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SOCIAL
EGG
FREEZING
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Dr Sharda Jain
Dr Poorva Bhargava
Introduction
• Social egg freezing (oocyte cryopreservation for non-
medical reasons) has evolved as a proactive option
for women looking to extend their reproductive
possibilities past their peak childbearing years
• It is the process of saving or protecting eggs, or
reproductive tissues so that a person can use them to
have biological children in future
1.NIH : https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/fertilitypreservation
2.Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal
Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30. doi:10.7759/cureus.47956
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Introduction
Women may save their oocytes when their reproductive potential is at its highest and use them later in life
when the conditions are more favorable for motherhood.
An important transition from the conventional timetables set by biological clocks and society norms.
Women have the chance to have more control over their reproductive processes, which lessens time
demands and enables them to make more informed life decisions.
The emergence of this trend highlights the complex interactions between developments in medical
technology, shifting societal perceptions, and changing ideas about motherhood and gender
Inhorn MC, Birenbaum-Carmeli D: Assisted reproductive technologies and culture change . Annu Rev Anthropol. 2008, 37:177-96. Proprietary and confidential-do not distribute
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What do the statistics say?
• In the UK, a 460% increase in oocyte cryopreservation cycles has been reported between 2010
and 2016.
• Similarly, an 880% and a 507% increase between 2010 and 2015 have been reported in the USA
and Australia and New Zealand, respectively.
• Advancements in cryopreservation techniques like oocyte vitrification (or ultra-rapid freezing),
have led to remarkable improvements in the efficacy of oocyte cryopreservation, post-thaw
oocyte survival, fertilization, and pregnancy rates.
• Broad acceptability and applicability of this reproductive option is still very less !
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Teo, U.L.; Kakkar, P.; El-Toukhy, T. Current Perspectives on Social Oocyte Freezing. J. Obstet. Gynaecol. 2021, 42, 370–378.
ASRM. Mature oocyte cryopreservation: A guideline. American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. Fertil. Steril. 2013, 99, 37–43.
Johnston, M.; Richings, N.M.; Leung, A.; Sakkas, D.; Catt, S. A major increase in oocyte cryopreservation cycles in the USA, Australia and New Zealand since 2010 is highlighted by younger women but a need for standardized data collection. Hum. Reprod. 2021, 36, 624–
635.
Peate, M.; Sandhu, S.; Braat, S.; Hart, R.; Norman, R.; Parle, A.; Lew, R.; Hickey, M. Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol. Womens Health 2022, 18, 17455057221139673.
Potdar, N.; Gelbaya, T.A.; Nardo, L.G. Oocyte vitrification in the 21st century and post-warming fertility outcomes: A systematic review and meta-analysis. Reprod. Biomed. Online 2014, 29, 159–176.
The Human Fertilization and Embryology Authority (HFEA) in
the U.K. approved the use of frozen oocytes in 2000,
highlighting that using frozen eggs in infertility treatment is
sufficiently safe
In 2013, the American Society of Reproductive Medicine
(ASRM) Ethics Committee removed the experimental label
from planned oocyte cryopreservation
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Kakkar P, Geary J, Stockburger T, Kaffel A, Kopeika J, El-Toukhy T. Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review. J Clin Med. 2023;12(13):4182.
Published 2023 Jun 21. doi:10.3390/jcm12134182
Indications
for social
egg
freezing
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1. “Running out of time”
running out of time to find a
partner, and secondly running out of
time to conceive naturally
Ticking biological clock
Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
Age-related
decline
in
fertility
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and
confidential-do
not
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decline in pregnancy rates with advancing
maternal age
begins as early as age 32, and by age 45 years, as
many as 99 percent of women are infertile
In India ageing is 5 years early in good 50%
cycles that result in pregnancy among older
women are less likely to progress to live births
because of higher rates of aneuploidy,
miscarriage, and stillbirth in this population
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an, Tse Yeun & Lau, Matthew & Loh, Seong & Tan, Heng. (2014). Female ageing and reproductive outcome in assisted reproduction cycles. Singapore medical journal. 55. 305-9.
