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Article

A Suggested One-On-One Method Providing Personalized Online Support for Females Clarifying Their Fertility Values

by
Carol Nash
History of Medicine Program, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
Women 2025, 5(4), 44; https://doi.org/10.3390/women5040044
Submission received: 8 September 2025 / Revised: 24 October 2025 / Accepted: 12 November 2025 / Published: 18 November 2025
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Abstract

Personalized medicine regarding the biopsychosocial model can extend to females considering fertility choices through online one-on-one interactions. This finding is relevant, as recent publications suggest that online one-on-one interventions might help them in this regard. An examination of one online one-on-one intervention considers its conceptual appropriateness. The investigation is through a narrative historical analysis of a previous online group meeting, personalized to help researchers reduce their burnout. The finding is that, with an adaptation of the group process to the individual’s schedule, some participants became overwhelmed by being responsible for their schedule. By using a modification of the same process—one that does not depend on them determining their participation schedule—females can respond to writing prompts that reveal their values, from the most objective to those that are increasingly subjective. However, notably, those who are clear about their values would likely experience the least difficulty in assuming responsibility for their participation. In this regard, methodological examples of possible prompts for the modified process are offered. Through the appropriate personalization of an online, one-on-one process, the future aim in testing this process is to improve the likelihood of success in helping females clarify their values for making fertility-related decisions.

1. Introduction

Fertility choices for females are decisions they may make on their own or with others [1]. These are decisions regarding if, when, and the number of times they become pregnant [2]. Their influence is a complex interplay of hormonal [3], emotional [4], health [5], social [6], economic [7], and cultural factors [8,9].
For this study, examining fertility choices, the definition of females is specific. Females are those born with at least one functioning womb [10] and ovary [11]. After the age of menarche [12], females release an egg from no less than one ovary approximately every month [13]. They have the possibility of becoming pregnant if the released egg meets a sperm [14], either in a fallopian tube or in a Petri dish [15], and becomes successfully implanted in the womb [16]. “Females” will be the term used in this study in contrast to “women” as the latter term may extend to transgender persons in some contexts [17] without these features [18]. They are not the focus of this investigation.
Females may consider their fertility choices at several points in their lives. The first point is in their childhood when they (1) initially become aware that females can become pregnant [19,20], (2) first start to menstruate [21], and (3) receive sex education [22]. When they reach the age of maturity, additional opportunities arise for considering fertility, when they (4) begin sexual relations [23], (5) review their method of contraception [24,25], and (6) identify a suitable mate for procreating [26]. Lastly, they may consider their fertility near the end of their reproductive life. These opportunities include when (7) displaying the symptoms of perimenopause [27] or following menopause [28].
Additionally, females may consider their fertility choices for various reasons. These may include their intentions, such as the desire to (1) have a child [29] or (2) never have children [30]. Others reasons are health-related concerns, such as they (3) experience significant gynecological difficulties [31], (4) have a genetically inheritable disease [32], (5) are diagnosed with a reproductive-affecting disease [33], (6) become pregnant with multiple fetuses [34], (7) are pregnant with a fetus that will likely have life-affecting abnormalities [35], or (8) experience an ectopic pregnancy [36]. Fertility choices become paramount when females (9) have failed contraception [37], (10) are raped [38], or (11) are unable to conceive after a year or more of unprotected sex [39]. There are also social pressures regarding conception that influence fertility choices. These social pressures include females (12) experiencing parent pressure to conceive [40], (13) wanting to experience pregnancy but having no suitable mate [41], (14) reaching the end of their reproductive years without becoming pregnant [42], or (15) fearing death (especially regarding climate change) [43].
At any of these times or for any of these reasons, females may seek information regarding their fertility choices. The type of information they seek depends on several factors: (1) their life stage [44], (2) the significance of the matter [45], (3) the importance of timeliness [46], (4) access to information [47], (5) trust in the information [48], (6) support from significant others [49], and (7) the consequences of their choice [50]. Those they may turn to for information range from a (1) mother [51], (2) partner [52,53], (3) family member [52,54], (4) friend [52,55], (5) healthcare provider [56], (6) spiritual advisor [57], (7) telephone hotline [58], (8) books [59], (9) pamphlets [60], or (10) the Internet [61]. Females can obtain this fertility-related information in group settings [62], one-on-one [60], or alone [59]. Moreover, a combination of these alternatives is usable at various times.
The fertility choice of females thus depends on a myriad of considerations, with the various options relevant in different dimensions. The range of considerations makes the decision-making process confusing, complicated [63], and often overwhelming [64]. One way females can reduce the amount to consider is by contemplating their fertility choices in relation to what they value. The finding is that those who are clear on their values experience the least difficulty in making a choice [65]. Personal values are those that influence individual action, serving as principles in life-guidance [66]. According to mainstream psychology since the 1990s [67], they affect perception, cognition, and behavior over time and across situations. Consequently, given their relevance to fertility choices, clarifying their values is the aim of interventions that aid females in making fertility decisions [68]. Moreover, females who aim to clarify their values assess personalized [68] and one-on-one [60] interventions as the most helpful regarding their fertility choices.
According to the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity [69].” In this regard, the environment and the individual’s psychosocial response to it affect biological functioning. These relationships have been a focus in the literature on personalized medicine [70,71,72,73], beyond genetic predisposition [74].
Personalized medicine for aiding females in making fertility decisions extends to online one-on-one interventions [75]. One-on-one interaction checks misleading claims and narratives from online information alone [76]. One study highlights the necessity of online interventions to include a one-on-one aspect, especially for contraceptive choices [77]. A one-on-one aspect is desirable because when there is a discussion of fertility choice in a group setting, females downplay their vulnerability and avoid emotional arousal [78]. Online one-on-one interventions, as one form of telemedicine, are found to help reduce stigma and embarrassment associated with seeking emotional support regarding fertility decisions [79].
The Health Narratives Research Process (HeNReP) is an author-designed and facilitated online one-on-one intervention. It evolved from the earlier online group process of the hospital-affiliated Health Narrative Research Group (HeNReG) to help alleviate burnout in researchers. A previous assessment of gender-related factors provides the foundation for undertaking this investigation. It is a 2025 publication on the UN Sustainable Development Goals of Well-Being, Gender Equality, and Climate Action [80] by the author. The more recent investigation in [81] concerned why females who participated in the HeNReP may need clarification of their values. The result was that females participating in the HeNReP who felt unsupported in their decisions by significant others were those who reported an additional burden in deciding the timing of their engagement in the HeNReP. The results of these two publications provided the impetus for presenting the possibility that a modified HeNReP might be helpful to females considering their fertility in an online one-on-one setting.
Except for two 2020 publications by the author that present accounts of the HeNReG method regarding the effect of COVID-19 limitations [82,83] and historical accounts on Values Clarification [84,85], the research supporting this study includes only publications from the previous five years. The selection of research published within this timeframe is to correspond with the requirements for reviewers of MDPI journals (of which this journal is one) to assess the relevance of publications in relation to whether their references are no more than five years old [86]. By limiting the citations to research published since 2021, the support for claims represents the most current studies available.
This study examines data using narrative historical analysis [87] from publications and other data collected and available to the author, regarding the online one-on-one HeNReP, in comparison with the earlier online group process of the HeNReG. The aim is to identify the types of changes to the process common to both when the HeNReG became an online group that are relevant to helping females clarify what they value regarding their fertility choices. The supported assumption is that females who are clear about their values from participating in a personalized online one-on-one process can commit themselves to their fertility choices at the appropriate time, considering relevant biological and environmental factors [88].

