Elective Oocyte Cryopreservation Research Articles

Knowledge, Attitudes, and Perceptions of Women of Reproductive Age Regarding Fertility and Elective Oocyte Cryopreservation: A Study from the Al-Qassim Region.

Oocyte cryopreservation is used for fertility preservation, medical reasons, and social reasons to overcome physiological decline in fertility with age. There was no research to find the knowledge, attitude, and perception of women regarding oocyte cryopreservation in our region. This study thus aimed to investigate the knowledge, attitudes, and perceptions of women of reproductive age in Al-Qassim, Saudi Arabia, regarding fertility and elective oocyte cryopreservation. An Arabic-language online survey was conducted over six months targeting women aged 18-45 years in the Al-Qassim region. A total of 612 participants completed the questionnaire, which covered topics such as reproductive aspirations, knowledge of fertility, knowledge of elective oocyte cryopreservation, and concerns regarding fertility preservation. Data analysis was performed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). The majority of participants (47.1%) wereaged 18-25 years. Participants' perceptions towards fertility preservation and social egg freezing were mixed, indicating varying levels of awareness about fertility issues. A statistically significant relationship was found between education level and knowledge of oocyte cryopreservation (p-value=0.004). Women with higher education levels (bachelor's, master's, and PhD degrees) demonstrated significantly greater knowledge(p-value=0.004) about oocyte cryopreservation compared to those with lower education levels. The study highlights the influence of educational attainment on knowledge of oocyte cryopreservation. These findings align with broader trends in health education, suggesting that higher educational attainment correlates with betterfertility health literacy. Enhancingfertility health literacy through educational programs may lead to more proactive health behaviours and betterawareness about available assisted reproductive technologies.

Understanding the Strengths and Limitations of Online Oocyte Cryopreservation Calculators.

Between 2010 and 2016, elective oocyte cryopreservation (OC) increased in use by 880% in the United States; however, there have been increasing reports of regret among patients after elective OC. There is a growing need for individualized counseling on the timing and number of oocytes to cryopreserve for patients to make informed choices and set realistic expectations, but currently available tools seem to be insufficient. The purpose of this review is to describe the OC calculators currently available online, identify sources of regret, and illustrate the need for unified counseling tools for improved patient care and education. OC calculators were identified via Google search. Only calculators that cite scientific literature were included in the review. Calculators for in vitro fertilization or embryo transfer were excluded. Thirteen OC calculators were found; however, only six cited literature supporting the calculator's design. When entering the same hypothetical patient parameters for age and number of oocytes cryopreserved, the calculators provided drastically different probabilities of live births. The lack of cohesive online educational materials creates confusion and stress for patients considering OC, leading to unrealistic expectations and increased feelings of regret thereafter. Physicians need tools to provide comprehensive guidance to patients seeking to cryopreserve oocytes.

O-074 Dual trigger is not superior to GnRH Agonist alone for final oocyte maturation in elective fertility preservation. A Randomized Controlled Trial

