Volume 51, Issue 8, August 2022

Age-related fertility decline and elective oocyte cryopreservation: Knowledge, attitudes and practices in a pilot study of general practitioners

Alison Slater    Raelia Lew    Michelle Peate   
doi: 10.31128/AJGP-10-21-6191   |    Download article
Cite this article    BIBTEX    REFER    RIS

Background and objectives

Increasing numbers of women are experiencing age-related infertility. General practitioners (GPs) are ideally placed to provide initial age-related fertility counselling and fertility specialist referral. The aim of this pilot study was to document doctors’ knowledge, attitudes and practices relating to proactive fertility counselling, ovarian reserve testing and oocyte cryopreservation.


Seventy-two GPs and general practice registrars were recruited through social media and completed an online survey.


Knowledge gaps were shown relating to age-related female fertility decline, ovarian reserve testing and elective oocyte cryopreservation. GPs were more likely to discuss reproductive planning with women aged 35–44 years, compared with younger women. The majority of participants agreed fertility counselling should be provided by GPs; however, barriers identified include limited time, knowledge and concern for causing patient distress.


Providing GPs with fertility-focused education and resources may enable sensitive, accurate and timely counselling to improve reproductive outcomes.


Women and couples are delaying having children until later ages when compared with previous generations.1 The prevalence of female infertility increases with advancing age because of the biological limits of oocyte metabolism and function.2 The risk of female infertility rises from 6% at age 20–24 years to 64% at age 40–44 years,3 with the most significant reduction occurring from the ages of 37–38 years.4 In this context, growing numbers of women and couples are being treated for age-related infertility.

Concurrently, a growing number of women are considering elective oocyte cryopreservation (EOC). EOC may allow conception of biologically related children later in life through in vitro fertilisation (IVF).5 The reasons women consider EOC are complex. Commonly women feel unready to conceive in the immediate future, often associated with the absence of a partner’s commitment to co-parenting.6,7 EOC has been considered non-experimental since 2012.8 It is used to store oocytes, ideally collected at a younger age when egg quality is better,4 to be used later through IVF. With encouraging data emerging on safety and efficacy, the Australian and New Zealand Society for Reproductive Endocrinology and Infertility (ANZSREI) in 2019 described EOC as an ethically permissible, safe, well-established mainstream treatment.2 The public are generally aware of EOC and ovarian reserve testing and support it.9–12

Ovarian reserve testing, requisite to planning EOC,4 includes measurement of anti-Müllerian hormone (AMH) and antral follicle count (AFC), which are helpful in assessing oocyte quantity and enable assisted reproductive technology (ART) practitioners to tailor treatment. Ovarian reserve testing does not predict fertility or fecundity outcomes.13 Age remains the best predictor of IVF success, with live birth rates per blastocyst transfer of 40% in women aged <30 years, dropping to 11% in women aged 41–42 years.14

Patients’ preferred first point of fertility education, investigation and referral for EOC are GPs.15 The Royal Australian College of General Practitioners (RACGP) guidelines state that patients should be assisted in ‘developing a reproductive life plan that includes whether they want to have children’ and assisted in planning ‘the number, spacing and timing of intended children’.16 Patients expect GPs to be knowledgeable about fertility health and to be able to provide evidence-based information.15 With increasing demand for EOC, it is important that GPs have accurate knowledge. It is not only patients who typically underestimate age-related fertility decline and overestimate success rates of ART,17–19 but also medical professionals, including obstetricians and gynaecologists, family physicians and nurses.20–22 This raises concerns about whether women are receiving appropriate advice. The aim of this study was to explore GPs’ knowledge, attitudes and practices relating to reproductive education, planning and EOC.


Approval was granted by the Human Research Ethics Committee of the University of Melbourne (1853398).

GPs and general practice registrars were invited to participate in an online survey. No validated questionnaire on this topic has been published, so a novel questionnaire was constructed using Qualtrics. Recruitment was through Facebook groups Doc to Doc, Doctors in Training Victoria, Medical Mums and Mums to Be, the authors’ personal pages, e-newsletters distributed via the RACGP and the Royal Women’s Hospital, Melbourne (March to July 2019). To be eligible, participants had to be currently practising in Australia and provide consent.