2. Results

Table 1 is a historical ordering of the relevant data. The data on the number and sex of the participants are from examining the descriptions of their research related to health that each participant provided in response to the first prompt of the 28 sessions. These were descriptions that the author/facilitator amalgamated each year into one document. Whether or not they completed the process was determined from examining the Facebook group entries on the yearly Facebook group for the HeNReG and the Messenger posts to the author/facilitator for the HeNReP. The group process of the HeNReG had more than twice as many participants per year as in the years with the most HeNReP participants. At least three-quarters of the participants in the HeNReG completed the process, whereas at most a little more than half of its participants completed the HeNReP. There were various reasons participants did not complete the process. The focus of this study is on females, their representation in both of these interventions, and those who completed the process. Table 1 shows that females represented the greater number of participants in both the HeNReG and the HeNReP. However, they represented a greater percentage of the participants in the HeNReP. Females were approximately two-thirds of the HeNReG regarding the percentage of those who completed either program. The percentages for the three years of the HeNReP were wide-ranging with no pattern. These numbers result from an examination of the materials over the five years of these online programs.
Of those females who did not complete either the HeNReG or the HeNReP, some left because of their feeling overwhelmed. For the HeNReG, this was a result of residual depression they reported to the facilitator, separate from their burnout. In the case of the HeNReP, there was no identification of depression as a factor. Instead, participants described the feeling of being overwhelmed as resulting from the responsibility of having to decide when to participate in the online interaction, as they lacked support from significant others in their lives. This result is particularly remarkable because only two participants felt overwhelmed in this way, and they had been members of both online groups.
Table 2 is data from the written responses on the feedback forms completed by each participant at two ending points for the HeNReG and once the process was complete for the HeNReP. The table demonstrates that neither participant 1 nor participant 2 was a member of the HeNReG in its first year online. However, both were members in the second year it was online, and neither completed the process. Both related that residual depression beyond their burnout was the reason for leaving the group. Yet, both participants demonstrated their interest in the program by later joining the online one-on-one process of the HeNReP. Participant 1 waited until the second year of the offering to participate. Participant 2 engaged in the HeNReP but did not complete it in the last year. In each case, both participants informed the facilitator that they could not complete the program because they were overwhelmed by having to remember and decide when to participate, lacking support from significant others.
Figure 1 presents the yearly process stages during the pandemic years of the HeNReG and the HeNReP. There is an italicized insertion of the prompts missed by Participant 1 and Participant 2 during the HeNReG at the appropriate stage. The abandonment stage in the HeNReP process for Participants 1 and 2 is red. The meaning of a participant completing the process is that they provided informed consent to join, engaged in all 28 sessions, and returned the required number of online feedback forms. Both participants returned the feedback forms for the HeNReG. Since neither completed the HeNReP process during the years they participated, they did not return the feedback form at the end of the process. These forms were available during the COVID-19 pandemic. They were completed by other participants who finished the process (see Table 1). The completion of the forms by other participants is why they are listed.
For those females with an experience of non-burnout-related residual depression during COVID-19, some remained with the program to the end and are not recorded in Table 2. One such participant provided this response to the feedback form question, “Do you have other thoughts/comments on your experience as a participant in the HeNReG this term, especially as a result of COVID-19?”
“COVID-19 and the isolation and anxiety it brought highlighted a lot of very negative attitudes I had towards my education and my future. Even prior to the pandemic I found it difficult to look forward, ask myself questions, and prioritize my health and wellbeing. With isolation I realized I had been so intensely geared towards producing that I had neglected every aspect of myself that I had not deemed useful in whatever I was doing at the time. It got rough. Although I still do struggle with that, finding time and understanding the importance of asking myself why and how and where do I as a person with history and heart fit, I do think that HeNReG has helped illustrate the importance of that. Putting the person back into the researcher. I think it’s really cool and I believe it has really helped me understand that it takes conscious effort to unlearn all of the harmful ideas that have been injected into a lot of us.”
In contrast, these were the HeNReG feedback form responses to the same question for the two participants who could not complete the process.
Participant 1: “I wish I had more energy and time to actually attend the sessions.”
Participant 2: “My only experience with group was during COVID. Doing the group online supported my ability to attend as no travel and also to spend time reflecting during the sessions. Also, anxieties related to speaking in groups was not an area I was concerned with. Facebook as a platform was a bit challenging as refreshing my screen did not always bring updated postings. Also, wonder if a more dynamic platform would be considered or tips for navigating the platform.”
It is relevant to consider the demographic information of these two participants and the reasons for their residual depression, causing them to leave the HeNReG. Table 3 presents that both females were middle-aged. One was a graduate student and the other a social worker.
Although a graduate student, the first participant had several years as a researcher in creating a framework for a somatic experience program that she implemented in her country—information she shared in emails and texts with the facilitator and her description of herself as a research in the first session in 2021: “I’m particularly interested in learning and education and how can we teach and learn about life, health, death through somatic experience.” This first participant was the caregiver of a parent with a terminal illness as a result of other family members providing insufficient and ineffective support. By the time of her participation in the HeNReP, that parent had died (information she provided to the facilitator by text). This loss left her unclear on what she now valued in life and overwhelmed with daily decision-making, including participating in the HeNReP, as is evident from this text message: “Just now I found the time to sit peacefully and write something that resonates with my health narrative research. Intense days over here. I apologize for taking so long. The current bi-polar episode was rather extensive and I’m still adjusting to the meds. Thank you so much for inviting me to do this.”
The second participant was diagnosed with a neurodivergent condition that made it difficult for her to make decisions. The expression of this difficulty was in her description of herself as a researcher in 2021. “Though organizing and scheduling can be challenging and skills can be learned to aid in reaching goals in this area I continue to struggle. My brain has difficulty with time and also with the different steps people draw upon to get there. Tutoring/coaching over the past few months have been helpful as I have been recognizing chunks of time. As a research related to health focus I look forward to exploring this area of my life further.” In her description of herself, participant 2 described her research program as concerned with investigating “social justice. Working primarily with people living in poverty, the ethical dilemmas… supporting people through their voice, tying in narrative concepts and models.” However, her focus during her participation in the HeNReG was not on this. Instead, it was the residual depression she experienced as a result of the lack of support she received from her family members, given her neurodivergence. Thinking about this lack of support in one of her March 2025 text messages, Participant 2 wrote, “Further, leaving home at 16 yrs and approx. 10 years of being away… one of my brothers, his spouse and I have conflict. This hurts me deeply as it brings up my life stuff.” A consistent problem with scheduling was an issue. Yet, as a member of the weekly, two-hour group process of the HeNReG, she was not required to decide the timing of the intervention. The problem with her inability to decide when to participate was not evident until making this decision was her responsibility. The reason for being unable to complete the process then became feeling overwhelmed because she was unclear on what she valued in making decisions, given the continued lack of support by her siblings for her neurodivergence.

3. Discussion

The evolution of the conceptual process limitations from the HeNReG to a proposed Health Narratives Fertility Process, or the HeNFeP, is depicted in Figure 2. The in-person HeNReG [82,83,89,91,92,93,94] evolved. It became a weekly online group meeting in a private Facebook group because of pandemic limitations that required online meetings. Participant preference for individual online communication with the facilitator then precipitated the additional change to a one-on-one online HeNReP [81,90]. The basis of suggesting the possible value of a HeNFeP is the result that process completion led to a return of participants to their research reenergized. Participants’ preference for a one-on-one process (similar to the HeNReP) for females considering their fertility choices corresponds with the goals of personalized medicine [75,76]. Moreover, and for various reasons, group interventions are those that are identified as unsuitable for females considering their fertility choices [77,78,79]. The results of this study suggest that, to be successful, a HeNFeP must take into account that some participants in a one-on-one online process might perceive themselves as having difficulty. The difficulty is their inability to be responsible for scheduling the intervention. This lack of accepted responsibility then leads to program incompletion. With these results as the foundation, examples of questions suitable for a proposed HeNFeP model are in Table A1.
In considering the value of the HeNReG → HeNReP model for developing a HeNFeP, it is reasonable to ask whether the author-developed process for burnout reduction in researchers is one of many that might be suitable for burnout reduction. A 2021 systematic review of burnout reduction programs for physicians identified no consistent pattern of successful or unsuccessful programs [95]. Discussion groups (n = 14), didactic sessions (n = 13), and small groups (n = 11) were the most frequent interventions. These group methods are ineffective for females who are considering their fertility for the reasons presented. Moreover, the purpose of these group activities was pedagogical, teaching stress management (n = 8), burnout reduction (n = 7), resilience (n = 7), and general wellness (n = 7). The purpose of a one-on-one online process, like the one suggested for the HeNFeP, is not didactic. Instead, it is to give the female the prompts, structure, time, and space to consider what she values regarding her fertility. As such, none of these intervention programs for reducing physician burnout is applicable. Females who are most clear on their values have the least problem in making fertility choices [65]. The proposed online HeNFeP, unlike other interventions, is designed for values clarification.
To say that the process undertaken in any of the HeNReG, HeNReP, or HeNFeP has values clarification as its purpose is not to equate this process with the 1966 theory of Values Clarification [85]. The development of Values Clarification was as a pedagogical theory for teaching the meaning and relevance of values [84]. Values Clarification aims to offer a conceptual structure to values regarding (1) prizing and cherishing them with appropriate public affirmation, (2) freely choosing them from alternatives after a consideration of the consequences, and (3) acting on them regularly, consistently, and repeatedly [84]. The process presented in this study encourages females to become more aware of what they value regarding their fertility. They do so by responding to prompts that stimulate a consideration of their values. These prompts are from the most objective to the most subjective. Therefore, the aim differs from Values Clarification. A recent systematic review and meta-analysis notes that, as a patient decision aid, there are many forms of values clarification. Moreover, there was confirmation that explicit methods of values clarification improve patient decision outcomes “by increasing values congruence and decreasing decisional conflict” [96]. The recommendation is that an explicit method of values clarification be part of patient decision aids. Those methods assessed included (1) Adaptive conjoint analysis, (2) Analytical hierarchy process, (3) Best–worst scaling, (4) Decision analysis, (5) Discrete choice experiment, (6) Open discussion, (7) Pros and cons, (8) Rating scales, (9) Rating scales + ranking, and (10) Time tradeoff + rating scales [96]. Compared with the 33 studies assessed, the structure of the HeNReG → HeNReP → HeNFeP model is unique in approach and purpose. The significant difference is that the focus of the values clarification in each of the assessed studies was a treatment result. The proposed HeNFeP offers a structure for females to have a better understanding of what defines their values. This clarification may or may not produce an immediate decision. What it would do, similar to the HeNReG and HeNReP, is reinvigorate the female to make fertility decisions based on her clarified values.
If given online access to the suggested questions for a HeNFeP, the female can engage in the process individually. However, presenting these questions to females must be more than completing a survey to gather data for designing public policy [97]. The female must consider that the process has all the positive features of one-on-one [98]. Yet, a one-on-one online process is only advisable under one condition. Over the 28 sessions, the participant develops trust in the process while considering her values. She connects with the facilitator as representing an “authentic leader” [99,100,101,102,103,104]. As an authentic leader, the facilitator of the online one-on-one HeNReP has the trust of the participant to structure the questions asked. This type of trust is necessary for a successful change in the process to a HeNFeP.
From the results of the females who did not complete the HeNReP because they were overwhelmed with deciding when to participate, the structure of a HeNFeP would take on the characteristics of the HeNReG by being at a regularly scheduled time. However, what that regular time would be would depend on the urgency of a female clarifying her values regarding her fertility choices. The examples of questions posed are the type that a female might ask to determine what she values if seriously considering pregnancy, either to become pregnant in the traditional manner or through fertility treatments. These would not be appropriate to ask if a female has become pregnant unexpectedly and does not want to continue the pregnancy. A female in this condition must make decisions quickly and is not prepared to think speculatively. Complexity arises when females feel they lack choice without a legitimate justification for ending a pregnancy [105]. Similarly, these questions are not appropriate for children who first learn that females can become pregnant because they are not yet aware of all that is associated with this knowledge—an unfortunate limitation for female children undergoing fertility-affecting cancer treatments [106]. For those who are at the stage in life of actively thinking about fertility choices, the online one-on-one HeNFeP could be once a week for twenty-eight weeks. A question would be posed to the female each week at the same time over the online platform agreed to between the facilitator and the participant. If a female is about to undergo fertility treatments, she might instead opt to complete the HeNFeP in a shorter time span [107], possibly even in one day. Ending fertility treatments may be a reason for a female to consider these types of questions over an extended time period [108].

