Introduction
The total fertility rate (TFR) of Saudi Arabia stood at 2.208 births per woman in 2022, registering a decline of 1.47% from 2.241 births per woman in 2021.1 About 6% of married women aged 15–49 years can expect no pregnancies after one year of attempts, while 14% experience problems with conception and reaching the completion of their pregnancies.2 In the last 70 years, fertility rates across the globe have reduced by a staggering 50% as a result of women’s increased participation in education and the labor market, the decline in infant mortality, and raising children becoming more expensive.3 Oocyte cryopreservation (OC) is a valuable procedure for a woman who is to undergo treatment using assisted reproductive technology. It is intended for female infertility, and the procedure, also called egg retrieval stimulation, entails the usage of ovarian hormone stimulation to Trigger ovarian response and harvest healthy eggs to freeze. The endorsement of a career-oriented outlook amongst women of age generally delays ideas of family formation in a nation’s population.4 The focus must now be on the growing burden of late childbearing through advocacy programs to change this position.5
Chen first reported successful pregnancy in a human after OC in 1986.
Even though OC does not guarantee a future successful pregnancy, it can instill in women a sense of countenance, hope, or satisfaction and magnificently enhances one’s morale while still at work.6 According to previous studies, egg freezing may be necessary for various reasons, including economic, social, health, educational, religious, psychological, and career aspects. Reasons for egg freezings include lack of a severe amendable relationship and a desire for children biologically belonging to a dedicated spouse or having a sick or much older husband.7 Inhorn’s work on OC highlights the complex interplay of gender, technology, and societal factors influencing women’s decisions regarding fertility preservation.8
The importance of the Information provided by the patients contributes to the decision-making process in OC, which was deeply relayed in the Turkish study. Studies in Turkey have tended to concentrate on the procedure itself, whereas this particular phenomenological study goes beyond by examining decision making, rationales, and meanings associated with OC. A key finding is that women experience discomfort, such as anxiety and uncertainty, when medical professionals make OC decisions without adequate patient information.9
The study, conducted in Al-Qassim, Saudi Arabia, to understand the awareness of women of reproductive age toward OC, revealed the crucial role of education in fertility health. Education is essential for making well-informed reproductive choices and for applying ART techniques like OC.10
This emphasis on education ensures that the audience feels more informed and aware of the importance of fertility health in reproductive decision-making. Research on OC must consider cultural context. This study of Iranian university students revealed generally positive attitudes toward OC but significant gaps in knowledge about ideal childbearing timing. The results highlight the need for culturally sensitive education and integration of this Information into reproductive health counseling.11
Although debates on the social freezing of eggs are focused on autonomy and issues of gender inequality, an examination of women’s lives suggests that the situation is more complicated than that. Women’s choices are not simple and are shaped by intersecting social determinants. This underscores the urgent need for an intersectional approach, which is crucial for understanding the full scope of the social freezing of eggs and its relation to social inequalities.12
In Saudi Arabia, the context surrounding fertility and reproductive choices is shaped by a unique interplay of cultural, social, and economic factors. OC has emerged as a significant option for women seeking to balance career aspirations with family planning, providing a means to postpone childbearing while preserving their fertility. However, despite the potential benefits of this procedure, there is limited research addressing women’s experiences, feelings, and motivations in the Saudi context. This gap highlights the need for an in-depth exploration of women’s attitudes toward social OC, especially as societal expectations continue to transform in response to contemporary economic and familial pressures.
Although the world is adopting OC as a new way to preserve one’s fertility, the studies analyzing the experiences and viewpoints of women who undergo OC in selected cultures, particularly Saudi Arabia, are fascinating. This study aims to investigate the experiences of women in Riyadh, Saudi Arabia, who have undergone OC. The results are anticipated to fill an essential gap in the literature on the issue of OC in different cultures.
Methodology
This mixed-method study consisted of two distinct, but interrelated phases conducted within Riyadh, Saudi Arabia. The participants in this study were women aged 18–47 years old who underwent OC at the center between January 1, 2019, and August 1, 2022, for social and medical grounds. Participants were enrolled between December 1, 2022, and ending June 29, 2023. Subjects were reached using the phone numbers identified in their documents and records to seek consent for involvement in the study. To appreciate the varying views held by people, purposive sampling was done to have participants with the highest diversity in age, location, social status, and number of eggs frozen. The primary investigator approached the women in person, by telephone, or on WhatsApp to determine whether they would like to volunteer to take part in the research. Women who declined to participate were omitted because of scheduling problems, emotional reasons, religious views, or lack of interest or response. Out of the 15 women who agreed to participate in the study, 10 were recruited face to face in different settings, four at the hospital, and one at a café. The study followed the Declaration of Helsinki and its subsequent revisions.
