Elective oocyte cryopreservation for age-related fertility decline

Abstract

Purpose Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation. This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counselling. Methods A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives. Results Clinician-led counselling regarding reproductive aging and fertility preservation is often overlooked. Elective oocyte cryopreservation is not a guarantee of live birth, and the answer regarding cost-effectiveness needs to be individualized. The existing studies on obstetric and perinatal outcomes following the use of egg freezing are, until now, reassuring. Constant monitoring of short-term and long-term outcomes, uniform regulation and evidence-based, individualized counselling is of paramount importance. Conclusions Elective oocyte cryopreservation is one of the most controversial aspects of the world of assisted reproduction, and a lot of questions remain unanswered. However, women today do have this option which was not available in the past. Elective oocyte cryopreservation for age-related fertility decline should be incorporated in women’s reproductive options to ensure informed decisions and reproductive autonomy.

Vitrification within a nanoliter volume: oocyte and embryo cryopreservation within a 3D photopolymerized device

“…Such cryopreservation permits women of reproductive age with a cancer diagnosis to preserve their fertility prior to gonadotoxic therapies [ 4 , 5 ]. Additionally, it enables the preservation of gametes for social reasons or in response to a diagnosis of low ovarian reserve, thus maintaining fertility for future family expansion [ 6 ]. Furthermore, those undergoing IVF can cryopreserve surplus oocytes or embryos for future cycles without the need to undergo hormonal stimulation for oocyte retrieval [ 7 , 8 ].…”

Infertility in systemic lupus erythematosus: what rheumatologists need to know in a new age of assisted reproductive technology

“…In 2012, the Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology determined oocyte cryopreservation was no longer experimental 63 ; since then, rates of elective oocyte freezing have increased yearly. 64 Most centres recommend freezing before age 35 years when possible: the maternal age at freezing strongly affects likelihood of later successful embryo formation and successful pregnancy. However, studies suggest that women often underestimate the effect of age on future fertility.…”

‘It takes a village’ – fertility treatment using donor gametes, embryos and/or surrogacy

“…In turn, this leads to an increased risk of age-related infertility. 18 Congenital bilateral absence of the ovaries is rare. There are several underlying genetic conditions affecting ovarian development in females, including Turner syndrome.…”

“…Finding a partner later in life, or desiring financial or career security before seeking parenthood has led to an increase in women postponing efforts to conceive. In turn, this leads to an increased risk of age‐related infertility 18 …”