Limitations and Suggested Future Research Directions

There are limitations to this study. Self-reporting by participants is one [109]. The author’s multifaceted role as creator of the burnout reduction process, facilitator, record keeper, archivist, researcher, and writer of this report means that there were many junctions where bias might arise without mitigation—representing an extreme form of convenience sampling [110]. The reason for this limitation is that much of the data for this assessment is not publicly available due to the agreement between participants and the facilitator at the time participants joined either process. Open to scrutiny is the anonymous information related to the HeNReG and HeNReP available from the author upon request—along with the relevant publications on HeNReG [82,83,89,91,92,93,94] and the HeNReP [81,90]. However, reliance on these publications risks circular reasoning. Comparing participant comments from multiple sources reduced bias. These sources include their yearly descriptions of themselves as researchers, the responses to the prompts, emails, and texts. An additional limitation is that the results focus on two participants in a program that had only sixteen participants over its three years. Yet, these results are the foundation of the suggestion that the participants do not determine the meeting schedule of the HeNReP. The number of relevant participants is extremely low. Therefore, conclusions drawn from Table 2 and Table 3 risk over-interpretation. The low number limits generalizability, making the proposed HeNFeP exploratory in nature, in the Appendix A. It is a proposal for future testing. The number of participants who were unable to complete the process is both low, and the reasons for their inability to complete the process were not dependent on the process. Instead, they are attributed to a lack of support by significant others and may represent a function of the residual depression these two participants experienced during their first membership in the HeNReG. For this reason, there may be no need to adjust the method of HeNFeP to be more in line with the original HeNReG. Future research in this area would compare the results of offering a HeNFeP at a specific time according to a schedule, with the participant deciding when and for how long they would engage with the process online. Also to be investigated are the types of questions that are most appropriate as prompts. Those suggested in Table A1. are examples. Female circumstances in making fertility choices could inform modifications to the questions designed by the facilitator. An additional limitation is that a facilitator of a HeNFeP must be considered an authentic leader [99,100,101,102,103,104] to have the trust of participants. Becoming an authentic leader requires dedicated practice [99]. It would be significant to determine whether there could be a creation of age-appropriate questions for children who first become aware of fertility choices. If so, they could be asked online one-on-one as part of health classes in educational settings. Similarly, research on cross-cultural contexts would be valuable, including translations of the 28 questions into various languages.

4. Materials and Methods

The method is a historical narrative inquiry [111]. There is a lack of consensus on narrative research [112]. This paucity is attributable to its dual purpose as a methodology and a conceptual framework that focuses on stories or descriptions of a series of events [113]. Historical narrative inquiry deconstructs values, assumptions, and beliefs to challenge accepted meanings [114]. This qualitative method is a form of interpretative phenomenology [115]. Beyond merely describing experiences, it reveals their meaning by understanding participant experiences regarding their personal and cultural significance. This focus necessitates a reflexive dialogue between the researcher and participant. The researchers acknowledge their interpretative role in the research process. This acknowledgment is necessary for understanding the co-constructed nature of the data analysis. By searching for patterns in the narratives, a significant benefit of narrative interpretation is the retention of the individual as the unit for analysis. This preservation of the individual is found surprisingly uncommon in most psychological research methods [87].
This selection as the methodology was because the informed consent of the participants was not for an empirical study. What participants agreed to was an intervention. The only permission granted for publication was an anonymous mention of the data by the author/facilitator alone, gathered yearly with each HeNReG or HeNReP. This methodology analyzes the materials from the author’s relevant publications on the HeNReP and records concerning the group process of the earlier online HeNReG. For the HeNReP, these records include (1) the Messenger texts for the one-on-one HeNReP, (2) annual reports, (3) emails between the participant and facilitator, (4) discussions between the participant and facilitator, (5) yearly membership records of the HeNReP, and (6) feedback form responses of the participant provided to the facilitator at the end of the HeNReP. Regarding relevant records of the earlier online group meetings of the HeNReG, the records are (1) the yearly private Facebook group weekly posts, (2) Messenger texts, and (3) feedback form responses of the participants, completed twice during the year. The assurance of rigor is from the person who originated the method, facilitated it, and separately maintains the records, comparing and contrasting the comments of participants in each of these data sources.
Historical narrative analysis is a social and historical contextualization of the content and structure of these publications and records [87] beyond textual description. The chosen approach for this analysis is the most common one for interpreting historical data [116]—a chronologically arranged description [117]. The aim is to reveal what is relevant regarding the materials when considering females who participated in the HeNReP, but expressed an increased burden from being required to control the timing of the intervention process. A triangulation of sources is employed to reduce bias and increase confidence in the robustness of the research results. This triangulation determines the external and internal validity, situating the data within historical contexts [118]. However, the triangulation of this study is limited to different data sources. The same participants provide data from each source.
An examination of those created during the pandemic years identifies the relevant author-collected and archived records. The purpose was to search for participant comments acknowledging their confusion regarding their health-related research. Acknowledgement of “confusion” by a participant—using this word—was necessary for data inclusion. The use of the term “participant” in these interventions is as a participant in the process. The participants are not subjects of an empirical study.
The publications concerning the HeNReP are [81,90]. There are several HeNReG publications [82,83,89,91,92,93,94]. Information on them was provided both before and after the group was online, following the COVID-19 pandemic restrictions. There is no repetition of them here. The focus of this study is the online HeNReG meetings, not the in-person meetings preceding the COVID-19 limitations. These publications are open access, aiding in bias avoidance. However, an informed consent agreement between the participant and the facilitator was approved in writing by the participant before joining either program. The agreement was that contributions in the Facebook groups, Messenger, the feedback forms, and emails are private. The permission granted by the participants is only for anonymous reference to comments across any of these sources.
The investigation represents a conceptual or methodological contribution rather than an empirical study. According to the 1969 foundational work on Methodology by De Groot [119], an empirical investigation has the following features: (1) evidence that can be observed and measured, (2) direct observation collects the data, (3) the primary goal is hypothesis testing, (4) the data are analyzed either statistically (quantitative) or by interpreting patterns (qualitative), and (5) replication of the conclusions can be by others. The feature of this study that differs from these requirements is that others cannot replicate the conclusions for the HeNReG and HeNReP, as the data are private. Nevertheless, in other regards, this study follows the process of empirical research without claiming to represent one.
In this regard, the research questions for this historical analysis are: (1) How do the female participants who did not complete the online one-on-one HeNReP compare with those females who did not complete the online group process of the HeNReG? and (2) How might the HeNReP, as an online one-on-one process, be modified to help females make values-based fertility decisions? The Results provide the answer to the first question. The answer to the second is a suggestion offered in the Appendix A.