The survey contained 41 questions developed to both assess and improve participants’ knowledge of EOC, with the academic expertise of co-author RL, Reproductive Endocrinologist, Infertility Subspecialist and author of ANZSREI Consensus Guideline on EOC2 and MP, Program Leader for Psychosocial Health and Wellbeing Research (emPoWeR) Unit, Department of Obstetrics and Gynaecology, University of Melbourne.

Facilitated learning was a recruitment incentive. After participants’ baseline knowledge was assessed, correct responses, supporting information and references were provided. Where participants selected ‘other’, free text boxes were provided for further comment. Questions and responses are shown in Tables 1–5.


Incomplete surveys were excluded from analysis. Data were analysed with SPSS version 24 and Microsoft Excel. Postcodes were assessed for rurality using the Accessibility/Remoteness Index of Australia.23 Total knowledge scores were calculated as the sum of correct responses (1 = correct, 0 = incorrect). Themes from free-text responses were explored. Associations between reservations about referring on for EOC (dichotomised: yes vs no or unsure) and likelihood of asking about reproductive plans or elective fertility preservation (dichotomised: likely vs neither or unlikely), attitude towards family planning counselling (dichotomised: agree vs neither or disagree), and frequency of ordering AMH (dichotomised: > annually vs < annually) were explored using Chi-squared tests. A student’s t-test was used to compare mean knowledge scores between those who had reservations about EOC and those who did not or were unsure. Free-text responses were analysed for common themes.



Seventy-two GPs and general practice registrars participated. Although a large variety of participants were represented, the majority were younger female GPs in metropolitan areas (Table 1). The average time to complete the questionnaire was 16 minutes (standard deviation [SD] = 7).

Table 1. Demographic characteristics of participants
Characteristic n (%)
General practitioner  57 (79.2)
General practice registrar  15 (20.8)
Age (years)
25–34  33 (45.8)
35–44 21 (29.2)
45–54 11 (15.3)
55–64 6 (8.3)
65–74 1 (1.4)
Male 5 (6.9)
Female 66 (91.7)
Unspecified 1 (1.4)
Major city 40 (55.6)
Regional 24 (33.3)
Remote 5 (6.9)
Unmatched/unspecified 3 (4.2)
Special interest
Women’s health or similar 21 (29.2)
Other 11 (15.3)
None 40 (55.6)
How did participants hear about this survey?
Social media 46 (63.9)
Flyer  1 (1.4)
Colleague 4 (5.6)
Email 8 (11.1)
Friend 2 (2.8)
RACGP e-newsletter 13 (18.1)
Other 2 (2.8)
RACGP, The Royal Australian College of General Practitioners

While 82% of participants were aware that EOC is no longer considered experimental, 40% were incorrect on timing of female fertility decline (Table 2). The average knowledge score was 5.4/12 (SD = 1.8; range = 0–9). Participants showed poor understanding of ovarian reserve testing. Forty per cent failed to identify that AMH was not a measure of oocyte quality/natural fertility. Quantitative interpretation of AMH levels was also poorly understood.

