Effect of Educational Program on Knowledge, Attitudes, and Intention of Unmarried Healthy Females regarding Oocyte Cryopreservation

Recently, there are increasing numbers of unmarried healthy reproductive-aged females and young females who have diseases associated with early loss of ovarian reserve. Oocyte cryopreservation is a specific technique for freezing one or more unfertilized ovum to be used in the future to get pregnancy. Aim: The aim of this study was to determine effect of the educational program on knowledge, attitudes, and intention of unmarried healthy females regarding oocyte cryopreservation. Subjects and method: Design: A quasi experimental research design was used to conduct this study. Setting: The study was conducted at six faculties of Tanta University Tanta Egypt. Subjects: A simple random sample of 100 unmarried working females was included in the study. Tools: (I): Knowledge, (II): Attitudes, and (III): Intention of unmarried females regarding oocyte cryopreservation. Results: There was a highly statistical significant difference between pre and post-program implementation in the studied unmarried healthy females’ knowledge, attitudes, and intention regarding oocyte cryopreservation (p<0.001*). Conclusion: Implementation of the educational program improved knowledge, attitudes, and intention of the studied healthy unmarried females regarding oocyte cryopreservation. Recommendations: Heath education and counselling programs, modules, and guidelines regarding oocyte cryopreservation should be provided by maternity and gynecological nurses to unmarried healthy females to help them have an informed decision to preserve their fertility in order to be pregnant during their preferred time.


Introduction
Recently, there are increasing numbers of females who delay marriage and chil0.dbirth to their thirties and forties with an average age of thirty-five years old. It is estimated that 45% of females between twenty and forty-four years' old will be single by the year 2030. Fertility rate decreases gradually by aging. Deterioration of females' fertility increases from early 30 years, and reaches its highest level by the age of ≥37 years. Egypt demographic and health surveys recorded a general collapse in fertility rate, especially among working age groups females

2022, von Wolf et al. 2018, & Conn's, 2018).
Oocyte cryopreservation is used to freeze one or more unfertilized ovum in the laboratory, in order to be fertilized by a sperm in the future. It can be used by unmarried healthy females as a family planning method and by non-healthy females who have different reproductive, gynecological, and medical illnesses to preserve their fertility for appropriate times It can also be used to electively cryopreserve gametes of fertile women who will undergo invetro fertilization

Aim of the study:
The aim of this study was to determine the effect of educational program on knowledge, attitudes, and intention of unmarried healthy females regarding oocyte cryopreservation.

Research hypothesis:
Unmarried healthy females are expected to have better knowledge, attitudes, and intention regarding oocyte cryopreservation after implementation of the educational program.

Subjects and Method:
Design: A quasi experimental research design preposttest was used to conduct this study. This design is suitable for the present research, because it tolerates simple assessment of the study participants' who were selected using a simple random sample to determine the effect of the educational program (Stratton, 2019).

Setting:
The study was conducted at 6 faculties out of 17 faculties and the Technical Institute of Nursing at Tanta University Tanta Egypt.

Subjects:
A simple random sample of 100 unmarried healthy working females was selected from the previously mentioned study settings. Calculation of the sample size was estimated at 95% confidence limit. So, the sample size was determined to be (n= 85) females, which is increased to (n=100) to improve quality of the study data.

Tools of data collection:
Three tools were developed and used by the researchers to collect data of this study: cost of withdrawal, concern about retrieval and storage, concern about the wrong use of frozen ovum, concern about poor storage of frozen ovum concern about the long storage period and fear of not using frozen ovum in the future, information about ovum freezing is important to me, freezing and storage operations must be monitored, ovum freezing settings must be certified and standards, infection control precautions should be used during freezing and storage operations, and I feel the test to check ovarian reserve should be freely available.
The unmarried females' attitudes were measured in a 3 point bipolar Likert scale. The total score of unmarried females' attitudes regarding oocyte cryopreservation ranged from (0 to 20).
The scoring system of unmarried healthy females' attitudes regarding oocyte cryopreservation was as follows: Agree answer was given score (2). Uncertain answer was given score (1). Disagree or didn't know answer was given score zero (0). The scores were inverted for the negative statements. The total score of unmarried healthy females' attitudes was calculated as follows: Positive attitude ≥60% and Negative attitude <60%.

Tool (III): Unmarried healthy females' intention regarding oocyte cryopreservation:
It was adapted by the researchers from Unmarried females' intention was measured in a five point's bipolar Likert Scale. The total score of unmarried females' intention regarding oocyte cryopreservation ranged from (0 to 28).

Method
Approval: An official letter clarifying the purpose of the study was obtained from the Faculty of Nursing Tanta University and submitted to the responsible authorities of the selected settings for permission to carry out the study.

Ethical and administrative consideration:
The study was approved by the ethical committee of Faculty of Nursing Tanta University. The researchers met with the unmarried females individually or in groups ranged from 4 to 6; explained the purpose of the study, invited them to participate; and had their informed consent. The researchers assured the participants that the nature of the study will not cause any harm and/or pain and the confidentiality and privacy will be put into consideration regarding the data collected, which will be used only for the purpose of this study. were done by the researchers before conduction of the actual study. Then, the tools were made ready to collect the necessary data of the study. The unmarried females who participated in the pilot study were excluded from the actual study data.

The actual study field:
The study is composed of the following

Data collection:
The data of this study were collected from the beginning of September 2022 to the end of January 2023 by using the previously mentioned study tools.

Statistical analysis:
The collected data were organized, tabulated and statistically analyzed using SPSS level of significant was adopted at p<0.05, and a highly significance was adopted at P<0.01 for interpretation of results of tests of significance (**).

Results:
The results of the present study are demonstrated into six tables and three figures as follows:  females' before and immediately after, and one month post the program (p<0.001).

Figure (1):
Illustrates that (95%) of the studied unmarried healthy females had low total level of knowledge regarding oocyte cryopreservation before the program, compared to (90%, and 55% respectively) of them had high level of knowledge immediately and one month after the program. the variable "concern about the cost of ovum withdraw" (p> 0.05). The table also demonstrations that there is a highly statistical significant difference in the total level of attitudes of the studied unmarried healthy females' before and one month post the program (p<0.001). proves that there is a highly statistical significant difference in the total level of intention of the studied unmarried healthy females' before and one month post the program (p<0.001).