5. Conclusions

This study is a conceptual and methodologically personalized contribution in assisting females in clarifying their values regarding fertility choices. Its relevance in this regard resulted from asking two questions about an online one-on-one process for reducing burnout in health researchers: (1) How do the female participants who did not complete the online one-on-one HeNReP compare with those females who did not complete the online group process of the HeNReG? and (2) How is the HeNReP modifiable to help females make values-based fertility decisions? The finding, through historical narrative analysis, was that those females who did not complete the HeNReP were overwhelmed with the decision-making involved in determining the schedule for the intervention. The reason was that they lacked support from those they considered significant in their lives. This result was in contrast to those females who did not complete the HeNReG, as their reason was residual depression. Nevertheless, the consideration was that, possibly, it was residual depression that affected their perception of support and made them overwhelmed. Based on these interpreted results, the HeNReP can evolve to become the HeNFeP for females who are considering fertility choices, both in the type of prompts provided to participants and in setting up an agreed-upon schedule for online one-on-one meetings within the selected online platform. The success of the one-on-one process necessitates a facilitator whom the female views as an authentic leader. Lacking such a facilitator, the proposal is that this process might also be completed individually, with the help of AI. In making these changes to a process for burned-out researchers, the expectation is that female participants can become more aware of what they value concerning their fertility choices.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study due to it being historical research.

Informed Consent Statement

Written informed consent was obtained from all individuals when they initially agreed to participate in the HeNReP or the HeNReG.

Data Availability Statement

No new data were created as this is a historical study.

Acknowledgments

Thank you to the members of the HeNReG and the HeNReP for their participation and their informed consent to publish their anonymous information.

Conflicts of Interest

The author declares no conflicts of interest.

Appendix A

A conceptual framework for a proposed HeNFeP is in Table A1. Females considering their fertility options may consider this framework helpful. The aim is to have these 28 prompts made available to them online. An example of a situation in which using the HeNFeP might be advisable is when females are intending to undergo in vitro fertilization (IVF) treatment. The suggestion is that during the initial meeting with a female to discuss the possibility of treatment, she would be sent these prompts one at a time. After the first prompt, the female receives each subsequent one following her written response. This intervention is a process that could include a facilitator providing the questions modified to correspond to the particular female. The questions might also be shared automatically, using AI, if the suggested questions of Table A1. are used. If the HeNFeP is one-on-one, the facilitator must be considered an authentic leader by the female for successful process completion [99,100,101,102,103,104].
Table A1. The first word of each type of question asked, with examples of the twenty-eight question prompts to female participants of a HeNFeP for clarifying their values regarding their fertility choices.
Table A1. The first word of each type of question asked, with examples of the twenty-eight question prompts to female participants of a HeNFeP for clarifying their values regarding their fertility choices.
OrderFirst WordBody of Question
1Describeyourself regarding your fertility choices
2Whenhave you thought about your fertility
3Whendid you consider whether you could become pregnant
4Whendid you idealize the male who might impregnate you
5Whenhave you worried about the possibility of pregnancy
6Wherecould you ask for help in making fertility choices
7Wheredo you locate the most trusted fertility information
8Whereis the healthcare provider you confide in with fertility choices
9Wherewould you go online to find fertility information
10Whohas engaged you in talking about fertility choices
11Whowould support your fertility choices
12Whowould you trust with your fertility choices
13Whohas given you valuable information regarding fertility choices
14Whatwould you do if you became pregnant
15Whatconditions would make you want to be pregnant
16Whatsupport would you expect from the father if you were pregnant
17Whatwould happen if you couldn’t realize your fertility choices
18Howwould you reorganize commitments if you became pregnant
19Howwould your health matter if you became pregnant
20Howmuch would the father know about your pregnancy
21Howwould you be sure you wanted to be pregnant
22Howdo you determine relevant information about pregnancy
23Whyare you unsure this is the best time to get pregnant
24Whydoes climate change matter regarding fertility choices
25Whydoes pregnancy create tension between males and females
26Whyis it relevant how you respond to a pregnancy
27Whyshould you notice the health-related concerns of pregnancy
28Whyreconsider what you value in your fertility choices
Considering what they value regarding their fertility, using this 28-session process is not appropriate in situations where a female must make a fertility choice under time constraints, such as providing informed consent for an emergency hysterectomy as a result of the discovery of an aggressive cancer. This method is most useful when a female has time to consider her fertility. Examples of when it would be appropriate to engage in a HeNFeP throughout the lifespan are when a female (1) receives sex education, (2) decides to become sexually active, (3) considers changing her method of contraception, (4) is considering getting pregnant, (5) wants to undergo IVF, (6) is deciding whether to freeze her eggs, (7) is experiencing perimenopause, or (8) has reached menopause. The common factor in determining whether it is appropriate to engage in a HeNFeP is if the female feels unclear on what she values and is interested in gaining clarification.