Quantitative Data Analysis
The Freezing Oocyte Questionnaire was developed in English, and its Arabic version was later created. This particular survey, which consisted of six questions, was developed based on existing sciences and submitted in a translated form into Arabic.13 The first part collected the respondents’ demographic data, including age, nationality, area of residency, job status and level, and social status. The second part had six multiple-choice questions aimed at exploring the knowledge of the subjects regarding the freezing of oocytes: reasons for doing so, methods employed, and difficulties encountered—parts three, four, and five contained information concerning medical-social-ethical issues of freezing women’s eggs. The last section contained specific inquiries on OC practices and their possible future uses. A univariate analysis was conducted in STATA BE, Version 18, to speculate the study’s outcomes.
Processing of Qualitative Information
Qualitative attributes were collected through the semi-structured interviews both in-person and over teleconferencing applications. Each interview took 11–25 minutes. The collected data was examined through several phases of thematic analysis. The first phase, archived as familiarization with the nature of the collected data, included selective transcription of the text and making notes about the first ideas related to the text. In the second phase, the initial codes were developed using a member of the open codes about key features in the data set. The third phase focused on identifying key themes by categorizing the codes based on their similarities in meaning. There were flag patterns concerning them as well. The corresponding authors evaluated, reviewed, and refined the themes in the fourth phase.
Results
In this research, we studied women’s perspectives regarding the issue of OC at a private medical center in Riyadh, Saudi Arabia. The findings are presented in a manner that highlights the key themes and associations derived from both quantitative and qualitative data related to women’s motivations, satisfaction, and concerns surrounding the OC process.
In Table 1, the demographics and assessment with the general features of the participants in the study and from general characteristics evaluate the association, especially with satisfaction on OC. The investigation also established that almost half of the respondents (46%) are aged forty years and above, which explains the reason behind the increasing number of older women looking for fertility services. Most respondents (97%) were Saudi nationals, and over two-thirds lived in the country’s central region. A significant number (47%) were unemployed; of those employed, only 13% were in the health care profession.
Table 1 Demographic and Clinical Characteristics of Participants and Their Association with Satisfaction in OC (n=100)
Concerning marital status, 52% of the participants were married, while 30% were single, and 17% were divorced. In addition, seeking OC was for more social (77%) and medical (23%) reasons. Therefore, many women think ahead and are willing to freeze their oocytes for social reasons. OC complications were very rare (2%), and few participants (5%) had a history of cancer.
In terms of participant characteristics and their satisfaction with OC, age (p=0.782), nationality (p=0.444), occupation (p=0.851), and marital status (p=0.901) were found to have no statistically significant relations. Regarding the varying rates of satisfaction based on age groups, there were some differences where women aged 35–39 reported the highest level of satisfaction at 78.6%, while the younger participants (18–24 years) were 77.8%. Even though the differences were not conclusive, Eastern (88.9%) and Southern (80.0%) women were more satisfied as compared to the Western (50.0%) and Northern (60.0%) women, endorsed a trend (p=0.099). Interestingly, women’s reasons for OC were highly associated with satisfaction (p=0.050), with women stating social reasons being most satisfied. It can also be seen that factors such as the presence of complications during the OC process were tied to low satisfaction (p=0.040). This can be illustrated by the 50% satisfaction rate among women who had complications compared to a 91.8% satisfaction rate among women who did not.
These results revealed the complexity of factors influencing women’s satisfaction with OC in this population, showing the subtle interrelations between demographic factors, personal motives, and health outcomes.
The social reasons for OC, as reported by the respondents, are presented in Table 2. The responses presented various reasons that push women into social egg-freezing. The reason most respondents reported was the respondents’ wish to postpone marriage or postpone pregnancy for social reasons by 53 participants (45.3%). This trend is common among women who want to finish their studies or focus on career growth before settling to start a family. A similar trend was also observed among many women (28.2%) who reported that they 59 decided that freezing oocytes would not help them have children in the future, which could harm their fertility.
20 Return to Table of Contents Participants cited other pertinent reasons, like the need to have a healthy child from good-quality eggs, 21 Participants (17.9%), and the inability to find an appropriate spouse, curiously mentioned by 10 participants (8.5%).
