Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion

Patient attitudes towards the use of autologous cryopreserved embryos for fertility treatment

Adenuga OS et al., 2017 · Fertility and Sterility

To evaluate couples’ perceptions of frozen embryos and their effect on fertility treatment decision making. Longitudinal, prospective, qualitative interview study of couples. Members of 37 couples participated in up to 6 semi-structured interviews over 12 months after scheduling an initial consultation with an infertility specialist (IS) - either a reproductive endocrinologist or urologist. Patients and their partners were interviewed separately by trained independent interviewers and were asked about their views on autologous cryopreservation at one-week and 12-months post consult. This is a secondary analysis of the interview data. Facilitated by NVivo analysis software, we categorized each participant’s comments into four categories and provide illustrative quotes for each. An exploratory study using qualitative data, this work was intended to generate hypotheses and inform future research directions rather than to make statistical comparisons. Initially, many participants expressed that they had no strong feelings regarding the use of autologous cryopreserved embryos, often admitting that they were unaware of what they were, but some participants did express strictly positive, strictly negative, or both positive and negative views (Table). At 12 months, more patients and their partners were familiar with the concept, and more participants discussed specific risks and benefits associated with freezing embryos and their storage. Those who opposed cryopreservation often cited moral or religious objections, but very few had strong enough negative views about embryo disposition to deter them from considering IVF as a treatment option. For most, other considerations, especially finances, were the primary barrier to pursuing IVF. Most patients and partners did not have strong views about autologous cryopreserved embryos after an initial appointment with an IS. At 12 months, stronger attitudes were apparent, but very few had strong enough negative views about embryo disposition to deter them from considering IVF as a treatment option.

Disclosure of experience with oocyte cryopreservation

Miller SJ et al., 2014 · The virtual mentor : VM

Planned oocyte cryopreservation: a systematic review and meta-regression analysis

Hirsch A et al., 2024 · Human Reproduction Update

Awareness of the age-related decline in fertility potential has increased the popularity of planned oocyte cryopreservation (POC). However, data regarding outcomes of POC, including rates of women returning to thaw oocytes, as well as pregnancy and live birth rates, are scarce and based mostly on small case series. POC was defined as cryopreservation exclusively for prevention of future age-related fertility loss. The primary outcome was live birth rate per patient. The secondary outcomes included the return to thaw rate and laboratory outcomes. A meta-regression analysis examining the association between live birth and age above 40 or below 35 was conducted. We conducted a systematic database search from inception to August 2022. The search included PubMed (MEDLINE) and EMBASE. Our search strategies employed a combination of index terms (Mesh) and free text words to compile relevant concepts. The systematic review and meta-regression were undertaken following registration of systematic review (PROSPERO registration number CRD42022361791) and were reported following guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 (PRISMA 2020). The database search yielded 3847 records. After the selection process, 10 studies, conducted from 1999 to 2020, were included. Overall, 8750 women underwent POC, with a mean cryopreservation age of 37.2 (±0.8). Of those, 1517 women returned to use their oocytes with a return rate of 11.1% (± 4.7%). The mean age at the time of cryopreservation for women who returned to use their oocytes was 38.1 (±0.4), with an average of 12.6 (±3.6) cryopreserved oocytes per woman. In a meta-analysis, the oocyte survival rate was 78.5% with a 95% CI of 0.74-0.83 (I2 = 93%). The live birth rate per patient was 28% with a 95% CI of 0.24-0.33 (I2 = 92%). Overall, 447 live births were reported. In a sub-group analysis, women who underwent cryopreservation at age ≥40 achieved a live birth rate per patient of 19% (95% CI 0.13-0.29, I2 = 6%), while women aged ≤35 years old or younger had a higher live birth rate per patient of 52% (95% CI 0.41-0.63, I2 = 7%).

Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline

Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, 2021 · Fertility and sterility

To provide evidence-based recommendations to practicing physicians and others regarding the efficacy of oocyte cryopreservation (OC) for donor oocyte in vitro fertilization and planned OC. The American Society for Reproductive Medicine conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1986 to 2018. The American Society for Reproductive Medicine Practice Committee and a task force of experts used available evidence and through consensus developed evidence-based guideline recommendations. MAIN OUTCOME MEASURE(S): Outcomes of interest included live birth rate, clinical pregnancy rate, obstetrical and neonatal outcomes, and factors predicting reproductive outcomes. RESULT(S): The literature search identified 30 relevant studies to inform the evidence base for this guideline. RECOMMENDATION(S): Evidence-based recommendations were developed for predicting the likelihood of live births after planned OC, autologous OC in infertile women, and donor OC, as well as factors that may impact live birth rates. Recommendations were developed regarding neonatal outcomes after using fresh vs. cryopreserved oocytes in cases of autologous or donor oocytes. CONCLUSION(S): There is insufficient evidence to predict live birth rates after planned OC. On the basis of limited data, ongoing and live birth rates appear to be improved for women who undergo planned OC at a younger vs. older age. Although there are no significant differences in per transfer pregnancy rates with cryopreserved vs. fresh donor oocytes, there is insufficient evidence that the live birth rate is the same with vitrified vs. fresh donor oocytes. Neonatal outcomes appear similar with cryopreserved oocytes compared with fresh oocytes. Future studies that compare cumulative live birth rates are needed.