Abstract Study question Is Dual trigger for final oocyte maturation associated with a higher number of mature (MII) oocytes compared to GnRH-a trigger alone in elective fertility preservation? Summary answer Adding hCG to GnRH-a for triggering final oocyte maturation does not increase the number of MII oocytes in elective fertility preservation cycles. What is known already Triggering final oocyte maturation represents a key step in ovarian stimulation. In good prognosis patients undergoing oocyte cryopreservation, the current standard approach involves the administration of a single bolus of GnRH-agonist 36 hours before the pick-up. Previous studies have shown a higher number of MII oocytes when Dual Trigger (hCG+ GnRH-a) is performed, compared to recombinant human chorionic gonadotropin (rhCG) alone. Nevertheless, a notable gap exists in the literature, as no studies have investigated the potential additional benefit in final oocyte maturation when dual trigger is compared to GnRH-a alone. Study design, size, duration This is a randomized controlled superiority trial including elective oocyte cryopreservation cycles performed in a University Hospital. A total of 109 women were enrolled in this study between October 2021 to April 2023 with a 1:1 allocation. Eligible patients were ≤40 years old, with an antral follicular count (AFC)<20 and anti-Mullerian hormone (AMH)≤3ng/ml. Patients were randomized to final oocyte maturation triggering with Triptorelin 0,2mg or a dual trigger (Triptorelin 0.2 mg + 250 ug rhCG). Participants/materials, setting, methods Controlled ovarian stimulation was performed using 225-300IU/day of rFSH alfa or beta, or equivalent rFSH delta (15-20μg), tailored to ovarian reserve and BMI. LH surge was suppressed through a progestin-primed ovarian stimulation (PPOS) protocol, with oral administration of micronized progesterone (200mg daily) from the beginning of ovarian stimulation until the trigger day. The primary outcome was the number of MII oocytes. Comparisons are presented as estimated mean difference (EMD) and corresponding 90% confidence interval (CI). Main results and the role of chance Overall, 104 patients were analyzed, 51 in the Dual trigger group and 53 in the control arm (GnRH-a). We found no statistically significant differences in the number of retrieved oocytes comparing Dual Trigger group (8.71 ± 4.90) and GnRH-a group (9.51 ± 5.19). Similarly, the number of MII oocytes demonstrated no significant differences, with 6.86 ± 4.40 in the Dual Trigger group compared to 7.87±4.40 in the GnRH-a group (EMD -1.01 [90%CI: -2.44;0.43]). Exploring the hormonal profile there were no notable variations in estradiol levels (2064.60 ± 890.50 pg/ml vs. 2494.41 ± 1341.05 pg/ml), progesterone levels (7.78 ± 3.88 ng/ml vs. 8.94 ± 5.10 ng/ml), LH (56.28 ± 26.83 IU/L vs. 63.41 ± 32.50 IU/L), and FSH (31.14 ± 7.86 IU/L vs. 31.53 ± 9.89 IU/L) on the day following the trigger. Notably, neither group exhibited any case of Ovarian Hyperstimulation Syndrome (OHSS). Limitations, reasons for caution The sample size was calculated to detect differences on the number of MII oocytes. Therefore, results for secondary outcomes (number of oocytes retrieved and hormonal profile) should be interpreted with caution. Wider implications of the findings Adding hCG to GnRH-a for triggering final oocyte maturation does not confer any additional benefits in elective fertility preservation in term of MII oocytes compared to the administration of GnRH-a alone. Trial registration number NCT04992468

Awareness, Attitude, and Fertility Desire in Elective Oocyte Cryopreservation of Adults in Four Areas of China.

Controversy exists on whether or not elective oocyte cryopreservation (eOC) can be conducted in public hospitals in China. Policymakers should take into account the benefits and risks in the Chinese population. This study explored basic data concerning the awareness, attitudes of eOC, and fertility desire of eOC in China to offer evidence for policy making. A total of 442 people in four areas of China responded to a survey. The questionnaire was divided into three parts: awareness, attitude, and fertility desire of eOC. Descriptive analysis and multivariable regression analysis were used in the study. Generally, the respondents had a positive or neutral attitude towards eOC. However, about 90% of respondents did not know the cost of eOC. In general, a more positive attitude was found towards eOC among participants who had heard of the procedure compared with those who had not. Most women did not desire to reproduce by eOC. After adjusting for access to information, we found that female, older age groups, and singles were more likely to have increased awareness than their counterparts. The awareness of participants who accessed information from any source had a higher relative probability of having good awareness levels compared to participants who had not accessed the information. Undergraduates exhibited significantly higher levels of cognitive understanding, as indicated by their increased familiarity and comprehension, compared to high school students (relative risk ratio = 1.44, confidence interval = 0.48,4.29). Continued discussion is needed regarding the ethical, legal, and social aspects of performing eOC in public hospitals. Furthermore, policies are needed to regulate eOC to protect the reproductive freedom of healthy women.

Follicular challenge test to predict suboptimal response to gonadotropin releasing hormone agonist trigger in elective oocyte cryopreservation cycles