Respondents reflected on the implications of OC; as far as they were concerned, in “his case”, the majority (59.8%) of the respondents believed that freezing oocytes provides an opportunity for a single woman who cannot ensure that she will meet the right partner in time, to have children in future. After that, 12.4% answered “no”, whereas 27.8% hesitated to answer “maybe”. Another matter was that quite a huge majority, 54.5%, maintained that OC makes it possible for those women who would otherwise not entertain the idea of raising a family now because of other commitments to come to such a consideration in the future. In stark contrast to this, 14.1% of the subjects believed it was impossible and 31.3% were indecisive.
Concerning women whose current relationships have ended,52.5% of the respondents approved of the statement that OC gives a woman an opportunity to start a family later, 14.1% disagreed, and 33.3% said they were uncertain.
It is reasonable to assert that social components influence respondents’ decisions to freeze oocytes. The participants seem to be quite aware of how such a process may help women take control of their reproductive health in the face of social and life obligations.
Delivers valuable insight into the social reasons women freeze eggs and shows apparent changes in how these women think. The most significant factor was the intention to avoid marriage or childbearing for social reasons, which covered 45.3% of the responses. This finding indicates that more women would like to have a plan B just in case to freeze their eggs. The second most common reason was the intention to give birth using good-quality eggs 17.9%. In addition, many women raised concerns about their existing relationship, as much of their concern was regarding the right partner and their desire to meet this partner soon.
Table 4 Perceptions About the Future Implications of Freezing Oocytes Among Women
Table 5 Association Between Reasons for Freezing Oocytes and Satisfaction with the Procedure
Table 6 Association Between Ethical and Cost Concerns Regarding Freezing Oocytes and Satisfaction with the Procedure
Table 7 Association Between Satisfaction with the Procedure and the Future Aspects of Freezing Oocytes
Regarding why it was important to freeze eggs, most participants (59.8%) believed and argued that it would help single women have children in the future, hence the reproductive rights context. Of equal proportions, a significant number, 54.5, agreed that this would help women who have other responsibilities take care of children in the future when circumstances allow them to. A further 52.5% of the participants regarded egg freezing as an option for those who want to have children in the future but do not know who their partner will be, which confirms that egg freezing is a measure for women who have an unstable personal situation.
Who wants to bear the cost/hassle of OC ? In respect of this, 92.0% agreed that OVA freezing procedures must possess a lot of documents, including the consent form, and more so where the patient is single. More than one-fifth, 20.0%, were worried about the possible concerns of future husbands while the majority, 80.0%, did not. The cost of undergoing procedures to freeze eggs, quite a number 67.0% of the respondents said, was a notable issue for most participants. This emphasizes the financial implications or costs of preserving one’s fertility.
Some women, however, had concerns with the cultural and religious barriers. About 29 points o percent of mentioned sociocultural aspects were barriers to participation, while 11.0% cited the religious aspects as a barrier. This finding indicates the scope of cultural and religious concern that ought to be taken into account in egg freezing procedures and concerning the type of information that should be offered in such a case so that it is respectful of their values.
Table 4 highlights participants’ perceptions regarding the future consequences of OC. The vast majority of respondents (83.0%) indicated that they were satisfied with the procedure of freezing oocytes, whereas only 17.0% reported being unsatisfied. The investigation of the barriers to repeating this procedure indicated that cost was the main limitation for 62.0% of participants, and this was followed by other factors (34.0%) for which no specific mention was given. Human factors such as culture (3.0%) and religion (1.0%) barriers have been least recognized and, as such, are regarded by few as a concern.
Concerning the adverse effects of the procedure, 62.0% of the participants did not worry about the frozen oocytes being misused, whereas 38.0% were uncomfortable Similarly, 63.0% of respondents indicated they were not concerned with improperly storing frozen oocytes, while 37.0% expressed fear. A minority (29.0%) expressed concerns about the length of time oocytes were to be kept in storage, while a majority (71.0%) felt secure within that period.
Most (68.0%) thought follow-up on OC and storage was optional. However, virtually all the participants in the study (96.0%) indicated that egg-freezing banks will have to be licensed and maintain technical standards to ensure quality in reproductive health.
Finally, regarding perspectives on the freezing of oocytes, 66.0% believed that the procedure could be useful for all women in the future, while 67.0% thought that it could help young women under 40. These findings point to a strong favorable attitude towards OC amongst participants, combined with concerns about costs and regulatory standards.