Table 2. Knowledge on fertility and fertility preservation and ovarian reserve testing (n = 72); the correct answer is marked with an asterisk
Question n (%)
The largest reduction in natural fertility occurs during which age range?
20–29 years  4 (5.6)
30–34 years 6 (8.3)
35–37 years*  43 (59.7)
38–40 years 19 (26.4)
Oocyte cryopreservation is no longer considered experimental according to the ASRM and the ESHRE.
True*  59 (81.9%)
False  1 (1.4)
Unsure 12 (16.7)
Oocyte cryopreservation is now considered very effective.
True* 43 (59.7)
False 14 (19.4)
Unsure 15 (20.8)
While individual circumstances must be considered, which comment regarding the age at freezing is incorrect?
Many women have cryopreserved oocytes over the age of 35 years. 11 (15.3)
The highest live birth rate is seen when oocytes are cryopreserved at younger ages. 9 (12.5)
Age-related decline in fertility is primarily related to the decline in the quality of the oocyte as it ages and not the age of the uterus. 8 (11.1)
The age of the women at time of freezing is not a good predictor of oocyte potential.* 44 (61.1)
Which is not a risk of oocyte cryopreservation?
Ovarian hyperstimulation syndrome 2 (2.8)
Risks during oocyte collection including infection, damage to organs, blood loss, ovarian torsion, risks related to anaesthesia 1 (1.4)
Increased risk of congenital abnormalities* 60 (83.3)
Financial risk (eg cost of medication, cycles, IVF, etc) 1 (1.4)
Long-term risk associated with IVF 3 (4.2)
Risks of child bearing at advanced maternal ages 1 (1.4)
Unspecified 1 (1.4)
Who can provide assisted reproductive technologies?
Gynaecologists 2 (2.8)
Gynaecologist with expertise in fertility 15 (20.8)
Fertility specialist 18 (25.0)
Gynaecologist with reproductive endocrinology and infertility training (CREI) 21 (29.2)
All of the above* 49 (68.1)
ASRM, American Society for Reproductive Medicine; CREI, Certificate of Reproductive Endocrinology and Infertility; ESHRE, European Society for Human Reproduction and Embryology; IVF, in vitro fertilisation
Counselling, attitudes and practices

Participants reported infrequent discussion of elective fertility preservation with patients (Table 3). Sixty-seven per cent were asked about EOC by patients semi-annually or less, and 92% referred patients for EOC semi-annually or less.

