This was presented during the Insight 17' event - Coimbatore / India (October 2017). Some questions were discussed concerning the Social Egg Freezing: 1. Why?; 2. Is it effective?; 3. Is it cost-effective?; 4. When it should be done? ; 5. Are the women the same in different countries?

1. MOBILE
BEST DATA PLANLorem Ipsum has two main statistical methodologies are used in data analysis which
summarizes data from a sample using indexes Tempor mediocrem imperdiet no usu,
tractatos salutatus ut est. Eu vel detraxit laboramus. Cu nam unum liber audiam.
Fertility Preservation inAddressing
Woman’s Biological Clock and
Decreasing fertility
Matheus Roque
ORIGEN – Centro de Medicina Reprodutiva -
BRAZIL
INSIGHT’17
Coimbatore
INDIA
28-29 Oct - 2017

2. WOMAN’S
Biological
Clock

3. FERTILITY
PRESERVATION
THE REAL LIFE …

4. 41 years old
Single
AMH 0.9 ng/mL

5. 41 years old (2014)
Single
AMH 0.9 ng/mL
June / 2014: 3 mature oocytes vitrified
September / 2014: + 3 oocytes vitrified
FERTILITY PRESERVATION
Should I freeze my eggs?
Fertility preservation in addressing women’s biological clock and decreasing fertility

6. 41 years old
Single
With 6 vitrified oocytes – 2014
FERTILITY PRESERVATION
Should I freeze my eggs?
Fertility preservation in addressing women’s biological clock and decreasing fertility

7. 41 years old
Single
With 6 vitrified oocytes – 2014
FERTILITY PRESERVATION ???
FERTILITY PRESERVATION
Should I freeze my eggs?
Fertility preservation in addressing women’s biological clock and decreasing fertility
OOCYTE CRYOPRESERVATION
Should I freeze my eggs?

8. 41 years old
Single
With 6 vitrified oocytes - 2014
2017 – 44 years old
Amenorrhea; AMH 0.1
OOCYTE CRYOPRESERVATION
Should I freeze my eggs?
Fertility preservation in addressing women’s biological clock and decreasing fertility

9. 41 years old
Single
2014 - With 6 vitrified oocytes
2017 – ICSI with sperm bank
TWINS
OOCYTE CRYOPRESERVATION
Should I freeze my eggs?
Fertility preservation in addressing women’s biological clock and decreasing fertility

10. Presentation Goals
Why?
Is it effective?
Is it cost-effective?
When it should be done?
Are the women the same in different
countries?

11. OOCYTE CRYOPRESERVATION
Fertility preservation in addressing women’s biological clock and decreasing fertility

12. WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

13. WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

14. WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fleming et al., Fertil Steril 2012
NGF
Non-growing follicles
Fertility preservation in addressing women’s biological clock and decreasing fertility

15. Faddy et al., Hum Reprod 1992; Cortvrint et al., Fertil Steril 2001
Birth
Optimal
Fertility
Decreased
Fertility
End of
Fertility
Irregular
menses
0 18 33 36 40 5127
Number of
follicles
1000
10000
100000
1000000
Pathological / Iatrogenic
WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

16. Pathological Iathrogenic
- Surgery
- Drugs – oncological / non-
oncological treatment
WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

17. 70% 60% 50% 30% 15%
Ata et al., Reprod Biomed Online 2012
Even with a good ovarian reserve,
there is an important increase in
aneuploidy rates with advanced
maternal age
WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

18. WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE
Fertility preservation in addressing women’s biological clock and decreasing fertility

19. Fertility preservation in addressing women’s biological clock and decreasing fertility
WHY OOCYTE CRYOPRESERVATION ?
OVARIAN RESERVE and OOCYTE QUALITY
Natural conception at a
relative early age
OOCYTE
CRYOPRESERVATION

20. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Trends of Elective Fertility Preservation
% Elective Fertility Preservation vs. Total number of oocyte vitrification

21. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective?