References

  1. Idris, I.B.; Hamis, A.A.; Bukhori, A.B.M.; Hoong, D.C.C.; Yusop, H.; Shaharuddin, M.A.-A.; Fauzi, N.A.F.A.; Kandayah, T. Women’s Autonomy in Healthcare Decision Making: A Systematic Review. BMC Women’s Health 2023, 23, 643. [Google Scholar] [CrossRef]
  2. Holt, K.; Galavotti, C.; Omoluabi, E.; Challa, S.; Waiswa, P.; Liu, J. Preference-Aligned Fertility Management as a Person-Centered Alternative to Contraceptive Use-Focused Measures. Stud. Fam. Plan. 2023, 54, 301–308. [Google Scholar] [CrossRef] [PubMed]
  3. Ramya, S.; Poornima, P.; Jananisri, A.; Geofferina, I.P.; Bavyataa, V.; Divya, M.; Priyanga, P.; Vadivukarasi, J.; Sujitha, S.; Elamathi, S.; et al. Role of Hormones and the Potential Impact of Multiple Stresses on Infertility. Stresses 2023, 3, 454–474. [Google Scholar] [CrossRef]
  4. Negris, O.; Lawson, A.; Brown, D.; Warren, C.; Galic, I.; Bozen, A.; Swanson, A.; Jain, T. Emotional Stress and Reproduction: What Do Fertility Patients Believe? J. Assist. Reprod. Genet. 2021, 38, 877–887. [Google Scholar] [CrossRef]
  5. Duane, M.; Stanford, J.B.; Porucznik, C.A.; Vigil, P. Fertility Awareness-Based Methods for Women’s Health and Family Planning. Front. Med. 2022, 9, 858977. [Google Scholar] [CrossRef]
  6. Rich, S.; Lamaro Haintz, G.; McKenzie, H.; Graham, M. Factors That Shape Women’s Reproductive Decision-Making: A Scoping Review. J. Res. Gend. Stud. 2021, 11, 9–31. [Google Scholar]
  7. Haque, R.; Alam, K.; Rahman, S.M.; Keramat, S.A.; Al-Hanawi, M.K. Women’s Empowerment and Fertility Decision-Making in 53 Low and Middle Resource Countries: A Pooled Analysis of Demographic and Health Surveys. BMJ Open 2021, 11, e045952. [Google Scholar] [CrossRef]
  8. D’Souza, P.; Bailey, J.V.; Stephenson, J.; Oliver, S. Factors Influencing Contraception Choice and Use Globally: A Synthesis of Systematic Reviews. Eur. J. Contracept. Reprod. Health Care 2022, 27, 364–372. [Google Scholar] [CrossRef] [PubMed]
  9. Hashemzadeh, M.; Shariati, M.; Mohammad Nazari, A.; Keramat, A. Childbearing Intention and Its Associated Factors: A Systematic Review. Nurs. Open 2021, 8, 2354–2368. [Google Scholar] [CrossRef]
  10. Rikken, J.F.W.; Kowalik, C.R.; Emanuel, M.H.; Bongers, M.Y.; Spinder, T.; Jansen, F.W.; Mulders, A.G.M.G.J.; Padmehr, R.; Clark, T.J.; Van Vliet, H.A.; et al. Septum Resection versus Expectant Management in Women with a Septate Uterus: An International Multicentre Open-Label Randomized Controlled Trial. Hum. Reprod. 2021, 36, 1260–1267. [Google Scholar] [CrossRef]
  11. Abruzzese, G.A.; Silva, A.F.; Velazquez, M.E.; Ferrer, M.; Motta, A.B. Hyperandrogenism and Polycystic Ovary Syndrome: Effects in Pregnancy and Offspring Development. WIREs Mech. Dis. 2022, 14, e1558. [Google Scholar] [CrossRef]
  12. Ramraj, B.; Subramanian, V.M.; Vijayakrishnan, G. Study on Age of Menarche between Generations and the Factors Associated with It. Clin. Epidemiol. Glob. Health 2021, 11, 100758. [Google Scholar] [CrossRef]
  13. Ma, L.; Shen, W.; Zhang, J. The Life Cycle of the Ovary. In Ovarian Aging; Wang, S., Ed.; Springer Nature Singapore: Singapore, 2023; pp. 7–33. ISBN 978-981-19-8847-9. [Google Scholar]
  14. Swanson, R.J.; Liu, B. Conception and Pregnancy. In Fertility, Pregnancy, and Wellness; Elsevier: Amsterdam, The Netherlands, 2022; pp. 53–71. ISBN 978-0-12-818309-0. [Google Scholar]
  15. Kölle, S. Sperm-oviduct Interactions: Key Factors for Sperm Survival and Maintenance of Sperm Fertilizing Capacity. Andrology 2022, 10, 837–843. [Google Scholar] [CrossRef]
  16. Ng, K.Y.B.; Evans, R.; Mentzakis, E.; Cheong, Y. P-405 Assessing Women’s Preferences in a Novel Intrauterine Device Designed to Monitor the Womb Environment in Real Time: A Discrete Choice Experiment. Hum. Reprod. 2022, 37, deac107.382. [Google Scholar] [CrossRef]
  17. Hilton, E.N.; Lundberg, T.R. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports Med. 2021, 51, 199–214. [Google Scholar] [CrossRef] [PubMed]
  18. Lindqvist, A.; Sendén, M.G.; Renström, E.A. What Is Gender, Anyway: A Review of the Options for Operationalising Gender. Psychol. Sex. 2021, 12, 332–344. [Google Scholar] [CrossRef]
  19. van der Doef, S. Can I Have Babies Too? Sexuality and Relationships Education for Children from Infancy up to Age 11; Jessica Kingsley Publishers: London, UK, 2021; ISBN 978-1-78775-500-0. [Google Scholar]
  20. Cacciatore, R.; Öhrmark, L.; Kontio, J.; Apter, D.; Ingman-Friberg, S.; Jokela, M.; Sajaniemi, N.; Korkman, J.; Kaltiala, R. What Do 3–6-Year-Old Children in Finland Know about Sexuality? A Child Interview Study in Early Education. Sex Educ. 2024, 24, 291–310. [Google Scholar] [CrossRef]
  21. Van Lonkhuijzen, R.M.; Garcia, F.K.; Wagemakers, A. The Stigma Surrounding Menstruation: Attitudes and Practices Regarding Menstruation and Sexual Activity During Menstruation. Women’s Reprod. Health 2023, 10, 364–384. [Google Scholar] [CrossRef]
  22. Maslowski, K.; Biswakarma, R.; Reiss, M.J.; Harper, J. Sex and Fertility Education in England: An Analysis of Biology Curricula and Students’ Experiences. J. Biol. Educ. 2024, 58, 702–720. [Google Scholar] [CrossRef]
  23. Luthfiyah, A.; Hayati, E.N. Understanding Premarital Sexual Behavior: A Qualitative Case Study among Male and Female College Students. J. Educ. Health Community Psychol. 2025, 14, 791–807. [Google Scholar] [CrossRef]
  24. Yeatman, S.; Sennott, C. Fertility Desires and Contraceptive Transition. Pop. Dev. Rev. 2024, 50, 511–538. [Google Scholar] [CrossRef]
  25. Watson, A.; Yarger, J.; Sedlander, E.; Urbina, J.; Hopkins, K.; Rodriguez, M.I.; Fuentes, L.; Harper, C.C. Concern That Contraception Affects Future Fertility: How Common Is This Concern among Young People and Does It Stop Them from Using Contraception? Contracept. X 2023, 5, 100103. [Google Scholar] [CrossRef]
  26. Hasnain, A.M.; Snopkowski, K. Maternal Investment in Arranged and Self-Choice Marriages: A Test of the Reproductive Compensation and Differential Allocation Hypothesis in Humans. Evol. Hum. Behav. 2024, 45, 99–110. [Google Scholar] [CrossRef]
  27. Tariq, B.; Phillips, S.; Biswakarma, R.; Talaulikar, V.; Harper, J.C. Women’s Knowledge and Attitudes to the Menopause: A Comparison of Women over 40 Who Were in the Perimenopause, Post Menopause and Those Not in the Peri or Post Menopause. BMC Women’s Health 2023, 23, 460. [Google Scholar] [CrossRef]
  28. Barber, K.; Charles, A. Barriers to Accessing Effective Treatment and Support for Menopausal Symptoms: A Qualitative Study Capturing the Behaviours, Beliefs and Experiences of Key Stakeholders. Patient Prefer. Adherence 2023, 17, 2971–2980. [Google Scholar] [CrossRef]
  29. Van Tintelen, A.M.G.; Stulp, G. Explaining Uncertainty in Women’s Fertility Preferences. Heliyon 2024, 10, e27610. [Google Scholar] [CrossRef] [PubMed]
  30. Nakkerud, E. “There Are Many People Like Me, Who Feel They Want to Do Something Bigger”: An Exploratory Study of Choosing Not to Have Children Based on Environmental Concerns. Ecopsychology 2021, 13, 200–209. [Google Scholar] [CrossRef]
  31. Santulli, P.; Blockeel, C.; Bourdon, M.; Coticchio, G.; Campbell, A.; De Vos, M.; Macklon, K.T.; Pinborg, A.; Garcia-Velasco, J.A. Fertility Preservation in Women with Benign Gynaecological Conditions. Hum. Reprod. Open 2023, 2023, hoad012. [Google Scholar] [CrossRef]
  32. Aureliano, W. Difficult Decisions and Possible Choices: Rare Diseases, Genetic Inheritance and Reproduction of the Family. Soc. Sci. Med. 2024, 363, 117380. [Google Scholar] [CrossRef]
  33. Bártolo, A.; Santos, I.M.; Monteiro, S. Toward an Understanding of the Factors Associated With Reproductive Concerns in Younger Female Cancer Patients: Evidence From the Literature. Cancer Nurs. 2021, 44, 398–410. [Google Scholar] [CrossRef]
  34. Dahl, S.L.; Vaksdal, R.H.; Barra, M.; Gamlund, E.; Solberg, C.T. Abortion and Multifetal Pregnancy Reduction: An Ethical Comparison. Etikk Praksis Nord. J. Appl. Ethics 2021. [Google Scholar] [CrossRef]