Table 5 analyzes the participant satisfaction associated with multiple reasons for freezing oocytes and using oocytes for ART. In the study, however, the reason for freezing oocytes was the main contributor to the women’s satisfaction levels.
Regarding the social indications for oocyte vitrification, social reasons were most satisfied, with 84.4% being satisfied and 15.6% not being satisfied. On the contrary, satisfaction was lower for medical reasons, with reported satisfactory and unsatisfactory scores of 78.3% and 21.7%, respectively. However, this difference was not statistically significant at (p=0.490).
The reasons why women opted to undertake social freezing were associated with notable trends. For those who did not want to get married or have any children immediately and therefore chose to freeze, 90.9% were satisfied, while only 9.1% were unsatisfied (p=0.076). There were, however, high levels of satisfaction among individuals freezing for medical reasons such as preserving future fertility (66.7% vs 33.3%). Yet 75.0% were satisfied as long as they did not have a partner currently to marry, corresponding with 25.0% being dissatisfied.
Regarding confidence concerning the future consequences of OC, significant correlations were obtained with the participants’ beliefs. More specifically, satisfaction levels were significantly higher among those who perceived that freezing oocytes enables a single woman to bear children in the future, even when she does not have a partner at that time (94.8% satisfied, p<0.001). A similar pattern was also expressed by those who believed that freezing oocytes makes it possible for women who have other obligations to have a family in the future (94.4% satisfied, p<0.001) and those who viewed it as allowing women who have gone through relationship breakdowns, to have a family (94.2% satisfied, p<0.001).
The results suggest that women’s perceptions of the potential futures enabled by OC are closely linked to their overall satisfaction with the procedure. While medical reasons for freezing oocytes did not show a statistically significant association with satisfaction, the social motivations, particularly regarding the anticipation of future family planning, correlated strongly with positive experiences of the freezing process.
Table 6 illustrates how ethical and cost factors associated with the egg-freezing process relate to the procedural satisfaction derived from the study. These findings reveal several interesting trends. The perception that a single oocyte would require the completion of some documentation, bearing in mind that it is more so in single women, had a positive correlation with satisfaction rate (p<0.001). Women who believed this were more satisfied (87.0%), while women who did not were less satisfied (37.5%). Conversely, worries regarding costs, future husbands’ vetoes, and ethnic or religious issues showed no remarkable correlation to satisfaction. These observations also bring the need to consider ethical issues, especially the need for informed consent when implanting the oocyte, to foster satisfaction with the process. Based on the findings, though, economic issues and sociocultural or religious factors have little impact on dissatisfaction among women toward the procedure.
Table 7 shows how women’s procedural satisfaction with OC relates to their perspectives on different aspects of oocyte frogmen’s future. Women’s satisfaction was an ideal variable that determined their views on various factors in future OC. This satisfaction was highly related to good information from physicians regarding the freezing procedure, p = 0.041. While 92.8% of satisfied women reported receiving good guidance from doctors, only 76.5% of unsatisfied women made similar reports. While these limits will ensure providers play an essential part in guaranteeing patient comprehension of and satisfaction with fertility women’s satisfaction, they must be noted.
There was no statistically significant effect of women’s current satisfaction on concerns and barriers to freezing oocytes in the future. However, more satisfied women than unsatisfied women had cost concerns (62.7% vs 58.8%. This was only minimally significant because most barriers and concerns regarding the improper thawing or storage of frozen oocytes were reported more in unsatisfied women). A higher proportion of satisfied women than dissatisfied women proposed initiating an accreditation process for egg-freezing banks, although this difference was not statistically significant (97.6% vs 88.2%; p=0.073). These studies also emphasize the need to enhance provider communication on OC so that women’s satisfaction with the procedure is improved and that dissatisfaction arising from concerns on misuse, storage, and costs are less than what is expected.
Qualitative Data
Variables such as the age of the participants during the interview and at the time of cryopreservation, marital status, occupation, number of times eggs were retrieved, and number of oocytes used are shown in Table 8.
Eight women opted to freeze eggs for medical reasons: contraction of sexually transmitted infections (STIs), particularly human immunodeficiency virus and human papillomavirus (n=2); malignant lymphoma (n=2); undergoing multiple abortions (n=1); carried genetic Alström syndrome (n=1); history of primary ovarian insufficiency (n=1); and history of sickle cell disease (n=1).
