Elective oocyte freezing for the preservation of fertility

Abstract

Oocyte cryopreservation has recently emerged as an option for women to preserve their fertility for medical (e.g. treatable malignancy) or elective indications (e.g. advancing age). This report describes an IRB-approved study of over 200 oocyte cryopreservation cycles at one center. Patients presenting for oocyte cryopreservation (January 2005 to 2010) were analyzed for day 3 follicle stimulating hormone (FSH), basal antral follicle count (BAFC), gonadotropin usage and the number of oocytes retrieved and cryopreserved. New patient consultations were performed on 516 women, of whom 175 (34%) proceeded to initiate a total of 233 cryopreservation cycles. Twenty-four cycles were cancelled (10%) after starting follicular stimulation due to poor ovarian response or self-withdrawal of the patients. Patients whose cycles were cancelled demonstrated a higher Day 3 FSH and a lower BAFC than patients who completed cycles (p < 0.01). In the 209 completed cycles, the most important predictors of a successful cycle included BAFC (r = 0.36), FSH (r = –0.25) and age (r = –0.18) with the mean number of oocytes cryopreserved at 13.6 ± 8.8. Information about long-term fertility preservation must reach both patients and health care providers so that more women can be educated about the benefits of proactive early physiological reproductive assessment and possible interventions available

You Have a New Super Power: Ethics of Oocyte Cryopreservation

“…Other issues such as partnership and economic situation has been also reported as other barriers on women's path for childbearing at younger age. Many women who wanted to have children find themselves in an inacceptable economic condition or not having an adequate partner [16][17][18][19]. Finally, what seems like a delay might be a consequence of the extensive and continuous overestimation of female reproductive potential with age and the capacity of reproductive treatments to recover the potential [20].…”

“…There are several contributors to this argument. First, by giving women time to flourish in their education and careers, planned OC reduces the pressure of the 'ticking biological clock' and the pressure of having a child when the woman is not yet financially, emotionally, or situationally ready [17,[29][30][31]. Although all these factors are obvious benefits, recent research suggests that the lack of a partner is one of the main reasons a woman preserves her oocytes compared to other reasons [27,32].…”

Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion

“…Rather, the data show that many women who want to have children face conflicts about their preferred life path in a culture where the optimal time for educational and career advancement coincides directly with the period that the body is best suited for reproduction. Moreover, many women report that their life circumstances (partnership, marriage, finances) are not as they want them, or as society supports or regards as acceptable, and these circumstances are what prevent them from starting a family at an earlier time (18)(19)(20)(21). Finally, what may appear to be affirmative delay may actually be the unwitting product of a ''knowledge gap'': the widespread and persistent overestimation of both female reproductive potential with age and the ability of reproductive medicine to restore that potential (22).…”

“…Planned OC may allow women time to establish suitable relationships or life circumstances to prepare for having and raising children. It reduces the pressure to have a child when not yet psychologically, socially, or situationally ready (19,31,32).…”