  35. Sharma, S.; Pandey, G. Understanding the Impact of Triazoles on Female Fertility and Embryo Development: Mechanisms and Implications. Toxicol. Rep. 2025, 14, 101948. [Google Scholar] [CrossRef]
  36. Baggio, S.; Garzon, S.; Russo, A.; Ianniciello, C.Q.; Santi, L.; Laganà, A.S.; Raffaelli, R.; Franchi, M. Fertility and Reproductive Outcome after Tubal Ectopic Pregnancy: Comparison among Methotrexate, Surgery and Expectant Management. Arch. Gynecol. Obs. 2021, 303, 259–268. [Google Scholar] [CrossRef] [PubMed]
  37. Maqsood, Z.; Zafar, M.; Mazha, S.B.; Sultan, K. Community Acceptability of Contraception after Induced versus Spontaneous Miscarriage. Prof. Med. J. 2021, 29, 36–40. [Google Scholar] [CrossRef]
  38. Lissmann, R.; Lokot, M.; Marston, C. Understanding the Lived Experience of Pregnancy and Birth for Survivors of Rape and Sexual Assault. BMC Pregnancy Childbirth 2023, 23, 796. [Google Scholar] [CrossRef]
  39. Kasaven, L.S.; Mitra, A.; Ostrysz, P.; Theodorou, E.; Murugesu, S.; Yazbek, J.; Bracewell-Milnes, T.; Ben Nagi, J.; Jones, B.P.; Saso, S. Exploring the Knowledge, Attitudes, and Perceptions of Women of Reproductive Age towards Fertility and Elective Oocyte Cryopreservation for Age-Related Fertility Decline in the UK: A Cross-Sectional Survey. Hum. Reprod. 2023, 38, 2478–2488. [Google Scholar] [CrossRef]
  40. Kidane, B.D.; Mekonnen, H.; Mekango, D.E.; Moges, S.; Ejajo, T. Fertility Desire and Associated Factors among People Living with HIV/AIDs Attending Anti-Retroviral Therapy Clinic in Wachemo University Negist Eleni Mohammed Memorial Teaching Hospital, Southern Ethiopia. Res. Sq. 2024. [Google Scholar] [CrossRef]
  41. Dias, I.C.; Gutierrez-Castellanos, N.; Lenschow, C.; Lima, S.Q. Ready or Not: Neural Mechanisms Regulating Female Sexual Behavior. Curr. Opin. Neurobiol. 2025, 93, 103069. [Google Scholar] [CrossRef]
  42. Temmesen, C.G.; Faber Frandsen, T.; Svarre-Nielsen, H.; Petersen, K.B.; Clemensen, J.; Andersen, H.L.M. Women’s Reflections on Timing of Motherhood: A Meta-Synthesis of Qualitative Evidence. Reprod. Health 2023, 20, 30. [Google Scholar] [CrossRef] [PubMed]
  43. Bielawska-Batorowicz, E.; Zagaj, K.; Kossakowska, K. Reproductive Intentions Affected by Perceptions of Climate Change and Attitudes toward Death. Behav. Sci. 2022, 12, 374. [Google Scholar] [CrossRef]
  44. Martins, M.V.; Koert, E.; Sylvest, R.; Maeda, E.; Moura-Ramos, M.; Hammarberg, K.; Harper, J. Fertility Education: Recommendations for Developing and Implementing Tools to Improve Fertility Literacy. Hum. Reprod. 2024, 39, 293–302. [Google Scholar] [CrossRef] [PubMed]
  45. Speizer, I.S.; Bremner, J.; Farid, S. Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls. Glob. Health Sci. Pract. 2022, 10, e2100450. [Google Scholar] [CrossRef] [PubMed]
  46. Hoffman, A.; Crocker, L.; Mathur, A.; Holman, D.; Weston, J.; Campbell, S.; Housten, A.; Bradford, A.; Agrawala, S.; Woodard, T.L. Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment. JMIR Form. Res. 2021, 5, e25083. [Google Scholar] [CrossRef]
  47. Grace, B.; Shawe, J.; Stephenson, J. A Mixed Methods Study Investigating Sources of Fertility and Reproductive Health Information in the UK. Sex. Reprod. Healthc. 2023, 36, 100826. [Google Scholar] [CrossRef]
  48. Ning, C.; Wu, J.; Ye, Y.; Yang, N.; Pei, H.; Gao, H. How Media Use Influences the Fertility Intentions Among Chinese Women of Reproductive Age: A Perspective of Social Trust. Front. Public Health 2022, 10, 882009. [Google Scholar] [CrossRef] [PubMed]
  49. Aassve, A.; Le Moglie, M.; Mencarini, L. Trust and Fertility in Uncertain Times. Popul. Stud. 2021, 75, 19–36. [Google Scholar] [CrossRef]
  50. Irvine, K.; Brown, R.C.; Savulescu, J. Disclosure and Consent: Ensuring the Ethical Provision of Information Regarding Childbirth. J. Med. Ethics 2025, 51, 550–557. [Google Scholar] [CrossRef]
  51. Skvirsky, V.; Taubman-Ben-Ari, O.; Horowitz, E. Mothers’ Experience of Their Daughters’ Fertility Problems and Treatments. J. Fam. Psychol. 2022, 36, 1418–1427. [Google Scholar] [CrossRef]
  52. Zinke-Allmang, A.; Bhatia, A.; Gorur, K.; Hassan, R.; Shipow, A.; Ogolla, C.; Keizer, K.; Cislaghi, B. The Role of Partners, Parents and Friends in Shaping Young Women’s Reproductive Choices in Peri-Urban Nairobi: A Qualitative Study. Reprod. Health 2023, 20, 41. [Google Scholar] [CrossRef]
  53. Sarnak, D.; Becker, S. Accuracy of Wives’ Proxy Reports of Husbands’ Fertility Preferences in Sub-Saharan Africa. DemRes 2022, 46, 503–546. [Google Scholar] [CrossRef]
  54. Sambasivam, I.; Jennifer, H.G. Understanding the Experiences of Helplessness, Fatigue and Coping Strategies among Women Seeking Treatment for Infertility—A Qualitative Study. J. Educ. Health Prom. 2023, 1, 309. [Google Scholar] [CrossRef]
  55. Chola, M.; Hlongwana, K.W.; Ginindza, T.G. Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia. Int. J. Environ. Res. Public Health 2023, 20, 3614. [Google Scholar] [CrossRef]
  56. Graham, L.K.; Maness, S.B.; Sundstrom, B. Contraception Knowledge among College Women in the Southeast United States. J. Am. Coll. Health 2025, 73, 1010–1014. [Google Scholar] [CrossRef]
  57. Kasprzak, B.; Zgórecki, P. Prophylactic Mastectomy and Ovariectomy—A Religious Perspective. Eur. J. Gynaecol. Oncol. 2021, 42, 414. [Google Scholar] [CrossRef]
  58. Wei, Y.; Song, H. Adult Female Callers’ Characteristics and Mental Health Status: A Retrospective Study Based on the Psychological Assistance Hotline in Hangzhou. BMC Public Health 2023, 23, 2295. [Google Scholar] [CrossRef]
  59. Martin, L.J. Knowing and Not Knowing about Fertility: Childless Women and Age-Related Fertility Decline. A&A 2021, 42, 30–48. [Google Scholar] [CrossRef]
  60. Dima, D.C.; Boyko, S.; Torchetti, T.; McBain, S.; Benko, S.; Khan, I.; Ye, X.Y.; Quartey, N.K.; Poznanski, D.; MacKinnon, K.; et al. Fertility Information Perceptions and Needs of People with Cancer, Their Family Members, and Caregivers. Support Care Cancer 2025, 33, 770. [Google Scholar] [CrossRef] [PubMed]
  61. Liu, P.; Cao, J.; Nie, W.; Wang, X.; Tian, Y.; Ma, C. The Influence of Internet Usage Frequency on Women’s Fertility Intentions—The Mediating Effects of Gender Role Attitudes. Int. J. Environ. Res. Public Health 2021, 18, 4784. [Google Scholar] [CrossRef]
  62. Zaki, L.; Rabinor, R. Fertility Counseling with Groups. In Fertility Counseling: Clinical Guide; Covington, S.N., Ed.; Cambridge University Press: Cambridge, UK, 2022; pp. 59–67. ISBN 978-1-009-03015-1. [Google Scholar]
  63. Costa Figueiredo, M.; Su, H.I.; Chen, Y. Using Data to Approach the Unknown: Patients’ and Healthcare Providers? Data Practices in Fertility Challenges. Proc. ACM Hum. Comput. Interact. 2021, 4, 1–35. [Google Scholar] [CrossRef]
  64. Yao, H.; Chan, C.H.Y.; Hou, Y.; Chan, C.L.W. Ambivalence Experienced by Infertile Couples Undergoing IVF: A Qualitative Study. Hum. Fertil. 2023, 26, 289–301. [Google Scholar] [CrossRef]
  65. Jones, G.L.; Moss, R.H.; Darby, F.; Mahmoodi, N.; Phillips, B.; Hughes, J.; Vogt, K.S.; Greenfield, D.M.; Brauten-Smith, G.; Gath, J.; et al. Cancer, Fertility and Me: Developing and Testing a Novel Fertility Preservation Patient Decision Aid to Support Women at Risk of Losing Their Fertility Because of Cancer Treatment. Front. Oncol. 2022, 12, 896939. [Google Scholar] [CrossRef]
  66. Sagiv, L.; Roccas, S. How Do Values Affect Behavior? Let Me Count the Ways. Pers. Soc. Psychol. Rev. 2021, 25, 295–316. [Google Scholar] [CrossRef] [PubMed]
  67. Sagiv, L.; Schwartz, S.H. Personal Values Across Cultures. Annu. Rev. Psychol. 2022, 73, 517–546. [Google Scholar] [CrossRef] [PubMed]
  68. Han, J.; Park, S.; Kim, S.H. Supporting Decision-making Regarding Fertility Preservation in Patients with Cancer: An Integrative Review. Eur. J. Cancer Care 2022, 31, e13748. [Google Scholar] [CrossRef]
  69. World Health Organization. WHO Remains Firmly Committed to the Principles Set out in the Preamble to the Constitution; World Health Organization: Geneva, Switzerland, 2025. [Google Scholar]
