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Fertility Physicians of Northern California Egg Freezing 20121203
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Fertility Physicians of Northern California Egg Freezing 20121203

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Summary of pros and cons of egg freezing, effectiveness for fertility preservation

Summary of pros and cons of egg freezing, effectiveness for fertility preservation

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  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012 Information about natural fertility rates associated with aging is difficult to determine today due to widespread use of contraception and limits on family size. In this compilation of data from 1600-1930 in women who used no form of contraception, a clear age-related decline in fertility was noted. Among women who were aged 40 or older when first married, nearly two-thirds were unable to ever have a child, a percentage much higher than for women who were younger when they married.
  • FPNC (c) 2012 The rate of pregnancy loss after clinical documentation of pregnancy also increases with age. In this study of 201 infertility patients undergoing ovulation induction (excluding women who had 2 or more miscarriages in the past), 20% of pregnancies miscarried after documentation of cardiac activity in women aged 40 or older, compared with a less than 5% rate of loss for women who are aged 35 or less. This high rate of miscarriage in older women is likely due to a higher incidence of aneuploidy in the embryos.
  • FPNC (c) 2012 Abnormalities in the oocyte associated with aging are the most likely explanation for the increased rate of chromosomally abnormal livebirths noted with advancing maternal age. The rate of chromosomal abnormalities is even higher at amniocentesis.
  • FPNC (c) 2012 Modest decreases in pregnancy rate were associated with advancing age of the male partner in this review. Significant changes were seen later for men than have been noted in women. There is no age at which a man cannot father a child. Given all of these findings, it can be concluded that age-related infertility is largely a problem that can be attributed to a decline in female fertility. It is unlikely that increasing age of the male partner explains much of the age-related decrease in fertility noted for women.
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012 (c) FPNC 2010 - IVF Seminar
  • FPNC (c) 2012 (c) FPNC 2010 - IVF Seminar
  • FPNC (c) 2012
  • FPNC (c) 2012
  • FPNC (c) 2012

Fertility Physicians of Northern California Egg Freezing 20121203 Fertility Physicians of Northern California Egg Freezing 20121203 Presentation Transcript

