Fertility knowledge and awareness in oocyte donors in Spain

Highlights

• The perceived ideal age for first and last birth in oocyte donation candidates does not correlate with the best biological age.

• In oocyte-donation candidates fertility knowledge and awareness are insufficient.

• One third of oocyte-donation candidates requested further information from healthcare professionals following the interview.

• The fertility of young people should be protected with educational interventions emphasizing the phenomenon of age-related infertility.

Abstract

Objective

To evaluate motherhood intentions and awareness of the limits of fertility as related to menstrual cycle, female age, and assisted reproductive technologies (ART) in oocyte-donation candidates in Spain.

Methods

Cross-sectional study with 229 women seeking information about oocyte donation in March–October 2013. Women were interviewed by healthcare professionals.

Results

The majority of participants (95.6%) wanted to be mothers in future and 36.7% already had children. Even so, knowledge about female reproduction was low: 48.3% failed to identify the ovulation time, 48.5% missed women's fertility peak before 25, and 27.9% overestimated the age limits for ART. University education does not improve global fertility knowledge and is associated with a later intended age for childbearing (p = 0.001), which results in a twofold risk of childlessness at age of 30 (RR = 1.95, 95% CI 1.11—3.43).

Conclusion

We conclude that fertility knowledge is insufficient but, encouragingly, nearly 30% of interviewees were proactive in seeking information from the healthcare professionals.

Practice implications

The future fertility of young people should be protected through educational interventions emphasizing the increasing phenomenon of age-related infertility at every point of contact with a women's health professional, for instance, when oocyte-donation candidates attend a fertility center for an information visit.

Introduction

Fertility awareness is usually considered to be the understanding of basic knowledge of a woman's anatomy and physiology and its application to family planning [1]. However, with the social trend across the developed world of postponing parenthood, other aspects of fertility knowledge such as age-related infertility are gathering relevance to the reproductive education of young people.

It has long been established that female fecundity declines after the age of 30 [2], [3] and more markedly past 35 [4]. However, this decrease in female fertility actually starts to be significant earlier, at around 27–29 [5]. At the other end of the scale, the median age at onset of female sterility has been set at 44.7 years, nearly 6 years before the median onset of menopause at 50.5 years [6]. These ages roughly coincide with the usual limits for assisted reproductive technologies (ART) in most countries. In Spain, for instance, the national law allows ART until an age “clinically adequate” (Law 14/2006). Although a specific age limit has not been established, private centers nationwide usually offer ART until 45 and 50 years with own and donated oocytes, respectively. Research has clearly indicated that ART cannot fully compensate for the loss of natural fertility, resulting in limited utility against age-related infertility [7], [8]. Unfortunately, this information has not been adequately conveyed to the general public [9], [10], [11]. Previous studies have investigated overall female fertility awareness and knowledge about potential risk factors for infertility, including a woman's age, among adults between 18 and 50 years old [12], [13], [14], [15]. Collectively, these studies have shown that there is a general understanding of environmental infertility risks such as smoking and obesity, but there is a lack of knowledge regarding the most important risk factor for female infertility: age.

A large body of research has focused specifically on university and postgraduate female students as they are both expected to be more educated and knowledgeable about fertility, and at the same time at higher risk of delaying motherhood than the general population [12], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]. Surprisingly, the conclusion of these studies is that knowledge about age-related infertility in highly educated people, although higher than in the general population, remains insufficient.

Spain is the European country with the highest proportion of first births above 30 years since 2002 (60%) [11], and one of the highest reported values for permanent involuntary childlessness (7%) [27]. Nevertheless only one study concerning fertility knowledge and awareness has been performed in Spain, revealing that Spanish women have only a modest knowledge of reproduction [12]. As far as we know, the present study is the first performed on candidate for oocyte donation in Spain. In this country, oocyte donors are healthy women between 18 and 35 years of age with different education levels, who voluntarily donate their oocytes after a complete physical and psychological evaluation [28]. Oocyte donation in Spain is highly regulated, anonymous and altruistic; however, economic compensation is included in the law; currently the compensation for a cycle of oocyte donation is around 1000€, in line with other European countries such as the UK. The motivation to donate in Spain is therefore a combination of altruism and financial considerations [29].

The purpose of this study is the evaluation of fertility knowledge and awareness in female oocyte-donation candidates, the identification of areas of least knowledge, and the evaluation of their interest in receiving further information. Based on our results, we expect to be able to provide women with information about their own fertility, and further to develop educational initiatives in the context of a private ART center. Information provision is a high priority in fertility care [30]. Improving the quality of the information given to women should improve their wellbeing and reduce their concerns regarding the medical procedures [31]. A recent study has shown that women's health providers are the preferred source for information on reproductive health [32], and the evaluation visit when becoming a donor could be a suitable occasion for encouraging these women to discuss health issues related to fertility and reproduction with a professional.