Table 3. Counselling and practices regarding reproductive planning and fertility preservation (n = 72)
Question n (%)
How often have you been asked about elective fertility preservation by patients in the last year?
Weekly or more 2 (2.8)
Monthly 7 (9.7)
Quarterly 15 (20.8)
Semi-annually 16 (22.2)
Annually or less 32 (44.4)
How often do you refer on for elective oocyte cryopreservation?
Weekly or more 1 (1.4)
Monthly 2 (2.8)
Quarterly 3 (4.2)
Semi-annually 17 (23.6)
Annually or less 49 (68.1)
Do you have any reservations on referring on for oocyte cryopreservation?
Yes 8 (11.1)
No 56 (77.8)
Unsure 8 (11.1)
What are those reservations? (n = 8)  
Religious 0 (0)
Moral 1 (12.5)
Financial 1 (12.5)
Efficacy 3 (37.5)
Other (Poor understanding, do not want to pressure women) 3 (37.5)
How likely are you to ask patients about their reproductive plans for patients aged … 18–34
35–44 years
Very unlikely 3 (4.2) 3 (4.2)
Somewhat unlikely 10 (13.9) 6 (8.3)
Neither likely or unlikely 10 (13.9) 8 (11.1)
Somewhat likely 34 (47.2) 24 (33.3)
Very likely 15 (20.8) 31 (43.1)
What are the main barriers for you to ask patients about their reproductive plans?
Time constraints 44 (61.1)
Insufficient knowledge 4 (5.6)
Insufficient resources 1 (1.4)
Not my role/responsibility 8 (11.1)
Wish to avoid causing stress for patient 24 (33.3)
Discomfort 8 (11.1)
Other (Mostly ‘when clinically relevant’, no barriers, perpetuating social pressures, ask routinely, if patient initiates, uncomfortable about bringing it up) 20 (27.8)
Is there a specific age at which you would typically begin to discuss age-related fertility decline?
Unlikely to discuss 11 (15.3)
Average age 31.7 years; standard deviation 5.3
Counselling should take place in women/couples that are desiring future pregnancy and delaying because of non-medical reasons for patients aged … 18–34
35–44 years
Strongly agree 18 (25.0) 54 (75.0)
Somewhat agree 38 (52.8) 14 (19.4)
Neither agree nor disagree 8 (11.1) 2 (2.8)
Somewhat disagree 5 (6.9) 0
Strongly disagree 2 (2.8) 1 (1.4)
This counselling should be done by:
General practitioner 59 (81.9)
Obstetrician/gynaecologist 48 (66.7)
GP with special interest in women’s
55 (76.4)
Fertility specialist 43 (59.7)
All of the above  1 (1.4)
Do not know 2 (2.8)
How likely are you to initiate a conversation regarding elective fertility preservation with a patient/couple that is desiring future pregnancy and delaying because of non-medical reasons for patients aged … 18–34
35–44 years
Very unlikely 10 (13.9) 6 (8.3)
Somewhat unlikely 12 (16.7) 7 (9.7)
Neither likely or unlikely 16 (22.2) 8 (11.1)
Somewhat likely 22 (30.6) 21 (29.2)
Very likely 12 (16.7) 30 (41.7)
What are the main barriers to initiating this conversation?
Time constraints 41 (56.9)
Insufficient resources 11 (15.3)
Reservations about fertility preservation 8 (11.1)
Insufficient knowledge 18 (25.0)
Discomfort 5 (6.9)
Not my responsibility 2 (2.8)
To avoid causing stress for patient 16 (22.2)
What do you think are the main reasons that some women/couples may wish to delay having children? (All that apply)
Career 69 (95.8)
Education 57 (79.2)
Travel 57 (79.2)
Not ready 61 (84.7)
Have not found the right partner yet 71 (98.6)
Saving money 61 (84.7)
Do not want children currently but concerned about changing mind in future 62 (86.1)
Other (Patient’s current health issues) 3 (4.2)
What are the main barriers to oocyte cryopreservation in women/couples delayingpregnancy for non-medical reasons? (All that apply)
Knowledge 61 (84.7)
Financial 67 (93.1)
Efficacy 19 (26.4)
Ethical reservations 17 (23.6)
Religious beliefs 13 (18.1)
Physical risks/side effects 24 (33.3)
Time commitment 41 (56.9)
Other (Mostly rural/remote access.
Also partner involvement, fear)
7 (9.7)
Please indicate to what extent you agree/disagree that women are sufficiently aware of age-related reduction of fertility in: themselves men
Strongly agree 6 (8.3) 0 (0.0)
Somewhat agree 37 (51.4) 8 (11.1)
Neither agree nor disagree 3 (4.2) 10 (13.9)
Somewhat disagree 22 (30.6) 37 (51.4)
Strongly disagree 4 (5.6) 17 (23.6)
Please indicate to what extent you agree/disagree that men are sufficiently aware of age-related reduction of fertility in: themselves women
Strongly agree 0 (0.0) 9 (12.5)
Somewhat agree 7 (9.7) 36 (50.0)
Neither agree nor disagree 4 (5.6) 6 (8.3)
Somewhat disagree 36 (50.0) 14 (19.4)
Strongly disagree 25 (34.7) 7 (9.7)

Eleven per cent reported reservations regarding EOC. Having reservations was associated with reduced likelihood to ask about reproductive plans (χ2 = 3.87, P = 0.049) or discuss EOC (χ2 = 4.35, P = 0.037) with patients aged 18–34 years, but not with the 35–44-year age group (χ2 = 3.48, P = 0.062; χ2 = 0.08, P = 0.783; respectively). A similar association was seen between reservations and attitudes towards elective fertility preservation counselling with the 18–34-year age group (χ2=6.05, P = 0.014) but not the 35–44-year age group (χ2 = 1.53, P = 0.217). Reservations were not associated with knowledge score (x̄yes = 5.5(1.9) vs x̄no/unsure = 5.4(1.8), t(60) = –0.148, P = 0.883). Common reservations related to concerns regarding efficacy (38%), costs (25%) and lack of knowledge (13%). One respondent commented:

[I] feel that a social shift in the workplace regarding women having children younger is required, rather than put the onus on women to take on financial and medical risks of oocyte storage, plus risk of future infertility.