This prospective study aimed to test the ability of follicular GnRH agonist challenge test (FACT) to predict suboptimal response to GnRH agonist trigger, assessed by LH levels post ovulation trigger in non-medical oocyte cryopreservation program. The study included 91 women that underwent non-medical fertility preservation. On day two to menstrual cycle, blood tests were drawn (basal Estradiol, basal FSH, basal LH, Progesterone) and ultrasound (US) was performed. On that evening, the women were instructed to inject 0.2 mg GnRH agonist (FACT) and arrive for repeated blood workup 10–12 h later in the next morning, followed by a flexible antagonist protocol. LH levels on the morning after ovulation trigger were compared to FACT LH levels. The results demonstrated that LH levels following agonist ovulation trigger below 15IU/L occurred in 1.09% of cycles and were predicted by FACT, r = 0.57, p < 0.001. ROC analysis demonstrated that FACT LH > 42.70 IU/L would predict LH post trigger of more than 30 IU/L with 75% sensitivity and 70% specificity, AUC = 0.81. LH levels post trigger also displayed significant positive correlation to basal FSH (r = 0.35, p = 0.002) and basal LH (r = 0.54, p < 0.001). LH levels post ovulation trigger were not associated with total oocytes number or maturity rate. The strongest correlation to the number of frozen oocytes was progesterone levels post agonist trigger (r = 0.746, p < 0.001). We concluded that suboptimal response to agonist trigger, as assessed by post trigger LH levels was a rare event. FACT could serve as an adjunct pre-trigger, intracycle tool to predict adequate LH levels elevation after agonist ovulation trigger. Future studies should focus on optimization of agonist trigger efficacy assessment and prediction, especially in high responders.

Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman.

This study aimed to (1) determine differences in depression, anxiety, body image, quality-of-life (QOL), and decision regret scale (DRS) scores in transgender individuals undergoing fertility preservation (FP) compared to those who decline and (2) determine if DRS score following FP varies between transgender individuals and cisgender women. Sixteen transgender birth-assigned (BA) females and 13 BA males, undergoing FP consultation at an academic center between January 2016 and November 2019, were compared to each other and cisgender cohorts with pre-existing data: 201 women undergoing elective oocyte cryopreservation (EOC) between 2012 and 2016 and 44 women with cancer undergoing FP between 1993 and 2007. Outcomes included demographics; validated scales for depression, anxiety, body image, QOL (see below) in the trans cohort; DRS score in all three cohorts. Of 29 transgender individuals participating, 10 BA females (62%) and 12 BA males (92%) underwent FP. Beck Depression Inventory II, Hospital Anxiety and Depression Scale, Body Image Scale for Transsexuals, Satisfaction with Life Scale, Short Form Health Survey-36, and DRS scores were not significantly different between trans individuals who underwent FP and those who declined. On univariate modeling, regret was significantly lower in transpeople undergoing FP compared to those who did not (OR 0.118, p = 0.03). BA female and BA male transpatients undergoing FP reported DRS median scores 5 (mean 9) and 7.5 (mean 15), respectively, both were not significantly different from cisgender women (p = 0.97, p = 0.25) nor from each other (p = 0.43). Depression, anxiety, body image, and QOL, in a group of individuals presenting for FP consultation, appear similar between transpeople undergoing FP and not, while regret is significantly lower in those choosing FP. FP is an option for transgender individuals without significant differences in regret compared to cisgender women.

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.

What are the knowledge, perceptions and attitudes towards fertility and elective oocyte cryopreservation (OC) for age-related fertility decline (ARFD) in women in the UK? Awareness of OC for ARFD has reportedly improved compared to studies carried out almost a decade ago, but inconsistencies in knowledge remain regarding the rate of miscarriage amongst specific age groups, the financial costs and optimal age to undergo OC for ARFD. The age of first-time motherhood has increased amongst western societies, with many women of reproductive age underestimating the impact of age on fertility. Further understanding of women's awareness of their fertility, the options available to preserve it and the barriers for seeking treatment earlier are required in order to prevent the risk of involuntary childlessness. A hyperlink to a cross-sectional survey was posted on social media (Instagram) between 25 February 2021 and 11 March 2021. Women from the general population aged 18-50 years were invited to complete the survey. In total, 5482 women fulfilled the inclusion criteria and completed the survey. The mean age of participants was 35.0 years (SD 10.25; range 16-52). Three quarters (74.1%; n = 4055) disagreed or strongly disagreed they felt well informed regarding the options available to preserve their fertility, in case of a health-related problem or ARFD. The majority overestimated the risk of miscarriage in women aged ≥30 years old, with 14.5% correctly answering 20%, but underestimated the risks in women ≥40, as 20.1% correctly answered 40-50%. Three quarters (73.2%; n = 4007) reported an awareness of OC for ARFD and 65.8% (n = 3605) reported that they would consider undergoing the procedure. The number of women who considered OC for ARFD across age groups were as follows: 18-25 (8.3%; n = 300), 26-30 (35.8%; n = 1289), 31-35 (45.9%; n = 1654), 36-40 (9.6%; n = 347), 41-45 (0.3%; n = 13), and 46-50 (0.1%; n = 2). The majority of women (81.3%; n = 4443) underestimated the cost of a single cycle of OC for ARFD (<£5000). Furthermore, 10.4% (n = 566) believed a single cycle would be adequate enough to retrieve sufficient oocytes for cryopreservation. Approximately 11.0% (n = 599) believed OC for ARFD may pose significant health risks and affect future fertility. Less than half agreed or strongly agreed that the lack of awareness regarding OC for ARFD has impacted the likelihood of pursuing this method of fertility preservation further (41.4%; n = 2259). Results from cross-sectional studies are limited as interpretations made are merely associations and not of causal relationships. The online nature of participant recruitment is subject to selection bias, considering women with access to social media are often from higher socioeconomic and education backgrounds, thus limiting generalizability of the findings. Further education regarding the financial costs and optimal age to undergo elective OC to increase the chances of successful livebirth are required. Clinicians should encourage earlier fertility counselling to ensure that OC is deemed a preventative measure of ARFD, rather than an ultimate recourse to saving declining fertility. No funding was required for this article. There are no conflicts of interests to declare. N/A.