  70. Alzeer, J. Integrating Medicine with Lifestyle for Personalized and Holistic Healthcare. J. Pub. Health Emerg. 2023, 7, 33. [Google Scholar] [CrossRef]
  71. Lim, S.; Nzegwu, D.; Wright, M.L. The Impact of Psychosocial Stress from Life Trauma and Racial Discrimination on Epigenetic Aging—A Systematic Review. Biol. Res. Nurs. 2022, 24, 202–215. [Google Scholar] [CrossRef] [PubMed]
  72. Record, J.D.; Ziegelstein, R.C. Personomics: The Personalization of Precision Medicine. In Implementation of Personalized Precision Medicine; Elsevier: Amsterdam, The Netherlands, 2025; pp. 407–415. ISBN 978-0-323-98808-7. [Google Scholar]
  73. Delpierre, C.; Lefèvre, T. Precision and Personalized Medicine: What Their Current Definition Says and Silences about the Model of Health They Promote. Implication for the Development of Personalized Health. Front. Sociol. 2023, 8, 1112159. [Google Scholar] [CrossRef]
  74. Molla, G.; Bitew, M. Revolutionizing Personalized Medicine: Synergy with Multi-Omics Data Generation, Main Hurdles, and Future Perspectives. Biomedicines 2024, 12, 2750. [Google Scholar] [CrossRef]
  75. Stern, D.L. The True ART: How to Deliver the Best Patient Care. In The Boston IVF Handbook of Infertility; CRC Press: Boca Raton, FL, USA, 2025; pp. 272–280. ISBN 978-1-003-46027-5. [Google Scholar]
  76. John, J.N.; Gorman, S.; Scales, D.; Gorman, J. Online Misleading Information About Women’s Reproductive Health: A Narrative Review. J. Gen. Intern. Med. 2025, 40, 1123–1131. [Google Scholar] [CrossRef]
  77. Athey, S.; Bergstrom, K.; Hadad, V.; Jamison, J.C.; Özler, B.; Parisotto, L.; Sama, J.D. Can Personalized Digital Counseling Improve Consumer Search for Modern Contraceptive Methods? Sci. Adv. 2023, 9, eadg4420. [Google Scholar] [CrossRef]
  78. Zou, W.; Tang, L.; Zhou, M.; Zhang, X. Self-Disclosure and Received Social Support among Women Experiencing Infertility on Reddit: A Natural Language Processing Approach. Comp. Hum. Behav. 2024, 154, 108159. [Google Scholar] [CrossRef]
  79. Bulletti, C. Telemedicine in IVF Programs. BJSTR 2023, 51, 42611–42618. [Google Scholar] [CrossRef]
  80. Nash, C. Regarding the UN Sustainable Goals of Well-Being, Gender Equality, and Climate Action: Reconsidering Reproductive Expectations of Women Worldwide. Sexes 2025, 6, 13. [Google Scholar] [CrossRef]
  81. Nash, C. Unresolved Depression on Alleviating Health Research Burnout. J. Biomed. Res. Environ. Sci. 2025, 6, 1143–1156. [Google Scholar] [CrossRef]
  82. Nash, C. Challenges Identifying and Stimulating Self-Directed Learning in Publicly Funded Programs. In The Digital Era of Learning: Novel Educational Strategies and Challenges for Teaching Students in the 21st Century; Keator, C.S., Ed.; Education in a competitive and globalizing world; Nova Science Publishers: New York, NY, USA, 2020; pp. 259–300. ISBN 978-1-5361-8750-2. [Google Scholar]
  83. Nash, C. Report on Digital Literacy in Academic Meetings during the 2020 COVID-19 Lockdown. Challenges 2020, 11, 20. [Google Scholar] [CrossRef]
  84. Simon, S.B.; Howe, L.W.; Kirschenbaum, H. Values Clarification; Warner Books: New York, NY, USA, 2009; ISBN 978-0-446-56525-7. [Google Scholar]
  85. Raths, L.E.; Harmin, M.; Simon, S.B. Values and Teaching: Working with Values in the Classroom, 1st ed.; C.E. Merrill Books: Columbus, OH, USA, 1966. [Google Scholar]
  86. MDPI. MDPI Review Reports. In Guidelines for Reviewers; MDPI: Basel, Switzerland, 2025. [Google Scholar]
  87. Josselson, R.; Hammack, P.L. Essentials of Narrative Analysis; American Psychological Association: Washington, DC, USA, 2021; ISBN 978-1-4338-3567-4. [Google Scholar]
  88. Abe, N.; Venkatesan, S. Reproductive Autonomy, Graphic Reproduction, and The Elephant in the Womb. Perspect. Biol. Med. 2025, 68, 99–116. [Google Scholar] [CrossRef]
  89. Nash, C. Team Mindfulness in Online Academic Meetings to Reduce Burnout. Challenges 2023, 14, 15. [Google Scholar] [CrossRef]
  90. Nash, C. Historical Study of an Online Hospital-Affiliated Burnout Intervention Process for Researchers. J. Hosp. Manag. Health Policy 2024, Online first, 1–17. [Google Scholar] [CrossRef]
  91. Nash, C. COVID-19 Limitations on Doodling as a Measure of Burnout. Eur. J. Investig. Health Psychol. Educ. 2021, 11, 1688–1705. [Google Scholar] [CrossRef] [PubMed]
  92. Nash, C. Doodling as a Measure of Burnout in Healthcare Researchers. Cult. Med. Psych. 2021, 45, 565–598. [Google Scholar] [CrossRef]
  93. Nash, C. Online Meeting Challenges in a Research Group Resulting from COVID-19 Limitations. Challenges 2021, 12, 29. [Google Scholar] [CrossRef]
  94. Nash, C. Enhancing Hopeful Resilience Regarding Depression and Anxiety with a Narrative Method of Ordering Memory Effective in Researchers Experiencing Burnout. Challenges 2022, 13, 28. [Google Scholar] [CrossRef]
  95. Vasquez, T.S.; Close, J.; Bylund, C.L. Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review. J. Grad. Med. Educ. 2021, 13, 471–489. [Google Scholar] [CrossRef]
  96. Witteman, H.O.; Ndjaboue, R.; Vaisson, G.; Dansokho, S.C.; Arnold, B.; Bridges, J.F.P.; Comeau, S.; Fagerlin, A.; Gavaruzzi, T.; Marcoux, M.; et al. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med. Decis. Mak. 2021, 41, 801–820. [Google Scholar] [CrossRef] [PubMed]
  97. Harper, J.C.; Botero-Meneses, J.S. An Online Survey of UK Women’s Attitudes to Having Children, the Age They Want Children and the Effect of the COVID-19 Pandemic. Hum. Reprod. 2022, 37, 2611–2622. [Google Scholar] [CrossRef]
  98. Barger, A.S. Artificial Intelligence vs. Human Coaches: Examining the Development of Working Alliance in a Single Session. Front. Psychol. 2025, 15, 1364054. [Google Scholar] [CrossRef]
  99. Williams, E.N.; Grande, S.; Nakamura, Y.T.; Pyle, L.; Shaw, G. The Development and Practice of Authentic Leadership: A Cultural Lens. Eur. J. Train. Dev. 2022, 46, 937–952. [Google Scholar] [CrossRef]
  100. Almutairi, M.; Timmins, F.; Wise, P.Y.; Stokes, D.; Alharbi, T.A.F. Authentic Leadership—A Concept Analysis. J. Adv. Nurs. 2025, 81, 1775–1793. [Google Scholar] [CrossRef] [PubMed]
  101. Chen, J.K.C.; Sriphon, T. Authentic Leadership, Trust, and Social Exchange Relationships under the Influence of Leader Behavior. Sustainability 2022, 14, 5883. [Google Scholar] [CrossRef]
  102. Ogunyemi, O.; Ogunyemi, K. Authentic Leadership: Leading with Purpose, Meaning and Core Values. In New Horizons in Positive Leadership and Change; Dhiman, S., Marques, J., Eds.; Management for Professionals; Springer International Publishing: Cham, Switzerland, 2020; pp. 369–380. ISBN 978-3-030-38128-8. [Google Scholar]
  103. Kelly, L. Authentic Leadership: Roots of the Construct. In Mindfulness for Authentic Leadership; Palgrave Studies in Workplace Spirituality and Fulfillment; Springer International Publishing: Cham, Switzerland, 2023; pp. 17–52. ISBN 978-3-031-34676-7. [Google Scholar]
  104. Brewer, K.L.; Devnew, L.E. Developing Responsible, Self-Aware Management: An Authentic Leadership Development Program Case Study. Int. J. Manag. Educ. 2022, 20, 100697. [Google Scholar] [CrossRef]
  105. Johnson, M.A.; Bloomer, F.; Pétursdóttir, G.M. “For Some Reason, She Just Wasn’t Able to Have an Abortion”: Social Attitudes, Reproductive Autonomy, and the Taboo of Regret. Sex Roles 2025, 91, 32. [Google Scholar] [CrossRef]
  106. Frederick, N.N.; Klosky, J.L.; Meacham, L.R.; Quinn, G.P.; Kelvin, J.F.; Cherven, B.; Freyer, D.R.; Dvorak, C.C.; Brackett, J.; Ahmed-Winston, S.; et al. Infrastructure of Fertility Preservation Services for Pediatric Cancer Patients: A Report From the Children’s Oncology Group. JCO Oncol. Prac. 2022, 18, e325–e333. [Google Scholar] [CrossRef]
  107. Sousa-Leite, M.; Costa, R.; Figueiredo, B.; Gameiro, S. Discussing the Possibility of Fertility Treatment Being Unsuccessful as Part of Routine Care Offered at Clinics: Patients’ Experiences, Willingness, and Preferences. Hum. Reprod. 2023, 38, 1332–1344. [Google Scholar] [CrossRef]