Comparison of the average number of oocytes collected per cycle among the various age groups
2. Lack of a suitable partner and fear of “panic partnering”
• Women need time before considering having a child
• Unsure about the potential longevity of their current partnership
• Want a clear idea about how they wanted to go about mothering, under what
circumstances; with whom and when
• a particular ideal of “proper” motherhood
• committed partner who had a strong desire to be a father and active in the woman’s
pregnancy and the upbringing of children
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Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
3. Fear of future regret and blame
fear of entering into parenthood with the
“wrong” male partner
fears that may one day experience
unwanted childlessness
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Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
4. Compromised fertility or health
endometriosis,
polycystic ovary syndrome,
blocked fallopian tubes,
the loss of an ovary from a previous illness,
perception of a risk of premature menopause or a diagnosis of a serious illness.
concern that fertility, or general health, may be compromised and that this would affect
the ability to conceive.
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Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
5. Critical events
a relationship breakdown,
a recent birthday,
a recent health scare, or
becoming aware for the first time about the efficacy of egg freezing early for older
women.
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Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
the media representation of social egg freezing portrays women as undertaking
this process because they have chosen to pursue their career and “delay”
motherhood.
6. The (in)significance of career
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Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173.
doi:10.1080/0167482X.2018.1460352
Medical dimensions of social
egg freezing
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Technological Advancements in Oocyte Cryopreservation
• The viability of thawed oocytes was impacted by traditional procedures
utilizing slow-freezing technology because the formation of ice crystals
frequently caused cellular damage.
• the development of vitrification, a quick-freezing method that avoids the
production of ice crystals, has significantly increased post-thaw survival
rates.
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Rienzi L, Cobo A, Paffoni A, et al.: Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study. Hum Reprod. 2012, 27:1606-12.
Cobo A, Kuwayama M, Pérez S, Ruiz A, Pellicer A, Remohí J: Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method. Fertil Steril. 2008, 89:1657-64.
Rienzi L, Romano S, Albricci L, et al.: Embryo development of fresh 'versus' vitrified metaphase II oocytes after ICSI: a prospective randomized sibling-oocyte study. Hum Reprod. 2010, 25:66-73.
Vitrification has a better chance of maintaining oocyte quality
and structural integrity .
Pre-freeze evaluation methods have also made improvements
in the selection of viable oocytes for freezing.
Now, it is possible to discriminate between oocytes with
optimum and inadequate developmental potential using
morphological and molecular criteria.
Improves not just the probability of oocyte survival post-thaw
but also the likelihood of conceiving successfully after
fertilization and implantation.
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Cobo A, Diaz C: Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011, 96:277-85.
Oocyte quality
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The woman’s age is a determining factor
in oocyte quality.
As age increases, there is a reduction in the
amount of adrenal androgenic hormones, with a
reduction in free circulating testosterone, which,
in turn, affects the levels of androgens in the
follicular fluid, favoring the reduction of
granulosa cells by the apoptosis´ process
01
Stress, regardless of the triggering
factor, is known to alter cortisol
levels, with a reduction in estradiol
biosynthesis by follicular cells,
resulting in a lower number and
worse quality of mature oocytes
02
Oocyte morphology
• An excellent oocyte morphology has a spherical
structure, surrounded by a uniform pellucid zone,
with a homogeneous and translucent cytoplasm,
free of inclusions, and with an appropriately sized
polar corpuscle
• Oxidative stress, caused by systemic disorders, is
responsible for stopping the cell cycle and
stimulating apoptosis in mature and immature
oocytes; however, immature oocytes seem to be
more susceptible to morphological changes such as
shrinkage, membrane defects, cytoplasmic
granulations and degeneration
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Improving oocyte quality
Given that many lifestyle conditions are responsible for changes to oocyte
quality and morphology, some habit changes should be encouraged.
Suspension of alcohol consumption during treatment is beneficial in
reproductive outcomes.
Smoking cessation for a period of 3 to 6 months seems to be beneficial
(Meldrum et al., 2016).
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Improving diet, choosing foods rich in antioxidants such as
pomegranate, chocolate, licorice, cumin, ginger, oregano, fruits,
vegetables and fish can all help reduce free radicals.