Of the 15 women, 7 focused on social reasons: 2 had late marriages, 1 was a barren divorce, and the others were due to gender selection, delay in pregnancy, lack of time, and vaginismus. The six prominent themes related to egg freezing were the concept and aim of freezing, patient experience, challenges faced, quality of service, communication and confidentiality, and recommendations.
Concept and Aim of Freezing
Most participants were familiar with OC. The need to maintain health persisted, regardless of medical or social reasons. Participants reported apprehensions about their inability to find a suitable partner and become a mother in the future due to their medical or social conditions.
Participants in the interview sessions mentioned the following:
OC is like a miracle from the sky to preserve my ovaries, especially with a family history of premature ovarian insufficiency. (Interview 5, 18 years old)
Freezing oocyte is a backup; it’s like your account in the bank, the only solution, but the priority for marriage is irreplicable by this technique. (Interview 9, 47 years old)
Consequently, freezing was viewed as a final resort and an alternative to fulfill their overwhelming desire to create a healthy family. Several women said that their unfulfilled desire for children was an emotional burden, and they had struggled to accept a future without children or children in good health.
I have a family history of a strange syndrome called Alström syndrome, which affects about 900 people worldwide. My husband and I unexpectedly gave birth to an abnormal child, and genetic testing revealed that 50% of their genes were abnormal. Then, I discussed it with my consultant. To fully profit, she approached me to perform a pregnancy test and tried to freeze my oocyte. (Interview 8, 33 years old)
More than one million STIs are acquired daily worldwide, posing a serious threat to global public health.14 Individuals who contracted STIs strongly felt a barrier or a hampered relationship with the opposite sex.15,16 One study participant said,
After marriage, during the first three months, I realized I was infected with the human papillomavirus; when I tried to determine the cause, I discovered it was caused by my husband’s illicit relationships. The reason for my freezing was to protect my sexual health. For me, one of the main causes of freezing is not finding a good partner, so ladies seek to do it. (Interview 15, 32 years old)
Women realized that egg freezing was not a guarantee of having a child; therefore, they opted to assume ownership and exhaust all options within their reproductive life years.17
Regarding the delay in the marriage, I was worried about my age and quality of oocytes, and I may not get married until the age of 40. When I did the freezing, I felt more relaxed, and not afraid about nightmares thinking it is a “creative technique”. (Interview 13, 40 years old)
I am pleased with this experience. I know I have no husband at the time, but at least I am attempting to protect my oocytes; I feel much better and more confident with my doctor; he was polite to me, explained things to me, and interacted with me even outside his office. (Interview 13, 40 years old)
Vaginismus involves recurrent or persistent involuntary spasms of the outer vaginal muscles that prevent the partner from penetrating during intercourse. This significantly impacts how a woman feels about herself, her partners, and their relationships. Fear- and disgust-based attributes are linked to lifelong vaginismus.18,19
I had difficulty having sex with my husband, like ‘killing me with a knife.’ I have three years of marriage and never acted like a normal couple in bed. I did it once under pressure and forcefully, but I prefer to do freezing until I can get a normal child without sex and IVF until I deliver by cesarean section. I feel worried and in trouble (no one will touch me). (Interview 7, 27 years old)
Most parents desired a child who shares their genetic makeup, and designer babies could soon become possible. Designer babies could potentially serve to not only eliminate hereditary diseases but also select specific physical characteristics and traits in offspring, thereby enabling parents to pass on preferred genetic attributes.20
The couple’s decisions will have an impact on the decision to freeze. Here, I froze; my spouse is requesting to choose the gender after the last birth (girl) so that he can choose the XY chromosome to be called by his grandfather’s name. (Interview 2, 47 years old)
One participant who was a medical professional highlighted the challenges faced by healthcare professionals, including demands and commitments during their years of training, as well as the taxing long working hours, as corroborated by a previous study.21
You know the life of a doctor. I couldn’t find time to spend with the kids because I was too busy with patients, clinics, workshops, conferences, and traveling from country to country. (Interview 4, 35 years old)
Experience of Freezing
Questions asked by peers about having children were sensitive topics that caused distress and were often considered inappropriate. However, most patients agreed that their egg-freezing experience was excellent and satisfactory.
