Postponing Pregnancy Through Oocyte Cryopreservation for Social Reasons: Considerations Regarding Clinical Practice and the Socio-Psychological and Bioethical Issues Involved

Abstract

Oocyte freezing for ‘social reasons’ refers to women of reproductive age who are aiming to prolong, protect and secure their fertility. The term emerged to describe application of the highly promising technique, namely vitrification on oocytes retrieved through controlled ovarian stimulation (COS) from women intending to preserve their fertility for social reasons. These women opt to cryopreserve their oocytes at a point in their life when they need to postpone childbearing on the grounds of so called ‘social’ reasons. These reasons may include a highly driven career, absence of an adequate partner, financial instability, or personal reasons that make them feel unprepared for motherhood. This is a sensitive and multifaceted issue that entails medical, bioethical and socio-psychological components. The latest trend and the apparent increase noted on oocyte freezing for ‘social reasons’ has prompted our team of fertility specialists, embryologists, obstetricians, gynecologists and psychologists to proceed with a thorough, critical and all-inclusive comprehensive analysis. The wide range of findings of this analysis involve concerns of embryology and epigenetics that shape decisions made in the IVF laboratory, issues regarding obstetric and perinatal concerns on the pregnancy concluding from these oocytes and the respective delivery management and neonatal data, to the social and bioethical impact of this trend’s application. This literature review refers to matters rising from the moment the ‘idea’ of this option is ‘birthed’ in a woman’s thoughts, to proceeding and executing it clinically, up until the point of the pediatric follow up of the children born. We aim to shed light to the controversial issue of oocyte freezing, while objectively exhibit all aspects regarding this complex matter, as well as to respectfully approach how could the prospect of our future expectations be shaped from the impact of its application.

The effect of human chorionic gonadotropin on the In vitro development of immature to mature human oocytes: A randomized controlled study

“…Infertility is a common problem in poor ovarian reserve women. [ 1 ] For in vitro fertilization (IVF), 15% of collected oocytes are immature (4% of them are in the metaphase I [MI] and 11% are in the germinal vesicle [GV] stage). [ 2 3 4 ] Factors that affect oocyte maturity include signal transmission failure between the cumulus cell and the oocyte, luteinizing hormone (LH) insufficiency, and intrinsic factors of the oocyte.…”

Safety of Ovaleap® (Follitropin Alfa) in Infertile Women Undergoing Superovulation for Assisted Reproductive Technologies: A Multinational Comparative, Prospective Cohort Study

“…Thus, the conduct of a freeze all policy may suggest that the patient was at an increased risk for OHSS. However, the trend observed in women of reproductive age in recent years toward delaying childbearing and “social egg freezing” and the improvements achieved in the cryopreservation techniques may suggest that OHSS risk may not necessarily be the underlying factor ( 30 , 31 ). Indeed, in some fertility clinics, there is an increase in practice to conduct freeze-all procedures independently of OHSS risk.…”

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

“…It should be voiced that from the early days of the Assisted Reproduction era, IVF techniques were conceptualized and developed serving the concept of personalized approaches for addressing infertile patients individually. Over the years, as dictated by lifestyle and reorganization of socioeconomical priorities, childbearing has been postponed, introducing new essential parameters when navigating through fertility treatments due to the factor of aging [ 140 ]. There is a noted progressive increase in the number of patients requesting ART treatment.…”