Oocyte Cryopreservation Center for Reproductive Health Evelyn - - PowerPoint PPT Presentation

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Oocyte Cryopreservation

Center for Reproductive Health

Evelyn Mok-Lin, MD

Assistant Professor, Obstetrics, Gynecology and Reproductive Sciences Medical Director, UCSF Center for Reproductive Health

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Disclosure

No one involved in the planning or presentation of this activity has any relevant financial relationships with a commercial interest to disclose.

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Why should women consider egg freezing?

To preserve a woman’s current fertility and increase their chances of achieving pregnancy at a later age

www.elle.com

Infertility is a Common Disease

• 12% of reproductive age women in the US have

infertility

• WHO ranks infertility as the 3rd most serious

disease worldwide

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Age is the #1 Predictor of Fertility

• Women are less likely to conceive and more

likely to miscarry as they get older

Heffner, NEJM 2004 6

Decreasing Egg Quantity with Age

Wallace and Kelsey, PLoS 2010

• Finite number of follicles at birth
• 12% remaining at age 30
• 3% remaining at age 40

Abnormal Spindles in Older Eggs

20-25 year old eggs

– 17% of eggs with abnormal spindle assembly

40-45 year old eggs

– 83% of eggs with abnormal spindle assembly

7 Battaglia et al, Human Reproduction 1996

Increasing Rates of Chromosomal Abnormalities with Age

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Medical indications for egg freezing

1. Need for medical or surgical treatments that reduce ovarian reserve and/or affect egg quality

• Chemotherapy
• Pelvic radiation
• USO/BSO
• *Testosterone for gender dysphoria

2. Risk for early menopause

• Family history of POI and/or personal history of

diminished ovarian reserve (DOR)

– If not otherwise ready to conceive – DOR does not equal poor egg quality or future infertility

3. Genetic mutation carrier

• BRCA, FMR

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Elective indications for egg freezing

20,000 women in the U.S. underwent elective egg cryo by 2018 1. Women who wish to delay childbearing due to personal or professional circumstances

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Elective indications for egg freezing

2. Women/couples who want to have more than 1 child

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Optimal timing for elective egg freezing

• What is the ideal age?
• Is there a minimum or maximum age?

Franasiak et al. Fertility and Sterility 2014

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Optimal timing for elective egg freezing

• Decision-tree model for egg freezing vs no action

– ages 25-40 yrs – attempt at procreation 3, 5 or 7 years after – unassisted attempts for 6 months and then IVF

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Mesen et al. Fertility and Sterility 2015

Mesen et al. 2015

• Live birth rate (LBR) highest when egg freezing performed

at <34 yrs (>70%)

– Steadily declines with increasing age to 26.2% at age 40 yrs

• Greatest improvement in LBR at age 37 yrs

– 30% difference in chance of live birth with egg freezing compared to no action (51.6% vs 21.9%) – Little benefit at ages 25-30 yrs (2.6-7.1% increase)

• Egg freezing was most cost-effective at age 37 yrs

https://uncfertility.com/treatment-options/egg-calculator/

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Embryo versus Egg Freezing

• Embryo cryopreservation

– Well-established

• Most data
• Highest success rates
• Allows for assessment of embryo quality and

preimplantation genetic testing (PGT)

– Limitations:

• More expensive
• Requires male partner or donor sperm
• Potential legal and ethical issues re: use / disposition

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Embryo versus Egg Freezing

• Oocyte cryopreservation

– More practical

• Offers flexibility for use with sperm of choice
• Lower cost and logistically easier

– Limitations:

• Less long-term data

– Short-term data with no increased risk of chromosomal

• r congenital anomalies
• Lower success rates

– Lab-dependent cryopreservation skills/techniques – No data on egg quality so difficult to estimate subsequent success rates

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Egg freezing process and timeline

Fertility Preservation Program

1 3 5 7 9

FSH+LH

hCG trigger Egg Retrieval

11 13 Days

• The procedure is typically completed within 2

weeks

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Fertility Preservation Program

Frequent monitoring visits

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Fertility Preservation Program

Egg retrieval with US guidance

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Fertility Preservation: Risks

• No association with subsequent ovarian or breast

malignancies

• Stimulation and procedure-related risks include:

– Ovarian hyperstimulation syndrome (OHSS) – Ovarian torsion – Bleeding – Infection – Injury to adjacent organs

• Symptoms

– Most common: bloating, cramping, headaches – Less common: nausea, mood swings, breast tenderness

Fertility Preservation Program

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Success rates

What are the expected chances of live birth from frozen eggs? How many eggs should I freeze?

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Predicting likelihood of live birth

• Goldman et al., Human Reproduction 2017:

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Goldman et al., 2017

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Decision regret and satisfaction after elective egg freezing

Surveyed 201 women after elective egg cryo

• 167 (83%)

reported increased control over reproductive planning

• 33 (16%)

experienced mod-severe regret

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Greenwood et al. 2018

Increased regret associated with:

• Lower number
• f eggs

cryopreserved

• Perceived

lower adequacy of information and emotional support

Greenwood et al., ASRM 2018

“It felt like a huge cloud that had been hanging over my head had been lifted.” “The process helped me evaluate what I really want in life.” “Just before egg freezing, I was considering marrying a man I knew I did not love because he wanted to have children soon and I knew he would be a sufficient father” “The process of freezing my eggs made me realize that I wanted a baby more than I wanted a partner, and I decided to have a baby on my own.” “I feel more worried now about my fertility than before. The process gives you a lot of information about your fertility- sometimes that information will be great, sometimes not great.” “It was extremely emotionally draining and I felt very lonely with a lack of support.”

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Summary

• A woman’s egg quantity and quality decline with

increasing age

• Egg freezing offers women the opportunity to

preserve fertility for medical or elective reasons

• Egg freezing is a safe, non-experimental

procedure that is typically completed within 2 weeks

• There may be emotional hazards and “false

hope” associated with elective egg cryo

• The decision to freeze or not freeze should be

tailored to the patient’s individual clinical and personal situation

Thank you