Evaluation of patient decision-making process and decision regret on method of cancer-related fertility preservation (fp)

Prior to cancer treatment, patients must make decisions on whether to undergo FP and method of FP. These decisions are often made within a short time frame and under stressful circumstances. Women who did not undergo FP prior to cancer treatment are more likely to regret their decision1, however it is unknown how this varies by FP method. The objective of this study was to evaluate patient decision-making on cancer-related FP method. A cross-sectional 25-item online survey, including 3 open-ended questions, was administered to patients with ovaries who underwent medically indicated FP after a cancer diagnosis or with a known mutation for hereditary cancer predisposition. The survey was distributed through oncofertility and adolescent and young adult cancer organizations and was open from February – March 2023. Items included demographics and information on counseling and decision-making on method of FP. Open-ended responses were analyzed using the constant comparative method. 240 respondents completed the survey: 52% underwent oocyte cryopreservation (OC), 29% embryo cryopreservation (EC), 19% a combination of OC and EC (OC/EC). No respondents reported regret undergoing FP in general. Most respondents agreed that if they were to go through the process again, they would make the same decision about FP method (80% EC, 72% OC, 59% OC/EC). The decision-making experience was described by the majority as overwhelming given the large amount of information and short time frame. FP decisions were described as providing a sense of empowerment in an otherwise uncontrollable situation. Commonly reported reflections on regret included: regret with EC given relationships ending; regret with OC and desire to have been counseled on possibility of using donor sperm; regret with EC given the Dobbs decision and concern for the legal safety of cryopreserved embryos (Table 1). Most women who have undergone cancer-related FP reported they would choose the same FP method again. Reasons for regret varied by FP method, however no one reported regret in undergoing FP in general.