Participants were less likely to ask women aged 18–34 years about their reproductive plans when compared with women aged 35–44 years. Barriers cited were time constraints (61%) and wishing to avoid causing stress (33%):

Concerns about perpetuating social pressures for women to procreate, when that may not be their wish/desire/goal.

Seventy-eight per cent felt fertility decline counselling should occur with women aged 18–34 years, and 94% agreed it should be discussed at 35–44 years. Most (83%) felt GPs should be the health professional to do this.

Fifty-three per cent reported being ‘very unlikely’ or ‘neutral’ about initiating an elective fertility preservation discussion in patients aged 18–34 years, with 30% retaining this attitude for ages 35–44 years. The most common barriers to counselling were lack of time (57%) and insufficient knowledge (25%) and resources (15%).

The majority (96%) believed women were delaying having children as a result of not having the right partner, career aspirations (93%) and ‘not wanting children currently but concerned about changing mind in the future’ (84%). The main perceived barriers were lack of knowledge of EOC (82%) and cost (90%).

A majority ‘somewhat’ or ‘strongly’ agreed that men (63%) and women (60%) were sufficiently aware of female age-related infertility, but that men (85%) and women (75%) were not sufficiently aware of men’s fertility reducing with age.

Ovarian reserve testing was not commonly requested (Table 5), with 75% requesting it semi-annually or less. On receiving a high AMH result, 19% offered reassurance regarding current fertility to patients <35 years and 11% for patients aged ≥35 years. With a very low AMH result, the majority of participants would arrange immediate fertility specialist referral (64% for patients aged <35 years; 78% for patients aged >35 years). The requirement for nuanced counselling on the AMH test was reflected on (for low AMH):

Advise lower than average ovarian reserve but explain complexity of the test and reassure based on age, offer fertility specialist referral if wished (but this is why I avoid ordering AMH).

Table 4. Attitudes and practices regarding ovarian reserve testing (n = 72)
Question n (%)
How often do you request ovarian reserve testing, in total, for all patients?
Weekly or more 0 (0)
Monthly 4 (5.6)
Quarterly 14 (19.4)
Semi-annually 14 (19.4)
Annually or less 40 (55.6)
In the last year, how often have you ordered an AMH test?
Weekly or more 0 (0)
Monthly 5 (6.9)
Quarterly 14 (18.1)
Semi-annually 7 (9.7)
Annually or less 47 (65.3)
As an estimator of ovarian reserve, in which scenarios do you order an AMH test? Younger than 35 years Aged 35 years
 and over
Pre-pregnancy investigation 1 (1.4) 14 (19.4)
Unable to conceive after trying for >6 months 17 (23.6) 36 (50.0)
Infertility investigations 35 (48.6) 39 (54.2)
Investigation prior to referral to fertility specialist 40 (55.6) 45 (62.5)
Post chemotherapy or ovarian surgery 15 (20.8) 14 (19.4)
On patient request 30 (41.7) 32 (44.4)
Other: (Most common answer was ‘never’, only in infertility context, and when requested by patient and after discussion about relevance) 12 (16.7) 11 (15.3)
What is your next management step after receiving a very low AMH result? Tick all that apply. Younger than 35 years Aged 35 years
 and over
Advise low chance of conceiving 5 (6.9) 6 (8.3)
Immediate referral to fertility specialist 46 (63.9) 56 (77.8)
Arrange other fertility investigations 32 (44.4) 30 (41.7)
Management unchanged 6 (8.3) 3 (4.2)
Other: (Most common answers were ‘never order’ or ‘ask the patient’) 11 (15.3) 10 (13.9)
What is your next management step after a high AMH result? Tick all that apply. Younger than 35 years Aged 35 years
 and over
Offer reassurance regarding current fertility 14 (19.4) 8 (11.1)
Immediate referral to fertility specialist 8 (11.1) 22 (30.6)
Arrange other fertility investigations 24 (33.3) 26 (36.1)
Management unchanged 18 (25.0) 18 (25.0)
Other: (Frequent answers were ‘consider PCOS’, ‘never’, counsel in context of fertility) 21 (29.2) 16 (22.2)
AMH, anti-Müllerian hormone; PCOS, polycystic ovary syndrome
Desire for training and resources

Most participants (92%) agreed that more information should be made available on EOC, preferably online (78%), with one participant suggesting an:

Article or module produced in co-operation with [the] RACGP.

