social egg freezing

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ELECTIVE EGG FREEZING
WITHOUT MEDICAL
INDICATIONS
(SOCIAL EGG FREEZING)
Prof. Aboubakr
Elnashar
Benha university Hospital,
Egypt
ABOUBAKR ELNASHAR
8/7/2020
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CONTENTS
INTRODUCTION
1.GUIDELINES OF SCIENTIFIC SOCIETIES
2.EFFICACY
2.1 Optimal Timing
2.2 Optimal Number
3.SAFETY
4.USE OF STORED OOCYTES
5.COST EFFECTIVNESS ANALYSIS
CONCLUSION
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INTRODUCTION
 Oocyte cryopreservation
 Not an experimental technique.
 Evidence on the efficacy& safety
(ASRM& ESHRE , 2013)
 Oocyte cryopreservation to defer childbearing
 Has become a great popular strategy to preserve
female fertility potential.
 Chance to conceive having their own genetic
offspring in the future.
(Cobo et al, 2013) ABOUBAKR ELNASHAR
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 Advanced Maternal Age (AMA) infertility
What?
 Infertility after 35 y (Goossens et al, 2009).
Causes
1. Decrease quality of oocytes
{Increase in the rate of oocyte aneuploidy}
Most important
2. Decrease numbers of oocytes:
Decrease ovarian reserve
3. Increase in the miscarriage rate
ABOUBAKR ELNASHARABOUBAKR ELNASHAR

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 Age related infertility.
 Female fertility
 decreases gradually
 significantly after age 32
 decline accelerates after age 35.
(Sozou et al, 2013)
 Causes
1. The decrease in follicular pool number& oocyte
quality
2. Higher risks of fetal chromosomal
abnormalities
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 Terminology: No agreement
 Social egg freezing
highlights the socioeconomic constraints leading
women to perform cryopreservation of oocytes
 Elective egg freezing:
acceptable by most women. (Mertes et al, 2012)
 Fertility preservation:
has been established in the context of gamete
cryopreservation for medical reasons.
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 Non medical egg freezing:
not appropriate
{decision to cryopreserve oocytes in order to protect
women against age related fertility decline is a
preventive medical treatment}.(Stoop et al2014)
 “AGE banking:
reflects the exact indication for the strategy of
anticipating gamete exhaustion.
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 Women who opt for oocyte cryopreservation are
commonly
 Caucasian
 Highly educated
 Middle class professional women
 In their mid to late 30s. (Baldwin et al, 2015)
 The most common reason to delay childbearing
 Lack of a partner
 Professional & financial issues.
Caucasoid, negroid, mongoloid
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 Austria, Malta& France
 Law forbidding oocyte cryopreservation for
non medical indications.
 except for egg donors with no children
 Few countries it is allowed
 Maximum age defines access to egg freezing
 Belgium (≤45 years)
 Denmark (<46 years)
 Germany (20 49 years). (ESHRE; 2017)
 No European countries fund social egg freezing.
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1. GUIDELINES OF SCIENTIFIC SOCIETIES
 ESHRE, 2012
 Adequate information for women interested in
postponing childbearing without false hopes.
 ASRM&SART, 2013
 should not be recommended in order to bypass the
age related fertility decline due to the absence of
data supporting
 safety, efficacy, ethics
 emotional risks
 cost effectivenessABOUBAKR ELNASHAR

