A Mixed-Methods Study Assessing Barriers and Behaviors of Military Service Members Pursuing Planned Oocyte...

Oocyte cryopreservation is an essential option for individuals to preserve their fertility. Although many patients perceive planned oocyte cryopreservation as a guarantee for delayed childbearing, a high success rate of achieving a subsequent pregnancy is strongly tied to the number of mature oocytes cryopreserved. There are numerous well-documented barriers to pursuing fertility preservation and achieving these age-recommended oocyte minimums. However, few studies have specifically analyzed the military healthcare system, which offers uniquely subsidized fertility care. The objective of this study was to evaluate military service members' understanding of age-related oocyte cryopreservation recommendations and identify challenges in achieving these targets within the military healthcare system.

This study was reviewed by our institution's IRB and determined it was not human research. This mixed-methods study employed both quantitative surveys and qualitative interviews to assess knowledge of age-dependent fertility preservation guidelines and explore personal, systemic, and logistical barriers that may impact service members' ability to meet their recommended oocyte count. Eligible participants included all patients presenting for planned oocyte cryopreservation at our institution from March 2023 to August 2024. We excluded all patients presenting for planned embryo cryopreservation, patients who underwent unplanned oocyte cryopreservation because of inability to extract sperm, and patients presenting for planned oocyte cryopreservation in anticipation of gonadotoxic treatment.

Of 54 eligible participants, 22 responded (response rate 40.7%), and 7 individuals participated in follow-up interviews. The majority of survey respondents were cisgender women (95.5%), who expressed plans to have 2 children in the future (63.6%). The primary motivations for choosing oocyte cryopreservation were the desire for a "sense of insurance" (59.1%) and the ability "to genetically build [their] families" (45.5%). Regarding oocyte retrieval outcomes, 68.2% of participants obtained 10 or fewer oocytes during their first cycle, with most participants stating that this number was lower than they had anticipated (59.1%). Only 36.4% successfully cryopreserved enough oocytes to reach an 80% chance of a live birth in the future. Almost half of our participants (45.5%) expressed interest but ultimately deferred another cycle, with many endorsing cost (35.0%) and the physical or emotional strain of the process (20.0%) as barriers to additional cycles. Our qualitative analysis of the follow-up interviews identified 5 major themes: risk mitigation, non-chargeable leave policy, financial burden, conflicting emotions, and military culture.

This study underscores significant strides in increasing access to care for military service members, yet highlights additional cost barriers that influence participants' ability to achieve age-related recommended oocyte minimums.