Table 5. Further training and resources wanted by participants
Question n (%)
More information on elective oocyte cryopreservation should be made easily available to general practitioners
Strongly agree 40 (55.6)
Somewhat agree 26 (36.1)
Neither agree nor disagree 6 (8.3)
Somewhat disagree 0 (0.0)
Strongly disagree 0 (0.0)
Additional information should be on: (All that apply)
Live birth outcomes for different providers 54 (75.0)
Available training 23 (31.9)
Procedures and logistics 44 (61.1)
Costs and cost benefit considerations 67 (93.1)
Other fertility preservation options 49 (68.1)
Ovarian reserve testing/pre-referral investigations 62 (86.1)
Other: (no suggestion provided) 1 (1.4)
Additional information should be in the format of: (All that apply)
Brochure 33 (45.8)
Website 56 (77.8)
Video 7 (9.7)
Training in person 23 (31.9)
Training online 39 (54.2)
Other: (‘article’ and no suggestion provided) 2 (2.8)


This is the first Australian study to assess GP knowledge, attitudes and practices regarding reproductive ageing and EOC.

Participants’ general knowledge of fertility was good; however, gaps were identified, including some estimating the age of onset of biological fertility decline too late, at 38–40 years, when it occurs at 35–37 years.14 Many participants did not identify age as the foremost predictor of successful EOC, with best efficacy shown when eggs are frozen before the age of 36 years.4 Knowledge of ovarian reserve markers, their interpretation and clinical utility was lower than general fertility knowledge. GPs surveyed overestimated their patients’ awareness of women’s fertility reducing with age, with the majority of GPs agreeing that men and women are sufficiently aware of women’s fertility reducing with age; however, studies have shown that patients, as well as obstetricians and gynaecologists, underestimate the reduction of fertility with age.18–20 This is concerning when GPs are expected to discuss reproductive planning,16 with 83% of participants feeling this was their role. Yet, only 12% of women undergoing EOC first learnt of it from a doctor, with more learning of it via peers or the media, and women wished they had undergone EOC at a younger age, stating lack of awareness as the reason for not doing so.24 Earlier discussion facilitates earlier, more effective EOC treatment.2 However, participants with reservations about EOC were less likely to discuss EOC with their younger patients. It may take women many years to decide to freeze oocytes (Sandhu S, Hickey M, Braat S, Lew R, Peate M, unpublished), and given the ultimate importance of timing for optimal efficacy, women need to be aware of EOC from a relatively early age.

Common barriers to family planning discussions were lack of time, knowledge, resources and fear of ‘causing stress’ for the patient. GPs may feel uncomfortable raising the topic of fertility with patients, concerned about perpetuating gendered stereotypes and applying perceived societal reproductive pressure. Prior et al reported younger Australian men and women would not feel uncomfortable if their GP brought up this topic (91% and 87%, respectively).25 It is, however, important, that information given is reliable. In light of the low knowledge level of ovarian reserve testing, most GPs were referring as appropriate to fertility specialists for counselling in context of a low AMH result. However, some participants offered patients with a normal or high AMH result false reassurance about current and future fertility. With women increasingly interested in EOC, there is an urgent need to support GPs to provide an accurate interpretation of AMH to avoid increasing distress or providing false reassurance. Providing further education for GPs and funding for provision of counselling would help to facilitate accurate and timely discussions.

