Discussion
infertility
This study reports on the development and phase 1 evaluation of an online Decision Aid for elective egg freezing. Participants reported that the tool was useful, acceptable and that they would recommend it to others considering egg freezing. Further evaluation of the Decision Aid is intended using a randomised control trial.The Decision Aid was well received by most participants. This may reflect using existing frameworks to guide the Decision Aid’s content and design [Most questions relating to the acceptability of the Decision Aid were scored positively by almost all participants, however, fewer women found the Decision Aid as helpful for reaching an egg freezing decision. Traditionally, Decision Aids are used to supplement clinician advice [While no serious worry or concern was raised from the Decision Aid, more than half the participants reported some distress from the content, including the information about female age-related infertility and its impact on success rates. This was in turn driving a sense of urgency to decide about egg freezing. Participants were typically in their mid-30 s, coinciding with the beginning of fertility decline [Most participants who completed the values clarification exercise agreed with their automated result and considered the task useful to some extent. However, less than a third found the activity very or extremely helpful. This is consistent with previous research suggesting that the effectiveness of values clarification exercises varies amongst individuals and information alone may be sufficient [Participants suggested adding personal stories to the Decision Aid that illustrate the experiences of women considering and undertaking egg freezing. It is contentious whether personal stories effectively support decision-making [Improvements in knowledge and reductions in decisional conflict were observed post-Decision Aid review. Most participants also perceived a greater understanding of egg freezing, its alternatives, and their respective pros and cons. Our study was not powered to detect a statistically meaningful effect of the Decision Aid, however, these results suggest the tool may favorably impact knowledge and decisional conflict outcomes. This will be further evaluated in a future randomised controlled trial.Study strengths include the first to describe the development and phase 1 evaluation of a Decision Aid for elective egg freezing. It addresses a gap in comprehensive and independent decision support for women considering the option. Limitations include potential bias from self-selection. Free-text sections were included in the survey for participants to add context to their answers, however, the study design limits the clarification or further exploration of their responses. Also, some participants had already decided about egg freezing which may have affected their perceptions of the Decision Aid and its utility.