A participant responded,
The best thing was that the doctors in the clinic explained to me very well, as they were using videos, pictures, and models to explain how they can do the procedure. It was excellent, clear, and simple. (Interview 8, 33 years old)
In Saudi Arabia, the private sector is considered better than the public sector owing to the insufficiency of and consumer dissatisfaction with public sector services.22
Two participants were unhappy and remarked as follows:
I am not satisfied with this experience; it was like profiteering. They just took my money, and nobody was interested in my health. The doctor had no clear plan and a very bad attitude (i.e., they want money). (Interview 14, 41 years old)
My experience has been terrible. The doctor explained quickly, he called the coordinator to explain the procedure to me, he didn’t give me a clear picture, and the coordinator explained about the medications rather than the doctor, which was not fine at all. (Interview 14, 41 years old)
Developing a patient’s trust is increasingly valuable and a fundamental aspect of successful patient care and favorable outcomes.23
The participants also felt the following:
They focused on the plan and explained the stages of the treatment steps (step by step). I just felt depressed when I used hormonal therapy, and it was complicated with hyperstimulation ovarian syndrome, moderate stage. I felt lower abdominal pain, so I followed up with the clinic, and I improved to resolve the symptoms and did not repeat my experience that year. I delayed it to the next year. Everything is going smoothly. I can freeze three of my ova with good quality. (Interview 3, 41 years old)
What happened to me was unfair. I followed up with the consultant; he was good with me and explained to me every difficult point, but when I did my freezing, the consultant was on vacation. I felt so sad and upset. I have canceled my visits. I took my frozen oocyte to another hospital. I feel strange feelings and will never repeat the experience in the same hospital. (Interview 6, 38 years old)
Challenges
OC faces several societal challenges; however, the medical field has made concerted efforts to overcome them, particularly considering Saudi Arabia’s new 2030 vision. Social barriers, including outdated beliefs, hinder the acceptance of OC. However, most patients at our religious center perceived that our Islamic vision aligns with human goals in the Holy Quran.
Wealth and children are the adornments of life in this world.
OC can solve the social problem of late marriage, particularly considering the changing responsibilities in Saudi Arabia. However, many couples or even single individuals encounter financial hurdles due to the cost implications associated with OC and the overall procedure.
Because the majority of these are very expensive, money is one of the largest obstacles in this field. I pay my gold to participate in this experience because it is too challenging to be paid for. (Interview 14, 41 years old)
I still see many people around me who are unable to pay for their contracts, checkups, or follow ups. The financial issue is still a major thing, depriving them of the right to have children. (Interview 10, 27 years old)
My spouse is ‘Shikhk,’ the major boss in his tribe, and I’m ashamed to tell anyone around him and me because we’re worried about their reactions. (Interview 2, 47 years old)
Nobody knows about my freezing except my sister; and my mom–I can’t tell her the truth since it feels like a great secret in my life. I just did it once, and then one of my colleagues asked me about my experience with cancer. I never told her the truth about how I can preserve my fertility. I only informed her there’s something called cryopreservation that you may ask your IVF doctor about; I never disclosed my personal experience. (Interview 9, 47 years old)
After the age of 40, my doubts and fears have increased. It is becoming extremely hard to find someone who wants to marry me at this age, (social perspective); it’s not fair. I try to avoid celebrations and family events because I don’t want to be asked this question: at this time, why don’t you choose your partner or soulmate? That’s why I can’t disclose my secrets or stories of OC or tell them the truth–because this is my barrier (social perspective). (Interview 14, 40 years old)
Quality of Service
The Saudi government has prioritized developing healthcare services at all levels, to provide adequate healthcare to all patients. Healthcare is a vital human right, especially when expensive procedures such as egg freezing are involved.