Study participants infrequently referred patients for EOC, with cost a barrier. EOC attracts no government rebate and costs approximately $6885–$8000 per cycle (more than one may be needed) in addition to annual storage fees and future costs associated with IVF,26 a personal cost that is perceived to be high by those who have undergone EOC.27 However, allowing concern regarding the cost to direct whether the conversation occurs does not consider patient autonomy and informed choice. To make an informed decision about use of elective ART, patients should be informed of all appropriate options. Informed choice can guide decisions that are consistent with personal values, which may include a willingness to self-fund EOC.

The limitations of this study include selection bias, limited sample size and lack of a validated questionnaire. Additional reservations and concerns may be held by non-participant GPs. Older GPs and male GPs have not been well represented, which may be a reflection of lack of interest in this field and/or limitations in the recruitment method. Sample size limited generalisability and the ability to explore associations. However, in the absence of any research in this area, this study can provide some insights – noting in particular that participants are likely to be those with an interest in reproductive health and thus these data may show higher knowledge and rates of discussion, more positive attitudes and greater rates of referral than GPs at a population level. Future research could look to validate the survey and collect data on a larger, more representative sample.

Implications for general practice

Participants in this pilot study displayed some gaps in knowledge of fertility, ovarian reserve testing and EOC. These include that reproductive planning discussions including EOC could be entered into at earlier life stages to offer women greater biological insight, perspective and choice. Participants requested more online fertility-focused education and training. The findings suggest a place for additional resources to assist GPs in providing timely and accurate counselling to enable patients to achieve their reproductive life plans.