  • Egg FreezingCan it Stop Your Biological Clock? FPNC (c) 2012
  • Agenda Update on egg freezing The process How age impacts fertility The success rates The pros & cons Best options Your questions FPNC (c) 2012
  • Egg Freezing Before Considered experimental treatment Not enough data to determine the outcome for children born from frozen eggs Pregnancy rates after IVF using slow-frozen oocytes have traditionally been poor – IR/Egg thawed 4.6% (Boldt, April 2005) ASRM says not to be offered for fertility preservation FPNC (c) 2012
  • Egg Freezing Now No longer considered experimental treatment Data suggest children born from frozen eggs are fine Pregnancy rates seem similar to those of IVF ASRM: Still not officially recommended for “social” fertility preservation, due to limited data FPNC (c) 2012
  • The Process of Egg Freezing FPNC (c) 2012
  • Egg Freezing – Gathering the Eggs (Egg Freezing A.K.A Oocyte Cryopreservation or “OC”) Basically the first part of an IVF cycle Stimulate multiple egg production with injectable hormones Measure progress of stimulation with blood samples and transvaginal ultrasounds Extract eggs from the ovaries (light IV sedation, needle extraction through vaginal wall) FPNC (c) 2012
  • Egg Freezing – Freezing & Storage Freeze (cryopreservation) using Vitrification technique Store eggs in computer controlled tanks Storage estimated to be safe for about 10 years; perhaps indefinitely FPNC (c) 2012
  • Egg Freezing – Fertilizing the Eggs Thaw eggs Effects of freezing and thawing require ICSI for fertilization Embryology lab monitors embryo progress Embryo transferred to uterus via catheter Pregnancy test in 2 weeks ICSI (Intracytoplasmic Sperm Injection) FPNC (c) 2012
  • Can Egg Freezing Insure AgainstAge-Related Infertility? FPNC (c) 2012
  • Effects of Age on Female Fertility:Chance of Conceiving Each Month 22 20 18 16 14 12 % 10 8 6 4 2 0 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 Age FPNC (c) 2012
  • Percentage Of Recently Married Couples Who Delivered A Living Child By Age Of Marriage – Ten Populations 1600-1930 100 94 91 85 80 70 Percent 60 40 48 36 43 40 35 20 17 0 4 20-24 25-29 30-34 35-39 40-44 45-49 Age Group Eventually Pregnant Pregnant The First Year FPNC (c) 2012Adapted using data from Menken J. Science. 1986; 23:1389.
  • Spontaneous Abortion FollowingDocumentation Of Fetal Cardiac Activity Percent Spontaneous Abortion 30 20 20 15 10 4 0 0 <31 31-35 36-39 >39 AgeKE Smith. F&S. 1996; 65:35 FPNC (c) 2012
  • Maternal Age And ChromosomalAbnormalities (Live Births) Age Risk 20 1/526 25 1/476 30 1/384 35 1/204 40 1/65 45 1/20Table adapted from Obstetrics: normal and problem pregnancies, thirdedition. Edited by SG Gabbe, JR Niebyl, JL Simpson.Churchill Livingstone, NY, NY. 1996, data from page 221. (c) 2012 FPNC
  • Increased Female Age Contributes to: Lower rates of conception Higher rates of miscarriage Higher rates of chromosomal abnormalities FPNC (c) 2012
  • Success Rates with Frozen Eggsare Age Dependent Success rates with oocyte cryopreservation via either slow-freeze or vitrification appear to decline with maternal age This is consistent with the clinical experience with fresh oocytes FPNC (c) 2012
  • (BTW, Male Fertility Declineswith Age Too)  Instudies controlling for female age, men older than 50 have pregnancy rates 23-38% lower than men under age 30. Kidd SA. Fert Steril. 2001; 75:237.  Some studies suggest a correlation between advancing male age and increasing miscarriage rates. FPNC (c) 2012
  • The Pros and Cons of EggFreezing FPNC (c) 2012
  • Egg Freezing – Considered Safe Considered very safe with proper monitoring by specialist (reproductive endocrinologist) Possibly some discomfort, bloating during stimulation Mild to Moderate ovarian hyperstimulation – ~8.5% (ASRM 2008), monitoring helps avoid this Less than 1% experience any serious complications, such as: – Severe ovarian hyperstimulation – Intraperitoneal bleeding – Ovarian torsion – Ruptured ovarian cyst – Infection FPNC (c) 2012
  • Egg Freezing – Considered SafeA study of 200 infants born from 165 vitrified oocyte pregnancies revealed no difference in birth weight or congenital anomalies among those born from vitrified oocytes compared to children conceived after fresh IVF. FPNC (c) 2012
  • Egg Freezing – Considered Safe A recent review of over 900 live births derived from cryopreserved oocytes, principally using slow-freeze, suggests there is no increased risk of congenital anomalies compared to the general US population. Only about 1500 babies born worldwide from frozen eggs – development of children must be studied further to determine true outcomes FPNC (c) 2012
  • Egg Freezing – Challenges Not all eggs survive the freezing or thawing – Eggs have high water content – Freezing can damage the cell membrane – Vitrification (rapid freezing) has reduced this problem – Requires high concentrations of cryoprotectant Not all eggs will be likely to fertilize Not all transplanted embryos will continue to develop FPNC (c) 2012
  • Egg Freezing – Challenges Delayed pregnancy (40s) – Patients in their 40s have a higher chance of complications More difficult for frozen eggs to fertilize; ICSI required ICSI may not deter transmission of genetic abnormalities from sperm Not enough data about storing frozen eggs FPNC (c) 2012
  • Egg Freezing – Cost Efficient? Costs are similar to IVF: – $9,850 for medical care and lab services – Another $2,000-$6,000 for medication – Long term cryopreservation about $600/year Eggfreezing for “social” reasons is not covered by insurance FPNC (c) 2012
  • Drawbacks to Egg Freezing No guarantee that fertility is safeguarded May require several cycles to obtain enough eggs for best chances Short and long-term costs Estimated that most women will never use their frozen eggs May increase the number of much older parents FPNC (c) 2012
  • In Support of Egg Freezing Offers some control over reproductive destiny Can provide women ‘a backup plan’ Younger eggs have lower rates of abnormalities Considered as safe as IVF Estimated success rates similar to IVF FPNC (c) 2012
  • Success Rates for Egg Freezing FPNC (c) 2012
  • ART Pregnancy Rates Using Fresh Eggs 70 60 50 Percent 40 30 20 10 0 5 7 26 30 32 34 36 42 44 46 28 38 40 <2 >4 Patient AgeArt Cycles Live Births National Data Own Eggs Donor Eggs FPNC (c) 2012 Per Transfer CDC 2006
  • Egg Freezing – Success Rates Slow freezing – 2-10% per embryo transferred Vitrification – data suggest that: – 85% will survive thawing – Success rates similar to IVF  45% pregnancy rate if eggs frozen before age 36  More data needed to determine with certainty “There is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh oocytes when vitrified/warmed oocytes are used as part of IVF/ICSI in young infertility patients and oocyte donors.” (ASRM 2012) FPNC (c) 2012
  • FPNC 2010 Ongoing Pregnancy perEmbryo Transfer Procedure PER PROCEDURE2010 Ongoing Pregnancy per <35 35-37 38-40 41-42Embryo Transfer Procedure Years Years Years YearsFresh IVF with Own Eggs(n=323) 44% 34% 34% 28%Frozen Embryo Transfer (FET)with Own Eggs (n=148) 41% 37% 36% 2/11Fresh IVF with Donor Eggs All Ages(n=29) 55% This data showing ongoing pregnancy rates is not final, and has not yet been reported to SART/CDC. Final “Live Birth” rates will be reported when the outcomes for all ongoing pregnancies are known. FPNC (c) 2012
  • Egg Freezing – Success Rates Best chance of success for one pregnancy: – Women under 35 – 20 eggs frozen (may require multiple cycles) – Still, NO guarantee of successful thaw, fertilization, implantation, or live birth FPNC (c) 2012
  • Your Options Timelyand natural conception Frozen eggs IVF Frozen embryos Donor eggs FPNC (c) 2012
  • Can ART Make Up For Babies Lost ByDelaying Attempts to Conceive?Begins Pregnant Not ART TotalAttempt % Preg PregnantAt Age30 91 9 - 9135 82 18 4 8640 57 43 7 64Assume attempt 4 yr if <35, 3 yr if 35-40, 2 yr if >40;2 cycles of IVF Leridon. Hum Reprod 2004;19(7):1548-53. FPNC (c) 2012
  • Best Defense Against Infertility:Follow a Healthy Lifestyle Maintain a healthy diet and weight Moderate, regular exercise Prenatal vitamins Minimize caffeine Avoid smoking and alcohol Avoid / treat sexually transmitted diseases FPNC (c) 2012
  • Key Messages Prevent infertility by appropriate life choices Plan your career AND your family Don’t wait for perfection—there is never a perfect time to start a family Test your ovarian reserve Seek expert help if any risk factors are present Know the facts about your reproductive life FPNC (c) 2012
  • We appreciate your feedback.Please use the evaluation form to shareyour thoughts with us. Thank you! Questions & Answers FPNC (c) 2012