P-398 Elective Oocyte Cryopreservation – a viable alternative as a means of fertility preservation

Abstract Study question What are the trends in women accessing elective oocyte cryopreservation (EOC) across a multi-site clinic in Sydney, Australia, thaw rates, utilisation and live birth rates Summary answer Over 9 years, there was a significant increase in women having EOC. 2.7% returned to use. Oocyte thaw survival rates were 89.5% with LBR 35.5%. What is known already Data from Australia/New Zealand and USA demonstrated a 3 to 8-fold increase in EOC cycles, with a reduction in mean age of women accessing treatment. &amp;lt;5% of women returned to use their frozen gametes and live birth rates were better in women aged &amp;lt; 35 years. HFEA data demonstrated the use of frozen oocytes did not appear to increase risk of adverse perinatal outcomes. Research has shown that almost half of the women who returned to use their frozen oocytes used donor sperm with an overall LBR of 20.9%. 91% of women had no regrets over their decision for EOC. Study design, size, duration This was a retrospective cohort study performed at a multi-site large private fertility clinic in Sydney, Australia. This clinic was the first in Sydney to offer EOC to women. All women accessing EOC from 2014 – September 2022 were included. Ethics approval was obtained. Participants/materials, setting, methods Data was collected from women undergoing EOC; including demographic information, controlled ovarian stimulation parameters, return to use, oocyte thaw survival rates, source of sperm used for fertilization, embryo biopsy rates, aneuploidy rates, as well as pregnancy rates. Main results and the role of chance There was a 17.5-fold increase in cycles of EOC over the 8-year study period; with a reduction in average age from 38.13 to 35.85 years. Overall the mean age was 36.6 of the 2278 women who underwent EOC, of which 30% were aged &amp;gt;38 years. The mean oocyte yield was 8.85. Of the 62 (2.7%) women who returned to use their frozen oocytes, 54.8% were &amp;lt; 38 years of age. Oocyte thaw survival rates were 89.5%. The majority of women who returned to use their frozen oocytes, used donor sperm for conception. Fertilization rates with intra-cytoplasmic sperm injection (ICSI) was 65.3%; with 8.3% of oocytes degenerating post ICSI. 41.6% of embryos developed into blastocysts with 27.8% utilization rate (good quality blastocyst formation rate). Overall LBR was 35.5% for all women. Clinical pregnancy rates (CPR) from warmed oocytes were 46.2% from women aged &amp;lt;38 years old and 22.2% from women &amp;gt;38 years old. Of women who returned for a frozen embryo transfer, LBR was 25%; all occurring in women who froze their oocytes prior to age 38. Limitations, reasons for caution In parallel to international studies, very few women returned to use their oocytes; results need to be interpreted with care when counselling women considering EOC. Lifestyle factors were unable to be accounted for. Most women have opted to continue storing and not dispose/donate their oocytes at the time of publication. Wider implications of the findings EOC proves to be a viable and useful option for fertility preservation. Due to the small proportion of women who return to use their oocytes; and paucity of data; it would be prudent to improve standardisation of data collection and outcome measure reporting. Trial registration number Not Applicable

