudes, and intentions toward fertility awareness and oocyte cryopreservation among obstetrics and gynecology resident physicians. Hum Reprod. 2016;31(2):403–11. Scholar
  28. 28.
    Lundsberg LS, Pal L, Gariepy AM, Xu X, Chu MC, Illuzzi JL. Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women. Fertil Steril. 2014;101(3):767–74. Scholar
  29. 29.
    Bunting L, Tsibulsky I, Boivin J. Fertility knowledge and beliefs about fertility treatment: findings from the international fertility decision-making study. Hum Reprod. 2013;28(2):385–97. Scholar
  30. 30.
    Dunson DB, Baird DD, Colombo B. Increased infertility with age in men and women. Obstet Gynecol. 2004;103(1):51–6. Scholar
  31. 31.
    Howe G, Westhoff C, Vessey M, Yeates D. Effects of age, cigarette smoking, and other factors on fertility: findings in a large prospective study. Br Med J (Clin Res Ed). 1985;290(6483):1697–700.CrossRefGoogle Scholar
  32. 32.
    Stovall DW, Toma SK, Hammond MG, Talbert LM. The effect of age on female fecundity. Obstet Gynecol. 1991;77(1):33–6.PubMedGoogle Scholar
  33. 33.
    Maroulis G. Effects of aging on fertility and pregnancy. Seminars in Reproductive Aging. 9(3):165–74.Google Scholar
  34. 34.
    Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. Federation CECOS. N Engl J Med. 1982;306(7):404–6. Scholar
  35. 35.
    American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee opinion no. 589. Fertil Steril. 2014;101(3):633–4. Scholar
  36. 36.
    Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod. 2002;17(5):1399–403.CrossRefPubMedGoogle Scholar
  37. 37.
    Steiner AZ, Jukic AM. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril. 2016;105(6):1584–8 e1. Scholar
  38. 38.
    Cramer DW, Xu H, Harlow BL. Family history as a predictor of early menopause. Fertil Steril. 1995;64(4):740–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Schattman GL, Clinical Practice. Cryopreservation of Oocytes. N Engl J Med. 2015;373(18):1755–60. Scholar
  40. 40.
    Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod. 1998;13(6):1532–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002;77(6):1148–55.CrossRefPubMedGoogle Scholar
  42. 42.
    American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee of the American Society for Reproductive Medicine. Female age-related fertility decline. Committee opinion no. 589. Obstet Gynecol. 2014;123(3):719–21. Scholar
  43. 43.
    Hoffman MC, Jeffers S, Carter J, Duthely L, Cotter A, Gonzalez-Quintero VH. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol. 2007;196(5):e11–3. Scholar
  44. 44.
    Forrester MB, Merz RD. Maternal age-specific down syndrome rates by maternal race/ethnicity, Hawaii, 1986-2000. Birth Defects Res A Clin Mol Teratol. 2003;67(9):625–9. Scholar
  45. 45.
    Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005;105(5 Pt 1):983–90. Scholar
  46. 46.
    Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708–12.CrossRefPubMedGoogle Scholar
  47. 47.
    Hvidman HW, Petersen KB, Larsen EC, Macklon KT, Pinborg A, Nyboe AA. Individual fertility assessment and pro-fertility counselling; should this be offered to women and men of reproductive age? Hum Reprod. 2015;30(1):9–15. Scholar
  48. 48.
    Mesen TB, Mersereau JE, Kane JB, Steiner AZ. Optimal timing for elective egg freezing. Fertil Steril. 2015;103(6):1551–6 e1-4. Scholar
  49. 49.
    van Loendersloot LL, Moolenaar LM, Mol BW, Repping S, van der Veen F, Goddijn M. Expanding reproductive lifespan: a cost-effectiveness study on oocyte freezing. Hum Reprod. 2011;26(11):3054–60. Scholar
  50. 50.
    Wyndham N, Marin Figueira PG, Patrizio P. A persistent misperception: assisted reproductive technology can reverse the “aged biological clock”. Fertil Steril. 2012;97(5):1044–7. Scholar
  51. 51.
    Benzies K, Tough S, Tofflemire K, Frick C, Faber A, Newburn-Cook C. Factors influencing women’s decisions about timing of motherhood. J Obstet Gynecol Neonatal Nurs. 2006;35(5):625–33. Scholar
  52. 52.
    Tough S, Tofflemire K, Benzies K, Fraser-Lee N, Newburn-Cook C. Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women. Matern Child Health J. 2007;11(2):189–98. Scholar
  53. 53.
    Tan SQ, Tan AW, Lau MS, Tan HH, Nadarajah S. Social oocyte freezing: a survey among Singaporean female medical students. J Obstet Gynaecol Res. 2014;40(5):1345–52. Scholar
  54. 54.
    Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53–5. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Montefiore Institute for Reproductive Medicine and Health, Department of Obstetrics, Gynecology & Women’s HealthAlbert Einstein College of Medicine / Montefiore Medical CenterBronxUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of WashingtonSeattleUSA
  3. 3.Research DepartmentThe American College of Obstetricians and Gynecologists (ACOG)WashingtonUSA

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