Abstract
With an upward trend in delaying parenthood, women across the world face an increasing risk of age-related infertility and involuntary childlessness. Elective oocyte banking strategies offer women the possibility to protect part of their reproductive potential until personal finances, personal relationship, or career have stabilized. Timely collection and cryopreservation of oocytes when they are most competent and chromosomal abnormality rates have not yet escalated are crucial for achieving high live births through in vitro fertilization (IVF) treatment at a later stage. To promote reproductive autonomy, women shall be informed about the decrease in fertility rates that sharply intensifies from the age of 35 years and the strategies available to maintain their reproductive potential. Together with this information, women should also recognize the limitations of available strategies including expected live birth rates, costs of the procedures, and overall approach performance, which is mainly associated with age at cryopreservation, number of oocytes banked, and age at accessing the banked oocytes. Evidence-based statistics are not yet available due to the relatively short period in which oocyte cryopreservation has been offered for elective purposes and the scarce number of patients returning for accessing their oocytes. However, to evaluate the applicability of fertility cryopreservation on a large scale, several theoretical models have been proposed to assess the expected efficacy and overall cost-effectiveness of different oocyte banking strategies. In this study, we review current oocyte cryopreservation methodologies, their applications, and outcomes. Moreover, we summarize current evidence regarding known parameters affecting oocyte banking efficacy. Finally, we discuss key points that could play a role in improving access to the service and optimization of oocyte banking frameworks.
Highlights
Social and financial causes are driving a progressive and concerning trend of reproductive delay in most affluent countries
Oocyte cryopreservation is an effective strategy to mitigate the consequences of age-related infertility, offering high chances of parenthood to women that have to delay childbearing for non-medical reasons including the achievement of a fulfilling personal relationship, financial stability, or determining career goals
If undertaken sufficiently early in life, oocyte banking provides an extremely high probability to result in live birth and, has high efficacy in extending the fertile lifespan of a woman
Summary
Social and financial causes are driving a progressive and concerning trend of reproductive delay in most affluent countries This is strongly shown by the increase in the average age of women carrying their first pregnancy, averaging at ∼29 years in Organisation for Economic Co-operation and Development (OECD) countries [1]. Poor oocyte quality, and a fast-increasing rate of aneuploidy in oocytes after the age of 35 years limit the efficacy of assisted reproduction in mature patients [7] These restrictions could be circumvented using gametes sourced from young donors, which have proven to lead to high clinical outcomes in advanced maternal age patients, suggesting that ovarian ageing and its associated processes are the main cause for the decline in IVF outcomes for older patients [8]. We are summarizing current evidence on the use of oocyte cryopreservation as a strategy to extend fertility potential
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