O-081 A 10-year follow-up of reproductive outcomes in women returning after elective oocyte cryopreservation

Abstract Study question What are the reproductive treatment outcomes in women who underwent elective oocyte cryopreservation (EOC) returning to our clinic with a desire for a child? Summary answer Whether to warm oocytes or to first use fresh oocytes for ART depends on age upon returning, but both strategies resulted in favourable reproductive outcomes. What is known already Most affluent countries have observed a trend towards postponement of childbearing, and EOC is increasingly used in an attempt to extend the reproductive lifespan and mitigate age-related fertility decline. Although most follow-up studies after EOC have focused on women who requested oocyte warming, a substantial proportion of women who do not conceive naturally eventually embark for a fertility treatment without using their cryopreserved oocytes. Reports on reproductive outcomes in past EOC users are scarce, and the lack of reproductive treatment algorithms in this group of women hampers efficiency of clinical practice. Study design, size, duration This retrospective observational single-center study includes 843 women who had elective oocyte vitrification for non-medical reasons between 2009 and 2019, and describes the outcomes of the diverse reproductive treatment strategies that were performed in these women when they returned to the same clinic because of a desire for pregnancy until May 2022. Participants/materials, setting, methods Patient characteristics and data of ovarian stimulation of EOC cycles were analyzed, as well as data related to ovarian stimulation and laboratory data of ART in women who pursued fertility treatment with and/or without using their cryopreserved oocytes. The primary outcome was the live birth rate (LBR) per patient after oocyte warming and after ART using fresh oocytes. Secondary outcomes were laboratory outcomes and LBR per embryo transfer. Main results and the role of chance A total of 1353 EOC cycles (1.6 ± 0.9 per patient) were performed. Mean age was 36.5 ± 2.8 years. At the time of EOC 174 (20,6%) women had a partner. On average, 13.7 ± 9.2 mature oocytes were cryopreserved. After 39.9 ± 23.4 months, 231 (27.4%) women returned to the clinic. Upon returning, mean age was 40.4 ± 3.1 years, mean AMH 2.3 ± 2.0 ng/mL, and 150/231 (64,9%) patients had a partner. As a primary approach, 110/231 (47.6 %) past EOC women embarked on oocyte warming, 50/231 (21.6%) had intrauterine insemination, and 71/231 (30.7%) had ART using fresh oocytes. Cumulative LBR (CLBR) was 45.9 % (106/231) and miscarriage rate (MR) was 30.7% (51/166) in the entire cohort. A subset of 90/231 (39.0%) patients exclusively had oocyte warming, at 41.6 ± 3.0 years, with 10.0 ± 5.2 oocytes warmed per patient. 52/231 (22.5%) patients exclusively had ART using fresh oocytes, at a mean age of 39.0 ± 2.8 years, with 9.9 ± 7.4 mature oocytes retrieved per patient. CLBR was 37/90 (41.1%) in the oocyte warming-only group and 25/52 (48.1%) in the OS-only group. MR/transfer was 25.0% and 29.3% in the oocyte warming-only group and the OS-only group, respectively. Limitations, reasons for caution Both the small sample size and the retrospective design are limitations of this study. The decision to embark on a specific reproductive treatment strategy was based on patient preference, after counseling of treatment options. This precludes direct comparison of the efficacy of reproductive treatment options in past EOC users. Wider implications of the findings Reporting of clinical outcomes of women who underwent EOC and returned to the clinic to embark on divergent reproductive treatment strategies is mandatory to establish guidelines for best clinical practice in this growing patient population. Trial registration number Not applicable

O-038 Is a 10-year retention period sufficient after elective oocyte vitrification (EOV)?