My experience was that I felt satisfied with all the services in the hospital. This was one of my preferred hospitals in Saudi Arabia; it is comparable to King Faisal Specialty Hospital. I work there, and I know that very well. (Interview 9, 47 years old)
I work in this field, and they follow the most recent research and try to improve the quality as much as they can. They care about the smallest details, such as the factory of trolly, which we saw was a small thing, but in IVF and freezing, it is critical to pay attention to small or tiny details. (Interview 13, 40 years old)
This hospital was not what I expected when I heard about it. When I paid money, I expected to receive more care. Nevertheless, when they admitted me to the OR to begin the procedure, they abruptly informed me that they could not find sperm and that my husband had azoospermia. It’s too late. What’s the use of the laboratory work if this is the outcome and you force me to freeze because of this error that occurred. It was poor quality. (Interview 14, 41 years old)
Communications and Confidentiality
Most participants reported excellent communication with healthcare providers and expressed confidence in their physicians, having selected them based on specific criteria. However, some participants shared the following experiences:
The issue of confiding was not clear, and no one explained it very well to me. It’s a dark secret with no clear debate. (Interview 10, 27 years old)
I am disappointed with this experience. It feels like a profiteering system; they took my money with no regard for my health. I and my husband had the same problem. When I contacted them, I could not find good communication. It’s all about money, but nobody tells us anything, so I don’t know. (Interview 14, 41 years old)
My first consultant in gynecology, when I asked him, was really tough. When I talked with this new consultant, when I informed him about my side, he started to check on me first by ultrasound, simply to reassure me. I felt glad, calm, and comfortable with myself. The doctor was excellent, but the coordinators’ behavior as consultants was unacceptable When I asked a special question, she answered it without consulting the doctor. I told her that she was a coordinator, not a doctor. (Interview 9, 47 years old)
Recommendations
When asked for their recommendations on egg freezing, they cited the following:
In the present study, more than 50% of participants were unemployed or self-employed. Participants working in healthcare comprised only 13% of the total participants, contrary to previous studies where participants were predominantly single or medical students.24 The study participants represented the general population of Saudi Arabia; thus, the results are novel. Many participants agreed to consider the process in the future, expressing a dire need for these processes in Saudi Arabia. The results of this study are like those of another study in which participants expressed interest in preserving their fertility,25 our study showed that participant knowledge was superior to other studies.26 Most participants expressed the need to freeze oocytes at ages <40 years, like the findings of another study in which participants identified the age indicated for freezing oocytes.27 Employment commitments, workload, fear of not having the right partner, and relationship failure were the predominant reasons for social egg-freezing. One common indication for freezing oocytes was an underlying systemic condition and its associated treatment. Moreover, 80% of the participants reported knowledge about egg freezing, suggesting a pre-existing awareness among women in Saudi Arabia. This is similar to the findings of studies from Western countries, where minimal barriers exist to undergoing this procedure.13 This study contributes to a better understanding of women undergoing OC for social and medical reasons. Healthcare professionals must know these motivations and perspectives to understand better the decision-making process’s underlying factors and emotional considerations. This understanding is crucial for providing proper counseling and optimal patient-centered infertility care. Furthermore, raising awareness of alternative methods to achieve motherhood is necessary to support effective policymaking. Policymakers must promote cost-effectiveness, and younger women should avoid unnecessarily pursuing medical or social egg-freezing strategies. Ideally, oocyte preservation should be free of financial barriers to access treatment. The least that can be done worldwide, as adopted in well-developed countries, is to include it as part of medical insurance or offer to consumers with soft loans. For prevention, early marriage should be promoted by creating public awareness about the ill effects of late pregnancies and the fact that IVF techniques, including egg freezing, do not guarantee pregnancy. Fertility preservation should be encouraged in all specialties, such as oncology, gynecology, and genetics, to provide patients with choices in adopting IVF technologies to obtain genetically related offspring. The findings of the present study are consistent with those of other studies.28 In 2019, Inhorn et al reported the hidden roles played by men in supporting women’s reproductive aspirations.26 The themes derived in other studies were similar to those in the present study and mainly concerned the fears and hopes underlying achieving safe motherhood. Most studies have reported that women consulted physicians much later than the ideal age for OC. Hence, women should be aware of the method earlier in life, and the responsibility of educating society should not be limited to only the medical field. A holistic, ethical, social, and political view must be undertaken to highlight the procedural advantages.
The findings of this study brought to light a correlation between age and the likelihood of OC. What was surprising to me was the extent of family pressure that was revealed in the qualitative interviews. Many women reported feeling pressured by their families to marry and have children early, stating, “My family pressured me to get married and have kids sooner”. This highlights the need to consider cultural and family factors in reproduction. Such aspects have been raised in studies around Turkey and Saudi Arabia.10,12
A more straightforward approach is required to understand OC in Saudi Arabia and other comparable cultural aspects that impact women’s decisions. Policies will also have to be developed to alleviate the costs that hamper women from attending to OC. In addition to these interventions, there should be more public education on the problems and benefits of such interventions, particularly the unintended consequences that may reinforce traditional gender biases. Further research should explicitly focus on understanding the influence of family pressure and broader sociocultural factors on reproductive decisions.