  108. Bluth, N.P. Reframing as Recourse: How Women Approach and Initiate the End of Fertility Treatment. Soc. Sci. Med. 2023, 338, 116310. [Google Scholar] [CrossRef] [PubMed]
  109. Ali, S.M.; Lee, R.R.; McBeth, J.; James, B.; McAlister, S.; Chiarotto, A.; Dixon, W.G.; Van Der Veer, S.N. Exploring the Cross-Cultural Acceptability of Digital Tools for Pain Self-Reporting: Qualitative Study. JMIR Hum. Factors 2023, 10, e42177. [Google Scholar] [CrossRef]
  110. Emerson, R.W. Convenience Sampling Revisited: Embracing Its Limitations Through Thoughtful Study Design. J. Vis. Impair. Blind. 2021, 115, 76–77. [Google Scholar] [CrossRef]
  111. Weiss, C.R.; Johnson-Koenke, R. Narrative Inquiry as a Caring and Relational Research Approach: Adopting an Evolving Paradigm. Qual. Health Res. 2023, 33, 388–399. [Google Scholar] [CrossRef] [PubMed]
  112. Andrews, M. Quality Indicators in Narrative Research. Qual. Res. Psychol. 2021, 18, 353–368. [Google Scholar] [CrossRef]
  113. Kutsyuruba, B.; Stasel, R.S. Narrative Inquiry. In Varieties of Qualitative Research Methods; Okoko, J.M., Tunison, S., Walker, K.D., Eds.; Springer Texts in Education; Springer International Publishing: Cham, Switzerland, 2023; pp. 325–332. ISBN 978-3-031-04396-3. [Google Scholar]
  114. Pino Gavidia, L.A.; Adu, J. Critical Narrative Inquiry: An Examination of a Methodological Approach. Int. J. Qual. Meth. 2022, 21, 16094069221081594. [Google Scholar] [CrossRef]
  115. Lim, W.M. What Is Qualitative Research? An Overview and Guidelines. Australas. Mark. J. 2025, 33, 199–229. [Google Scholar] [CrossRef]
  116. Kreuzer, M. The Grammar of Time: A Toolbox for Comparative Historical Analysis, 1st ed.; Methods for Social Inquiry Series; Cambridge University Press: Cambridge, UK, 2023; ISBN 978-1-108-71823-3. [Google Scholar]
  117. Sukhera, J. Narrative Reviews: Flexible, Rigorous, and Practical. J. Grad. Med. Educ. 2022, 14, 414–417. [Google Scholar] [CrossRef] [PubMed]
  118. Bhat, R.M.; Rajan, P.; Gamage, L. Redressing Historical Bias: Exploring the Path to an Accurate Representation of the Past. J. Soc. Sci. 2023, 4, 698–705. [Google Scholar] [CrossRef]
  119. De Groot, A.D. Methodology: Foundations of Inference and Research in the Behavioral Sciences; De Gruyter: New York, NY, USA, 1969; ISBN 978-3-11-231312-1. [Google Scholar]
Women 05 00044 g001
Figure 1. The yearly 28-session process during the COVID-19 pandemic of the HeNReG and the HeNReP Data on the dates and prompts missed by Participants 1 and 2 are from the 2020/2021 Facebook group weekly entries. Data on when participants left the process for the HeNReP from [90]. This figure is author-created for this publication.
Figure 1. The yearly 28-session process during the COVID-19 pandemic of the HeNReG and the HeNReP Data on the dates and prompts missed by Participants 1 and 2 are from the 2020/2021 Facebook group weekly entries. Data on when participants left the process for the HeNReP from [90]. This figure is author-created for this publication.
Women 05 00044 g001
Women 05 00044 g002
Figure 2. The evolution of the conceptual process from the HeNReG to the proposed HeNFeP. This figure is author-created for this publication.
Figure 2. The evolution of the conceptual process from the HeNReG to the proposed HeNFeP. This figure is author-created for this publication.
Women 05 00044 g002
Table 1. Yearly participants of the HeNReG between 2020 and 2022, and of the HeNReP from 2022 to 2025, the number completing either (percentage), those who were female (percentage of participants), and, of the females, those who completed the process (percentage of completed).
Table 1. Yearly participants of the HeNReG between 2020 and 2022, and of the HeNReP from 2022 to 2025, the number completing either (percentage), those who were female (percentage of participants), and, of the females, those who completed the process (percentage of completed).
HeNReG: 2020–2022HeNReP 2022–2025
2020/20212021/20222022/20232023/20242024/2025
Participants2019772
Completed15 (75%)15 (79%)4 (57%)0 (0%)1 (50%)
Female13 (65%)12 (63%)6 (86%)5 (71%)2 (100%)
Female completed10 (67%)9 (60%)4 (100%)0 (0%)1 (50%)
Source: for the HeNReG from [89], and for the HeNReP from [90]. An analysis of Facebook entries, Messenger texts, and feedback forms provides the data for these publications.
Table 2. Yearly female HeNReG participants between 2020 and 2022, and the HeNReP from 2022 to 2025, who did not complete the online process, indicating an additional burden beyond their burnout. During the years of the HeNReG, the reason for leaving was reported to be residual depression. During the HeNReP, a feeling of being overwhelmed in determining when to participate, due to a lack of support, was the reason for ending involvement in the process.
Table 2. Yearly female HeNReG participants between 2020 and 2022, and the HeNReP from 2022 to 2025, who did not complete the online process, indicating an additional burden beyond their burnout. During the years of the HeNReG, the reason for leaving was reported to be residual depression. During the HeNReP, a feeling of being overwhelmed in determining when to participate, due to a lack of support, was the reason for ending involvement in the process.
HeNReG: 2020–2022HeNReP 2022–2025
2020/20212021/20222022/20232023/20242024/2025
Participant 1 X X
Participant 2 X X
Source: for the HeNReG from [89], and for the HeNReP from [90]. An analysis of feedback forms provides the data for these publications.
Table 3. Participant number (#) of those who could not complete the HeNReG (who also could not complete the HeNReP), their demographic, description of their research related to health, and the reason given by each participant for their non-burnout-related depression expressed during their participation in the HeNReG and the HeNReP.
Table 3. Participant number (#) of those who could not complete the HeNReG (who also could not complete the HeNReP), their demographic, description of their research related to health, and the reason given by each participant for their non-burnout-related depression expressed during their participation in the HeNReG and the HeNReP.
#DemographicDescription of Research Related to HealthPerceived HeNReG Participant Reasons for Their Non-Burnout-Related DepressionPerceived HeNReP Participant Reasons for Inability to
Schedule Meetings
1Middle-aged
Graduate student		Developing a teaching framework for learning about life, health, and death through somatic experienceActing as the caregiver for a parent with terminal illness, with a lack of effective family supportOverwhelmed from death of parent with the terminal illness for whom caregiving was provided
2Middle-aged
Neurodivergent
Social worker		Investigating social justice. Working primarily with people living in poverty, the ethical dilemmas… supporting people through their voice, tying in narrative concepts and modelsDeficient sibling support for neurodivergenceOrganizing and scheduling are a challenge because of difficulties with conceptualizing time and the steps to follow
Source: Information gathered from emails, messages, and in-person communications.
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Nash, C. A Suggested One-On-One Method Providing Personalized Online Support for Females Clarifying Their Fertility Values. Women 2025, 5, 44. https://doi.org/10.3390/women5040044

AMA Style

Nash C. A Suggested One-On-One Method Providing Personalized Online Support for Females Clarifying Their Fertility Values. Women. 2025; 5(4):44. https://doi.org/10.3390/women5040044

Chicago/Turabian Style

Nash, Carol. 2025. "A Suggested One-On-One Method Providing Personalized Online Support for Females Clarifying Their Fertility Values" Women 5, no. 4: 44. https://doi.org/10.3390/women5040044

APA Style

Nash, C. (2025). A Suggested One-On-One Method Providing Personalized Online Support for Females Clarifying Their Fertility Values. Women, 5(4), 44. https://doi.org/10.3390/women5040044

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