Abstract Study question In Belgium, by law, a retention period of 10-years is standard. Is this period sufficient for women to return to the clinic and use their vitrified oocytes? Summary answer A standard cryopreservation period of 10-years seems sufficient since half of the women returned to the fertility clinic and 96% used the vitrified oocytes. What is known already The main driver for elective oocyte cryopreservation is to buy more time to find a suitable partner. The question remains whether 10 years of cryopreservation is sufficient for women to accomplish their goal of finding a partner and procreate with or without using their vitrified oocytes. The return rates and the utilisation rates of the vitrified oocytes reported in the literature are low. Most women do not use their vitrified oocytes. Little is known about women's reproductive pathways after EOV and the destination of the expired surplus vitrified oocytes. Study design, size, duration Computerized clinical data were retrieved from a pioneer cohort of women who underwent EOV in our centre for age-related reasons more than 10 years ago (between 2009 and 2012). Hence, the legal cryopreservation period of their oocytes expired between 2019 and 2022. We documented reproductive choices for those who returned to the centre and we investigated the intended destination of the expired vitrified oocytes for those who did not return. Participants/materials, setting, methods Data were collected from clinical charts of women who vitrified oocytes. According to Belgian law, unused vitrified oocytes expire when reaching the age limit of 48 years for use or by reaching the standard cryopreservation period of 10 years. We evaluated whether women eventually started treatment, assessed their relational status, the utilisation rate of the vitrified oocytes and the intended destination of the vitrified oocytes as stated in their informed consents. Main results and the role of chance 117 women vitrified their oocytes at least 10 years ago. Women's oocyte cryopreservation period expired because they were either beyond the age limit for use (n = 82) or because the legal oocyte cryopreservation period of 10 years was reached (n = 35). Five women requested transport of their oocytes for treatment in a centre abroad. Fifty-two out of 117 women (44.4%) returned for assisted reproduction. Eventually, 96% (50/52) of them used their vitrified oocytes for treatment and 21/50 had a child or ongoing pregnancy. Upon return to the clinic, 22 women were single and 27 had found a partner, two women returned with a co-parent and one woman had a female partner. Furthermore, 7/117 women returned to the clinic but eventually refrained from treatment. Fifty-one women never returned to the centre. Only five women asked to prolong the cryopreservation period for medical reasons. The others not using their vitrified oocytes, did not initiate further action concerning the cryopreservation period, use or destination of their stored oocytes. Hence, the destination of the cryopreserved oocytes was according to the women's choice stated in the informed consent. The majority donated their oocytes for research (60%), others (31%) opted to destroy the oocytes after 10 years of cryopreservation. Limitations, reasons for caution It was not possible to map out the reproductive pathway of women who did not return to the centre and whose vitrified oocytes expired for use. Follow-up of reproductive choices and outcomes in women who did not return for treatment is required for a comprehensive appraisal of EOV. Wider implications of the findings The vast majority of the women who returned for treatment used their vitrified oocytes. Those not returning did not initiate further action concerning the use or destination of their vitrified oocytes. These results add to our knowledge on the utilisation rate after EOV, essential to improve counselling of future EOV-candidates. Trial registration number not applicable

An exploratory study of motivations for elective oocyte cryopreservation.

Oocyte vitrification is a scientific advance that has changed the reproductive perspective of human society. This procedure has been offered as an alternative to the voluntary postponement of pregnancy, giving women a new perspective on their reproductive autonomy. The number of women who consult and then choose to freeze oocytes has increased almost exponentially in Chile and throughout the world. There is little knowledge about the motivation, experience, and results of elective oocyte cryopreservation in Chile. The objective was to know the motivation, experience, and future reproductive desire of the women who underwent this technique. Cross-sectional descriptive study based on a questionnaire sent by e-mail in which females who had previously undergone elective oocyte cryopreservation between January 2011 and December 2019 at Clínica Alemana, Santiago, Chile, participated. Of 342 women who had completed a cycle of elective oocyte cryopreservation, 193 agreed to participate, and of these, 98 (51%) answered the survey satisfactorily. Women who underwent this procedure for medical indication, including endometriosis, cancer, and low ovarian reserve, were excluded. The most frequent reason for the procedure was age (44%). Concerning the procedure: 94% do not regret having it done, and 74% of the women believe that they will use their oocytes at some point in their lives. Finally, from the time of oocyte cryopreservation to date, 11% of the surveyed women have used their vitrified oocytes, and 27% have become pregnant. Women who undergo elective oocyte cryopreservation for social reasons are mainly women without a partner whose main motivation is their reproductive age. The vast majority do not regret doing so.

Vitrification with Dimethyl Sulfoxide Induces Transcriptomic Alteration of Gene and Transposable Element Expression in Immature Human Oocytes.