Limitations
The interpretability and generalizability of this study are affected by several limitations. First, the sample size does not reflect the demographic variation of women contemplating OC in the Kingdom of Saudi Arabia. In addition, the study was conducted in one geographical area, which may restrict the external validity of the results as women’s reproductive health decisions are sensitive to sociocultural contexts. Third, the collection of self-reported data, design flaws of the questionnaire, etc. However, further studies should actively seek to overcome these problems by using broader samples, mixed methodologies, and sampling strategies that increase sample variation.
Conclusion
This research has highlighted how the medical and socio-cultural of women impacted the OC intersect. There is a need for improved culturally sensitive healthcare and educational services for better access and awareness. This is better to show that the public policy advocacy that contributes to the unique impacts of OC on a woman’s reproductive health and why is particularly concerning.
Declaration of AI and AI-Assisted Technologies in the Writing Process
During the preparation of this work the authors used ChatGpt4 to check the spelling and grammar. After using the tool, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.
Ethical Concern
Ethical clearance was obtained from the King Fahad Medical City (Protocol No. 22-256E. Approved date November 2, 2022). The research adheres to the Declaration of Helsinki and its subsequent revisions, ensuring the highest ethical standards. All participants were able to obtain information about the research to be undertaken and signed a written informed consent. Such confidentiality was preserved. The revised manuscript that the participants informed consent included publication of anonymized responses/direct quotes.
Acknowledgment
The authors would like to thank Mr. Hashim H. Alsaeedi for his thoughtful suggestions and comments and Mrs. Hessah Dhuhayyan Albogami, the IVF coordinator, for her assistance in data collection.
Funding
The authors gratefully acknowledge the financial support provided by the Research Center at King Fahad Medical City, Saudi Arabia for this research.
Disclosure
The authors report no conflicts of interest in this work.
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Fatimah A Alzahrani,1 Dania Al-Jaroudi,2 Hamad Ali Alsufyan,3 Ali A Alzahrani,4 Saad Abdullah Alshehri,5 Sultana SK Jalwi,6 Elhadi Miskeen7
1Department of Obstetrics and Gynaecology, Al-Habib Medical Group, Riyadh, Saudi Arabia; 2Department of Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 3Department of Obstetrics and Gynaecology, Thuriah Medical Center, Riyadh, Saudi Arabia; 4Department of Public Health, King Faisal Medical City for Southern Regions, Abha, Saudi Arabia; 5Department of Medical Laboratory. Thuriah Medical Center, Riyadh, Saudi Arabia; 6Department of Obstetrics and Gynaecology (Medical Student), College of Medicine, University of Bisha, Bisha, Saudi Arabia; 7Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, Bisha, Saudi Arabia
Correspondence: Fatimah A Alzahrani, Department of Obstetrics and Gynaecology, Al-Habib Medical Group, Riyadh, Saudi Arabia, Email [email protected]
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Abstract
Objective: Women increasingly desire fertility at later ages, yet fertility rates decline with age. Oocyte cryopreservation, offer support for women seeking pregnancy at advanced maternal ages. This mixed-methods study explored the experiences and perspectives of 100 women aged 18– 47 in Riyadh, Saudi Arabia who underwent oocyte cryopreservation for social and medical reasons. The research aims to understand the motivations, challenges, and satisfaction levels associated with oocyte cryopreservation within the context of Saudi Arabian society and culture.
Methods: Using mixed methods, 100 subjects were enrolled in ten months. Self-administered questionnaires were dispersed to 100 women who underwent oocyte cryopreservation at a private clinic. Fifteen women willing to undergo recorded interviews were interviewed for 11—to 25-minute sessions. The interviews were transcribed entirely and subjected to thematic content analysis. Quantitative data was analyzed on STATA BE Version 18.
Results: 77 women (77%) froze their oocytes for social reasons, and the women understood the medical/non-medical rationale for freezing. Interestingly, women’s reasons for oocyte cryopreservation were highly associated with satisfaction (p=0.050), with women stating social reasons being most satisfied. It can also be seen that factors such as the presence of complications during the oocyte cryopreservation process were tied to low satisfaction (p=0.040). Six thematic areas around oocyte cryopreservation are presented, including freezing concepts and aims, patient experience, challenges in service quality, communication and confidentiality, and -proposals.
Conclusion: This research has highlighted how the medical and socio-cultural of women impacted the oocyte cryopreservation intersect. There is a need for improved culturally sensitive healthcare and educational services for better access and awareness. This is better to show that the public policy advocacy that contributes to the unique impacts of oocyte cryopreservation on a woman’s reproductive health and why is particularly concerning.
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Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer