Table 2.

Best practice guidelines for patient-centered elective egg freezing: listening to women’s voices and recommendations

Dimensions	Recommendations of EEF patients
System factors
Information	• National registries (i.e., of clinics providing EEF services, numbers of cycles performed, and pregnancy outcomes) • Specific information on EEF on clinic websites and advertising materials • Instructional media for home or office use (e.g., webinars and videos on self-injection), which are EEF specific (i.e., focusing on women only) • Written materials on EEF (e.g., brochures and data sheets), including up-to-date clinical outcome data, provided during office visits • Clear consent forms, free of excessive legalese, for EEF patients only • Clinic-based EEF informational sessions in evenings for single professional women • Detailed information on EEF procedures, risks, and outcomes, provided face-to-face and in a timely fashion • Anticipatory EEF guidance on ideal numbers of eggs and cycles • Provision of realistic expectations for EEF outcomes based on women’s age and fertility profiles
Competence of clinic and staff	• Education of community-based gynecologists on women’s fertility decline and EEF options to raise women’s awareness • Education of all EEF clinical staff (i.e., physicians, nurses, ultrasound technicians, and clinical psychologists) on EEF procedures and outcomes for delivery of accurate and consistent information • Hiring of diverse clinical staff with expertise on EEF care for single, lesbian, ethnic, and religious minority women
Coordination and integration	• Timely recommendations and referrals to EEF services from community-based gynecologists during well-woman exams • Ease of transfer from local physicians’ offices to EEF clinics • Coordination with on-site and community-based pharmacies for ease of access to EEF hormonal medications
Accessibility	• Convenient EEF clinic hours for single working women (e.g., before and after work) • Reasonable wait times and waiting lines for EEF appointments and procedures • Woman-only EEF injection classes during evening hours • Private areas within clinics devoted exclusively to EEF patients, apart from couples-oriented infertility patient waiting areas • EEF stand-alone specialty clinics
Physical comfort	• Injection instruction, support, and assistance to address fear of needles and self-injection among single EEF patients • Information on EEF physical discomforts, including expectations about potential side effects and days lost from work • Timely management of post-EEF complications (e.g., OHSS)
Continuity and transition	• Reliable transportation services and home health-care options for single EEF patients on day of egg retrieval • Consistent follow-up for EEF patients post-retrieval • Provision of EEF information and next steps, based on number of eggs retrieved and stored • Clear information and guidelines on egg disposition and storage limits, including on consent forms and annual renewal forms
Cost	• EEF “packages” (e.g., discounted prices for multiple cycles) • EEF financing options (e.g., loans and monthly payment plans) • Acceptance of credit card payments for EEF services • Refunds for EEF cancellations • Stable annual storage fees and billing practices for EEF patients • Income-based EEF discounts for low-income patients • Acceptance of EEF insurance (and increased insurance coverage on part of employers and states) • Clinic price consciousness and reduction of EEF fees to increase patient access, especially for low- and middle-income and minority patients
Human Factors
Attitude and relationship with staff	• Consistent one-on-one relationships with providers (especially physicians) throughout the EEF process • Extra clinical support for single women, who are navigating and absorbing EEF information on their own
Communication	• Adequate pre-EEF fertility screening and counseling • Appropriate bedside manner during EEF appointments and post-retrieval to avoid information delivery perceived as cavalier, overly optimistic, or “doomsday” • Delivery of post-EEF “bad news” (e.g., low numbers of eggs retrieved) appropriately and compassionately • Realistic information on potential outcomes of egg thawing (e.g., potential loss of frozen eggs)
Patient involvement and privacy	• Sensitivity to EEF patients without male partners (i.e., the majority) by not assuming accompaniment of husbands • EEF-specific informed consent forms that do not require partners’ consent • Assessment of EEF patients’ post-retrieval assistance and transportation needs
Emotional support	• Psychologists and social workers within clinic settings who specialize in EEF and needs of single women • Provision of EEF support groups, especially in clinics serving large EEF patient populations • Extra emotional support for the significant numbers of EEF patients whose partners have left or divorced them • Acknowledgement of the potential “loneliness” of EEF patients in IVF clinic settings and provision of maximal social support