Despite substantial advancements in the field of cryobiology, oocyte and embryo cryopreservation still compromise developmental competence. Furthermore, dimethyl sulfoxide (DMSO), one of the most commonly used cryoprotectants, has been found to exert potent effects on the epigenetic landscape of cultured human cells, as well as mouse oocytes and embryos. Little is known about its impact on human oocytes. Additionally, few studies investigate the effects of DMSO on transposable elements (TE), the control of which is essential for the maintenance of genomic instability. The objective of this study was to investigate the impact of vitrification with DMSO-containing cryoprotectant on the transcriptome, including on TEs, of human oocytes. Twenty-four oocytes at the GV stage were donated by four healthy women undergoing elective oocyte cryopreservation. Oocytes were paired such that half from each patient were vitrified with DMSO-containing cryoprotectant (Vitrified Cohort), while the other half were snap frozen in phosphate buffer, unexposed to DMSO (Non-Vitrified Cohort). All oocytes underwent RNA sequencing via a method with high fidelity for single cell analysis, and which allows for the analysis of TE expression through Switching Mechanism at the 5'-end of the RNA Transcript sequencing 2 (SMARTseq2), followed by functional enrichment analysis. Of the 27,837 genes identified by SMARTseq2, 7331 (26.3%) were differentially expressed (p < 0.05). There was a significant dysregulation of genes involved in chromatin and histone modification. Mitochondrial function, as well as the Wnt, insulin, mTOR, HIPPO, and MAPK signaling pathways were also altered. The expression of TEs was positively correlated with the expression of PIWIL2, DNMT3A, and DNMT3B, and negatively correlated with age. These findings suggest that the current standard process of oocyte vitrification, involving DMSO-containing cryoprotectant, induces significant transcriptome changes, including those involving TEs.

Egg freezing for social reasons: con

ASRM 2013, current position: Data on the safety, efficacy, cost-effectiveness, and emotional risks of elective oocyte cryopreservation are insufficient to recommend elective oocyte cryopreservation.

"The Future of Elective Oocyte Cryopreservation in Extending Women’s Reproductive Potential"

"The Future of Elective Oocyte Cryopreservation in Extending Women’s Reproductive Potential"

Oocyte Cryopreservation for Medical and Planned Indications: A Practical Guide and Overview.

Oocyte cryopreservation (OC) is the process in which ovarian follicles are stimulated, the follicular fluid is retrieved, and mature oocytes are isolated and vitrified. Since the first successful pregnancy utilizing previously cryopreserved oocytes in 1986, OC has become increasingly utilized as an option for future biologic children in patients facing gonadotoxic therapies, such as for the treatment of cancer. Planned OC, also termed elective OC, is growing in popularity as a means to circumvent age-related fertility decline. In this narrative review, we describe both medically indicated and planned OC, focusing on the physiology of ovarian follicular loss, OC technique and risks, timing of when OC should be performed, associated financial considerations, and outcomes.

Oocyte vitrification for oncological and social reasons.

The aim of this review is to present information related to oocyte cryopreservation, and particularly oocyte vitrification, performed to preserve fertility in oncologic and social indications. The success rates of oocyte cryopreservation have increased with the widespread use of the vitrification technique and are currently similar to those of in vitro fertilization performed with fresh oocytes. Vitrification is the most successful technique for oocyte cryopreservation. The most important factors that influence the success rate are the patient's age at the time of vitrification and the number of mature oocytes frozen. Thus, live birth rates differ for each age depending on the number of oocytes thawed and the freezing method. The American Society of Reproductive Medicine and the American Society of Clinical Oncology recommend presenting the option of oocyte cryopreservation for fertility preservation in cancer patients. Besides cancer patients, use of oocyte vitrification is increasing in women who wish to postpone pregnancy age and to have reproductive freedom with the development of the cryopreservation technique and the achievement of pregnancy rates similar to the use of fresh oocytes. Patients are provided consultancy service in terms of indication, the success rates by age, and the total number of oocytes frozen. It should be emphasized that this procedure is not a type of insurance policy for fertility, especially in elective oocyte cryopreservation.

Outcomes of Fertility Preservation for Female Cancer Patients in a Single Tertiary Center.