The use of antioxidant supplements such as vitamin C, vitamin E,
Zinc, Selenium, Omega 3 also seems to help balance the
oxidative process
All obese patients, but especially those with a BMI greater than or
equal to 35 kg/m2, should be encouraged to lose weight before
starting IVF cycles.
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Assessing Fertility Preservation Options
For women considering postponing motherhood, social egg freezing is a feasible
alternative alongside embryo freezing and ovarian tissue cryopreservation in
the range of fertility preservation techniques.
In order to develop embryos that may be frozen and kept, harvested oocytes
must be fertilized with sperm.
Ovarian tissue cryopreservation entails removing and freezing a piece of the
ovary that contains primordial follicles with the goal of reimplanting the tissue
in the future.
This approach is appropriate for people who may soon undergo fertility-
threatening treatments like chemotherapy.
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus.
2023;15(10):e47956. Published 2023 Oct 30.
Proprietary and confidential-do not distribute
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus.
2023;15(10):e47956. Published 2023 Oct 30.
• The choice of preservation technique is made after taking into
account
each individual's medical history,
marital situation, and
long-term family planning objectives.
• Women must be able to weigh the benefits and drawbacks of each
strategy in order to make judgments that are appropriate for their
particular situation.
Medical Eligibility and Screening
The follicle stimulating hormone (FSH), anti-müllerian hormone (AMH), and antral
follicle count (AFC) are three hormones that may be measured to determine the health
of the ovaries .
Women undertake tests to ascertain their ovarian reserve, which represents the
number and quality of their accessible eggs, before beginning social egg freezing.
To determine if a person is qualified for the procedure and to uncover any underlying
health issues that can compromise the effectiveness of the freezing and thawing
process, a thorough medical assessment is crucial.
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus.
2023;15(10):e47956. Published 2023 Oct 30.
Assessment of ovarian reserve
• In addition to age, assessment of markers of ovarian reserve, including AMH
concentration, antral follicle count, and day 3 FSH and E2 concentrations, can help
guide counseling.
• The best marker of egg quality is chronologic age,
• Age at the time of the procedure remains one of the most critical points of counseling.
• A cycle day 2 or 3 FSH >10 international units/l, E2 >80 pg/ml, or AMH <1 ng/ml
portends a poorer prognosis in terms of oocyte yield at the time of retrieval
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Scott RT Jr, Elkind-Hirsch KE, Styne-Gross A, et al. The predictive value for in vitro fertility delivery rates is greatly impacted by the method used to select the threshold between normal and elevated basal follicle-stimulating hormone. Fertil Steril 2008; 89:868.
• Early follicular phase follicle-stimulating hormone (FSH), estradiol and
inhibin B, anti-Müllerian hormone (AMH), and antral follicle count,
providing age-specific ranges that should ideally recognize early ovarian
depletion.
• However, due to wide variations across individuals, these tests provide
only partial sensitivity in discriminating the specific reproductive lifespan
of the patient.
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Poli M and Capalbo A (2021) Oocyte Cryopreservation at a Young Age Provides an Effective Strategy for Expanding Fertile Lifespan. Front. Reprod. Health 3:704283. doi: 10.3389/frph.2021.704283
• A thorough medical history is taken to uncover any existing illnesses or
prescription drugs that can influence the ovarian response to stimulation.
• Egg quality and quantity can be affected by conditions, including
polycystic ovarian syndrome (PCOS), endometriosis, and certain drugs.
• Candidates are put through testing to rule out infectious disorders that
may jeopardize the security of the freezing procedure for eggs.
• Human immunodeficiency virus, hepatitis B, and hepatitis C screens.
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• Additional tests include psychological tests to make sure that individuals
are psychologically prepared for the procedure and its potential results
due to the emotional and psychological effects of egg freezing.
• Comprehensive explanations from doctors gives women the ability to
make well-informed decisions about whether to move forward and
offers a chance to resolve any concerns.
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Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus.
2023;15(10):e47956. Published 2023 Oct 30.
• Clinicians create customized stimulation protocols to get the best
egg production based on the findings of the ovarian reserve
evaluation.
• Multiple follicles can be stimulated to grow and mature at
the same time using drugs such as gonadotropins.