Competing interests: None.
Provenance and peer review: Not commissioned, externally peer reviewed.
Funding: None.
Correspondence to:
The authors would like to thank all the general practitioners who contributed to this research.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log
  1. Australian Bureau of Statistics. Births, Australia 2019. Canberra, ACT: ABS, 2020. Available at [Accessed 26 January 2021]. Search PubMed
  2. Lew R, Foo J, Kroon B, Boothroyd C, Chapman M; Australasian CREI Consensus Expert Panel on Trial evidence (ACCEPT) group. ANZSREI consensus statement on elective oocyte cryopreservation. Aust N Z J Obstet Gynaecol 2019;59(5):616–26. doi: 10.1111/ajo.13028. Search PubMed
  3. Menken J, Trussell J, Larsen U. Age and infertility. Science 1986;233(4771):1389–94. doi: 10.1126/science.3755843. Search PubMed
  4. Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N. No. 356-egg freezing for age-related fertility decline. J Obstet Gynaecol Can 2018;40(3):356–68. doi: 10.1016/j.jogc.2017.08.004. Search PubMed
  5. Goldman KN, Grifo JA. Elective oocyte cryopreservation for deferred childbearing. Curr Opin Endocrinol Diabetes Obes 2016;23(6):458–64. doi: 10.1097/MED.0000000000000291. Search PubMed
  6. Hammarberg K, Kirkman M, Pritchard N, et al. Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Hum Reprod 2017;32(3):575–81. doi: 10.1093/humrep/dew342. Search PubMed
  7. Pritchard N, Kirkman M, Hammarberg K, et al. Characteristics and circumstances of women in Australia who cryopreserved their oocytes for non-medical indications. J Reprod Infant Psychol 2017;35(2):108–18. doi: 10.1080/02646838.2016.1275533. Search PubMed
  8. Ethics Committee of the American Society for Reproductive Medicine, Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: An ethics committee opinion. Fertil Steril 2018;110(6):1022–28. doi: 10.1016/j.fertnstert.2018.08.027. Search PubMed
  9. Wennberg AL, Rodriguez-Wallberg KA, Milsom I, Brännström M. Attitudes towards new assisted reproductive technologies in Sweden: A survey in women 30–39 years of age. Acta Obstet Gynecol Scand 2016;95(1):38–44. doi: 10.1111/aogs.12781. Search PubMed
  10. Lallemant C, Vassard D, Nyboe Andersen A, Schmidt L, Macklon N. Medical and social egg freezing: Internet-based survey of knowledge and attitudes among women in Denmark and the UK. Acta Obstet Gynecol Scand 2016;95(12):1402–10. doi: 10.1111/aogs.13024. Search PubMed
  11. Martyn F, O’Brien YM, Wingfield M. Review of clinical indicators, including serum anti-Müllerian hormone levels, for identification of women who should consider egg freezing. Int J Gynaecol Obstet 2017;138(1):37–41. doi: 10.1002/ijgo.12167. Search PubMed
  12. Hurley EG, Ressler IB, Young S, et al. Postponing childbearing and fertility preservation in young professional women. South Med J 2018;111(4):187–91. doi: 10.14423/SMJ.0000000000000789. Search PubMed
  13. Fritz R, Jindal S. Reproductive aging and elective fertility preservation. J Ovarian Res 2018;11(1):66. doi: 10.1186/s13048-018-0438-4. Search PubMed
  14. 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):633–34. doi: 10.1016/j.fertnstert.2013.12.032. Search PubMed
  15. Hammarberg K, Zosel R, Comoy C, et al. Fertility-related knowledge and information-seeking behaviour among people of reproductive age: A qualitative study. Hum Fertil (Camb) 2017;20(2):88–95. doi: 10.1080/14647273.2016.1245447. Search PubMed
  16. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice 2018. 9th edn. East Melbourne, Vic: RACGP, 2016. Search PubMed
  17. Gossett DR, Nayak S, Bhatt S, Bailey SC. What do healthy women know about the consequences of delayed childbearing? J Health Commun 2013;18 Suppl 1(Suppl 1):118–28. doi: 10.1080/10810730.2013.825677. Search PubMed
  18. Deatsman S, Vasilopoulos T, Rhoton-Vlasak A. Age and fertility: A study on patient awareness. JBRA Assist Reprod 2016;20(3):99–106. doi: 10.5935/1518-0557.20160024. Search PubMed
  19. Guedes M, Canavarro MC. Risk knowledge and psychological distress during pregnancy among primiparous women of advanced age and their partners. J Midwifery Womens Health 2014;59(5):483–93. doi: 10.1111/jmwh.12205. Search PubMed
  20. Fritz R, Klugman S, Lieman H, et al. Counseling patients on reproductive aging and elective fertility preservation – A survey of obstetricians and gynecologists’ experience, approach, and knowledge. J Assist Reprod Genet 2018;35(9):1613–21. doi: 10.1007/s10815-018-1273-7. Search PubMed
  21. García D, Vassena R, Prat A, Vernaeve V. Poor knowledge of age-related fertility decline and assisted reproduction among healthcare professionals. Reprod Biomed Online 2017;34(1):32–37. doi: 10.1016/j.rbmo.2016.09.013. Search PubMed
  22. Esfandiari N, Litzky J, Sayler J, Zagadailov P, George K, DeMars L. Egg freezing for fertility preservation and family planning: A nationwide survey of US Obstetrics and Gynecology residents. Reprod Biol Endocrinol 2019;17(1):16. doi: 10.1186/s12958-019-0459-x. Search PubMed
  23. Psycho-oncology Co-operative Research Group. Accessibility/Remoteness Index of Australia Look Up Tool. Camperdown, NSW: PCRG, [date unknown]. Available at [Accessed 20 July 2019]. Search PubMed
  24. 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):1343–49. doi: 10.1016/j.fertnstert.2013.07.201. Search PubMed
  25. Prior E, Lew R, Hammarberg K, Johnson L. Fertility facts, figures and future plans: An online survey of university students. Hum Fertil (Camb) 2019;22(4):283–90. doi: 10.1080/14647273.2018.1482569. Search PubMed
  26. Hunter G. How much does egg freezing cost? Sydney, NSW: Finder AU, 2021. Available at [Accessed 8 November 2021]. Search PubMed
  27. de Groot M, Dancet E, Repping S, et al. Perceptions of oocyte banking from women intending to circumvent age-related fertility decline. Acta Obstet Gynecol Scand 2016;95(12):1396–1401. doi: 10.1111/aogs.13019. Search PubMed

FertilityOocyte cryopreservation

Download article