22. OOCYTE CRYOPRESERVATION
Is it effective?
Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al, Fertil Steril 2015

23. OOCYTE CRYOPRESERVATION
Is it effective?
Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al, Fertil Steril 2015
0
10
20
30
40
50
60
70
80
90
100
6 months 6-12 months 12-18 months 18-24 months 24-36 months 36-48 months 48-60 months
39.7 37.9 38.1 38.4 35.6 36
100
%
IMPLANTATION RATE ACCORDING TO STORAGE TIME
Implantation Rate

24. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al, Fertil Steril 2015
OOCYTE CRYOPRESERVATION
Is it effective?
35
36
37
38
39
40
41
42
43
44
45
46
Implantation Rate OPR / ET OPR / cycle LBR / donation
cycle
39
45.3
39.9
39.1
%
Clinical outcomes cryopreserved oocytes - ovum donation
Clinical outcomes cryopreserved oocytes - ovum donation

25. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al, Fertil Steril 2015
OOCYTE CRYOPRESERVATION
Is it effective?
0
10
20
30
40
50
60
70
80
90
100
5 10 12 15 20 25 30 35 40 43
6.1
39.4
53.5
67.5
80.5
85.4 89.9
94.8 95.5 97.3
%
Cumulative live birth rate according to the number of oocytes
consumed
No. of consumed oocytes

26. Fertility preservation in addressing women’s biological clock and decreasing fertility
The arguments against allowing this
application of the technology are not
convincing
ESHERE Task Force, Hum Reprod 2012
OOCYTE CRYOPRESERVATION
Is it effective?

27. Fertility preservation in addressing women’s biological clock and decreasing fertility
Oocyte vitrification and thawing should no
longer be considered experimental
ASRM, Fertil Steril 2013
OOCYTE CRYOPRESERVATION
Is it effective?

28. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?

29. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?
No. of oocytes according to women’s age

30. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al, Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?
0
10
20
30
40
50
60
70
80
90
Survival Rate Embryo transfer
rate / patient
Implantation Rate Ongoing pregnancy
rate / patient
85.2 85.4
35.9
25
%
Clinical outcomes cryopreserved oocytes – elective cryopreservation
Clinical outcomes - Mean age at Fertility Preservation 37.2 years old

31. Fertility preservation in addressing women’s biological clock and decreasing fertility
Doyle et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?

32. Fertility preservation in addressing women’s biological clock and decreasing fertility
Doyle et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?
0
10
20
30
40
50
60
70
80
Fertilization Rate IR CPR / Transfer LBR / transfer cycle
69.5
41.2
54.4
38.6
71.7
35.4
45.1
36
%
Clinical Outcomes – autologous ICSI cycles with vitrified vs fresh
oocytes
Vitrified Oocytes (n=128) - 34.9 years Fresh Oocytes (n=2963) - 35.5 years

33. Fertility preservation in addressing women’s biological clock and decreasing fertility
Doyle et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
Is it effective?
Predicted probability of having at least one, two, and three
children

34. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective? YES
Is it cost-effective?

35. Fertility preservation in addressing women’s biological clock and decreasing fertility
Hirshfeld-Cytron et al., Fertil Steril 2012
OOCYTE CRYOPRESERVATION
Is it cost-effective?

36. Fertility preservation in addressing women’s biological clock and decreasing fertility
Hirshfeld-Cytron et al., Fertil Steril 2012
OOCYTE CRYOPRESERVATION
Is it cost-effective?
Oocyte cryopreservation is not cost-effective for
healthy women planning delayed childbearing

37. Fertility preservation in addressing women’s biological clock and decreasing fertility
Hirshfeld-Cytron et al., Fertil Steril 2012
OOCYTE CRYOPRESERVATION
Is it cost-effective?
Oocyte cryopreservation is not cost-effective for
healthy women planning delayed childbearing
*oocyte cryopreservation at age 25

38. Fertility preservation in addressing women’s biological clock and decreasing fertility
Devineet al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
Is it cost-effective?

39. Fertility preservation in addressing women’s biological clock and decreasing fertility
Devine et al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
Is it cost-effective?

40. Fertility preservation in addressing women’s biological clock and decreasing fertility
Devine et al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
Is it cost-effective?
Oocyte cryopreservation at age 25

41. Fertility preservation in addressing women’s biological clock and decreasing fertility
Van Loendersloot et al., Hum reprod 2012
OOCYTE CRYOPRESERVATION
Is it cost-effective?

42. Fertility preservation in addressing women’s biological clock and decreasing fertility
OOCYTE CRYOPRESERVATION
Is it cost-effective?
Van Loendersloot et al., Hum reprod 2012

43. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective? YES
Is it cost-effective? Controversial; probably
YES
When it should be done?

44. Fertility preservation in addressing women’s biological clock and decreasing fertility
Mesen et al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
When it should be done?

45. Fertility preservation in addressing women’s biological clock and decreasing fertility
Mesen et al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
When it should be done?

46. Fertility preservation in addressing women’s biological clock and decreasing fertility
Mesen et al., Fertil Steril 2015
OOCYTE CRYOPRESERVATION
When it should be done?

47. Fertility preservation in addressing women’s biological clock and decreasing fertility
Cobo et al., Fertil Steril 2016
OOCYTE CRYOPRESERVATION
When it should be done?
<= 35y
>= 36y

48. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective? YES
Is it cost-effective? Controversial; probably
YES
When it should be done? < 35-37 years old

49. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective? YES
Is it cost-effective? Controversial; probably
YES
When it should be done? < 35-37 years old
Are there differences in different ethinicity?

50. Fertility preservation in addressing women’s biological clock and decreasing fertility
Iglesias et al., Fertil Steril 2014
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

51. Fertility preservation in addressing women’s biological clock and decreasing fertility
Iglesias et al., Fertil Steril 2014
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

52. Fertility preservation in addressing women’s biological clock and decreasing fertility
Iglesias et al., Fertil Steril 2014
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

53. Fertility preservation in addressing women’s biological clock and decreasing fertility
Iglesias et al., Fertil Steril 2014
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

54. Fertility preservation in addressing women’s biological clock and decreasing fertility
Iglesias et al., Fertil Steril 2014
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?
Total gonadotropin (IU) 2,420  840 2,910  902 <.001
INDIAN WOMEN: 6-year advancement in ovarian aging
Sub-optimal response

55. Fertility preservation in addressing women’s biological clock and decreasing fertility
Maalouf et al., BJOG 2016
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?
United Kingdom (UK) Database
2000 to 2010: 38,709 women
Live birth rate and the effect of ethnicity

56. Fertility preservation in addressing women’s biological clock and decreasing fertility
Maalouf et al., BJOG 2016
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

57. If true biologic differences exist, they may profoundly affect
patient counseling and the adaptation of COS protocols to
biologic age rather than chronologic age
Iglesias et al., 2014
Fertility preservation in addressing women’s biological clock and decreasing fertility
Maalouf et al., BJOG 2016
OOCYTE CRYOPRESERVATION
Are there differences in different ethinicity?

58. Presentation Goals
Why? Decrease in ovarian reserve and egg
quality
Is it effective? YES
Is it cost-effective? Controversial; probably
YES
When it should be done? < 35-37 years old
Are there differences in different ethinicity?
Probably YES

59. Fertility preservation in addressing women’s biological clock and decreasing fertility
Is this the perfect strategy to make sure a
woman will delivery a baby in the future ???
OOCYTE CRYOPRESEVATION
But so far, this is the BEST strategy to
increase the chances of delivering a baby
with own oocytes in the future

60. TAKE –HOME MESSAGES
OOCYTE CRYOPRESERVATION
Oocyte vitrification should not be considered as experimental
It is not the guarantee of future pregnancy, but can really
increase the chance
Adequate information / avoid raising false hopes
The final decision is not ours but the patient's
The women should be advised about Oocyte
Cryopreservation

61. Corpo Clínico:
Marcello Valle
Selmo Geber
Marcos Sampaio
Matheus Roque
Rodolfo Salvato
Alessandra Kostolias
Rafaela Batisti
Mauro Bellece
Monique Ubaldo
Ana Carolina Iacob
Rodrigo Abud
Nilson Lama
Françoise Padula
Thank you!
matheusroque@origen.com.br
pt.slideshare.net/MatheusRoque1
Laboratório:
Brunna Vaz
Lucas Nazareth
Ana Carolina Pontes
Thaiza
Psicologia:
Sheila Veloso
Enfermagem:
Karla Santiago
Adriana Janotti
Thais Bastos
Joana Paes
Marcelle
Nutrição:
Camilla Estima