To report our experience of fertility preservation (FP) in female cancer patients. We retrospectively analyzed the medical records of female who underwent elective oocyte or embryo cryopreservation before cancer treatment between January 2015 and December 2020 at Asan Medical Center. We analyzed the type of cancer, the rate of reuse of cryopreserved oocytes or embryos, and fertility outcomes such as the resumption of menstruation or pregnancy. A total of 174 patients underwent 182 oocyte retrieval cycles after controlled ovarian stimulation for oocyte or embryo cryopreservation. The median age of patients was 33.0 (range 19-46) years, and the patients were most unmarried female (65.52%). The majority of patients were diagnosed with breast cancer (78.16%), and the remaining were diagnosed with gastrointestinal (6.33%) and hematologic malignancies (5.75%). The maturation rate of oocyte cryopreservation was 83.33%, and the fertilization rate of embryo cryopreservation was 72.07%. Of the 57 patients currently not undergoing cancer treatment, 34 resumed menstruating and 19 (33.33%, 19/57) returned to attempt a pregnancy. Among them, five patients succeeded in natural pregnancy. Eleven patients received frozen-thawed embryo transfer, and four patients succeeded in becoming pregnant (36.36%, 4/11). Only 6.3% of patients returned to use their gametes, and 93.7% of gametes are still in storage. FP in cancer patients should be considered before cancer treatment. Through continuous research on oncofertility, it is necessary to consider how to increase the return rate and provide appropriate information to cancer patients of reproductive age.

OVARIAN RESPONSE AND ANTI-MULLERIAN HORMONE IN FERTILITY PRESERVATION VERSUS ELECTIVE OOCYTE CRYOPRESERVATION CYCLES: A SOCIETY FOR ASSISTED REPRODUCTIVE TECHNOLOGY REGISTRY STUDY OF 10,040 CYCLES

The relationship between anti-Mullerian hormone (AMH) and response to controlled ovarian hyperstimulation (COH) is well established, however, it is unknown whether this relationship is preserved in cancer patients. Thus, we investigated the association between ovarian response and AMH for medically indicated fertility preservation (FP) and elective oocyte cryopreservation (OC) cycles.

Elective Oocyte Cryopreservation: What Patients Understand and What They Need to Understand

Life circumstances, including not having a partner, may prevent women from having children during their most fertile years. To avoid age-related infertility women who plan to have children at an age when their fertility is likely to have declined can freeze their eggs when they are younger and use them in an assisted reproductive technology (ART) procedure when the time for childbearing is right for them. Research shows that a significant proportion of young women would consider safeguarding their reproductive potential or are at least open to the idea of oocyte freezing. To make informed decisions about fertility preservation women need accurate and realistic information about the likelihood of a live birth considering their circumstances; the cost of retrieval, storage, and later use of the eggs; the known and potential risks of the procedure for the woman herself and any future children; and the potential emotional risks of elective oocyte cryopreservation. In this presentation I will suggest how clinics can ensure women have all the information they need to make the best possible decision they can about if and when to freeze their eggs.

Reproductive outcomes from ten years of elective oocyte cryopreservation

Research questionTo assess the relationship between the number of oocytes retrieved during elective oocyte cryopreservation (EOC) cycles with various clinical, biochemical, and radiological markers, including age, body mass index (BMI), baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥ 12 mm on the day of trigger. To also report the reproductive outcomes from women who underwent EOC.MethodsA retrospective cohort of 373 women embarking on EOC and autologous oocyte thaw cycles between 2008 and 2018 from a single London clinic in the United Kingdom.Results483 stimulation cycles were undertaken amongst 373 women. The median (range) age at cryopreservation was 38 (26–47) years old. The median numbers of oocytes retrieved per cycle was 8 (0–37) and the median total oocytes cryopreserved per woman was 8 (0–45). BMI, E2 level and number of follicles ≥ 12 mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed there was no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. Thirty six women returned to use their cryopreserved oocytes, of which there were 41 autologous oocyte thaw cycles undertaken. There were 12 successful livebirths achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths were achieved in women who underwent EOC ≥ 40 years old, and 82% of all livebirths were achieved in women who had done so between 36 and 39 years old.ConclusionClinical, biochemical and radiological markers can predict oocyte yield in EOC cycles. Reproductive outcomes are more favourable when cryopreservation is performed before the age of 36, with lower success rates of livebirth observed in women aged 40 years and above.