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 ACOG, 2014
Endorsed the guideline of ASRM SART
 Canadian Fertility & Andrology Society (CFAS)2015
 The need to counsel women about their chances of
success.
 RCOG, 2018
 Caution because cryopreserved oocytes do not
guarantee a child in future
 In the UK, the length of cryostorage of oocytes for
non medical reasons is 10 y.
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2. EFFICACY OF SOCIAL EGG FREEZING
2. 1. Optimal timing to freeze oocytes
 Success rate of IVF using cryopreserved oocytes
declines rapidly as the age of a woman increases.
 Average ages to cryopreserve oocytes are between
36 & 38 years.
(Hammarberg et al, 2017)
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 Lack of agreement regarding the optimal timing of
oocyte cryopreservation.
 Before 35 y (Tsafrir et al, 2015)
 Before 36 y (Doyle et al, 2016)
 Before 37 y (Hammarberg et al, 2017)
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2. 2. Optimal number of oocytes to freeze
 A minimum of
 8 10 cryopreserved oocytes to obtain a realistic
chance to achieve a pregnancy
(Cobo et al, 2016)
 Probability of LBR
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 Mathematical model
 To predict the probability of live birth based on
1. Number of cryopreserved oocytes
2. Female age.
(Goldman et al, 2017)
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3. SAFETY OF “SOCIAL FREEZERS” AND
OFFSPRING
 Risks associated with oocyte cryopreservation
 Ovarian stimulation: OHSS
 Oocyte retrieval: minimal
 infection
 damage to organs
 blood loss
 ovarian torsion
(Gelbaya et al, 2010)
 IVF success outcomes or the euploidy rate.
 No effect of Long term cryopreservation of oocytes
(Goldman et al, 2015)
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 Pregnancy in older women: higher risk of
 Ectopic pregnancy
 Preeclampsia
 Gestational diabetes
 Preterm delivery& low birth weight.
(Liu et al, 2011)
Counseling of women cryopreserving oocytes,
regarding the potential risks of pregnancy at an
advanced age should be mandatory.
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 Obstetric & perinatal risks
 Oocyte cryopreservation does not seem to be a
harmful procedure. (Cobo et al, 2014)
 Children
 No studies as yet have reported long term follow up
of children born following oocyte cryopreservation.
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 Use of FET compared with children born to fertile
women, was associated with
 small but statistically significant increased risk of
childhood cancer
 This association was not found for the use of other
types of fertility treatment examined.
Childhood cancer
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 An elevated risk of childhood cancer
(14 cancer cases; hazard ratio, 2.43 [95% CI, 1.44 to 4.11]; incidence rate
difference, 26.9 [95% CI, 2.8 to 51.0] per 100 000),
 Leukemia
(5 cancer cases; incidence rate, 14.4 per 100 000; hazard ratio, 2.87
[95% CI, 1.19 to 6.93]; incidence rate difference, 10.1 [95% CI, -4.0 to
24.2] per 100 000)
 Sympathetic nervous system tumors
(<5 cancer cases; hazard ratio, 7.82 [95% CI, 2.47 to 24.70]).
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4. USE OF STORED OOCYTES
 Called the "usage rate“
 Represents a critical issue for egg freezing for
non medical indications.
 Only 50.8% of women who cryopreserved oocytes thought they would use their eggs in the
future.
(Stoop et al, 2015)
(Cobo et al, 2018)
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 Reasons for an elevated rate of non used stored
oocytes.
(Hammarberg et al, 2017)
1. Not wanting to be a single parent
2. Preferring to conceive naturally
3. Not wanting to use a sperm donor.
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5. COST EFFECTIVE ANALYSIS
 A crucial aspect to define procedure related benefits.
 Should take into account
 not only the economic point of view but also the
 psychological and
 sociological aspects
{ it is hard to estimate from a monetary standpoint}.
 Freezing gametes at an early reproductive age:
improve the chances of childbirth using own
gametes: reduce costs associated with infertility
TT
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 Limitations for cost effectiveness egg freezing.
(Ben‐Rafael, 2018)
1. Wide range of IVF costs worldwide
Since the costs of IVF differ between countries, the costs should be compared
as multiples of the cost of single IVF cycle for each country.
2. Realistic usage rate of cryopreserved oocytes.
 The likelihood of usage rate is quite low
 it is critical to know the realistic usage rate in order
to have a more accurate prediction.
3. The lack of real indications for egg banking
which are the basis of social freezing, is probably
the huge limitation for cost effectiveness, reflected
in a high societal cost.
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 Oocyte cryopreservation more cost effective if
 At least 61% of women who cryopreserved
oocytes at the age of 35 returned for IVF
 there was a willingness to pay €19,560 extra per
additional live birth.
(Van Loendersloot et al, 2011)
 Performed before the age of 38 and if more than
49% of those women, who did not achieve a
spontaneous pregnancy, returned to use their
cryopreserved oocytes.
(Devine et al, 2015) ABOUBAKR ELNASHAR
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 From this result, the theoretical rate to be
cost effective is not achieved even in the last
age group.
(Ben‐Rafael, 2018)
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CONCLUSION
1. The most common reason to delay childbearing
 Lack of a partner
 Professional & financial issues.
2. Oocyte cryopreservation
 Not an experimental technique.
3. Efficacy
 Optimal timing Before 35 y
 A minimum of 8 10 cryopreserved oocytes
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4. Safety
 The procedure seems to be safe
5. Usage rate is low 12%
6. Cost effectiveness: There is a limitations for
assessment
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