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Prognosis-Fertility awareness
• For fertility preservation, the main prognostic factor for success rates is the age at egg
freezing.
• The best results are achieved if eggs are cryopreserved before 36 years of age according
to a metaanalysis .
• A woman wishing to become pregnant in her 40s with her own fresh eggs has a 6.6%
estimated success rate, but if she had frozen her eggs at the age of 30, the success rate
would jump to > 40% per transfer.
• However, most patients proceed with cryopreservation at the age of 36–39, with the
mean age at the time of freezing being 37–38 and 80% of patients being above 35
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Scientific evidence-outcomes of thaw cycles
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Kakkar P, Geary J, Stockburger T, Kaffel A, Kopeika J, El-Toukhy T. Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review. J Clin Med. 2023;12(13):4182.
Published 2023 Jun 21. doi:10.3390/jcm12134182
• Lack of Evidence
• Uncertain Outcomes
• Lower cost-effectiveness
• Unjustified/Misused Intent
• Unquantified Risk Vs Benefit ratios
• Unclear Recommendations from leading organizations
Social, ethical and legal issues
• Beneficence Value : Social egg preservation doesn’t meet the beneficence value compared to
the risks involved.
• Against Hippocratic oath: Egg social freezing is the application of medical techniques for non-
medical purposes, opposed to Hippocrates oath ("Primum non nocere").
• Risk of OHSS –due to repeated cycles of stimulation(since women prefer higher number of
oocyte preserved)
• Postoperative complications :Surgical risk of oocyte retrieval(bleeding/infection)
• Non-confirmed utility : Uncertainty that a women will eventually use her preserved egg in
future- chances of turning into medical waste.
Klemetti R, Sevon T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod. 2005;20(12):3293-300.
Bennett SJ, Waterstone JJ, Cheng WC, Parsons J. Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures. J Assist Reprod Genet. 1993;10(1):72-77.
Doyle JO, Richter KS, Lim J, Stillman RJ, Graham JR, Tucker MJ. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes
and age at retrieval. Fertil Steril. 2016;105(2):459-66
Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589.
Ethical issues
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Mertes and Penning G:
Investigated ethics and moral aspects of ART and social cryopreservation
Analogy : They compared oocyte freezing to preoperative autologous blood storage
for elective surgeries. They claimed that: "the basic structure in both situations is the
storage of body material to treat possible future health problems.“
They suggested: "Rather than viewing egg freezing as the alternative to reproducing
at a younger age, it should be viewed as the alternative to using a donor egg. From
this perspective, egg freezing becomes a form of preventive medicine".
Mertes H, Pennings G, Dondorp W, de Wert G. Implications of oocyte cryostorage for the practice of oocyte donation. Hum Reprod. 2012;27(10):2886-93
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• Chance of Medical Waste development?
A woman may not necessarily use their cryopreserved oocytes, many of these oocytes
stored in "oocyte banks" will never be used- Is it going to be commercialized??Is it going
to turn up as medical waste??
• Guarantee of a successful conception?
There are no guarantees. Preservation is a relatively new technology and the number of
children born as a result of this technique is still limited.
• What does the data say?
Follow-up data regarding any possible offspring health risks are still being collected and
long-term studies are not yet available. The probabilities to conceive from
cryopreservation had recently increased significantly, but the chances of conceiving
through natural reproduction at a relative early age are much higher
Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589.
Legal issues
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Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589.
Mohapatra S. Using Egg Freezing for Non-Medical Reasons: Fertility Insurance or False Hope? - Legal, Ethical, and Policy Considerations. SSRN Electronic Journal. 706-708.
• Commercialization
Given the very low success rates of cryopreservation for women in their 40s, the potential for commercial
exploitation undeniably exists.1
• High costs
Cryopreservation generally is not covered by insurance, unless fertility preservation is done due to disease
or cancer cases.2
• Altruistic Donation and Potential Exploitation:
Freeze and share’ arrangement as developed by a British fertility Center (The London Egg Bank) offered a
solution for the high cost. Under this arrangement selected women get free ovarian stimulation, harvesting
and one year storage in exchange for donating half of their oocytes to program another woman that can get
pregnant only with donated eggs. