Fertility preservation in addressing women's biological clock and decreasing fertility
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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?
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Fertility preservation in addressing women's biological clock and decreasing fertility
- 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
- 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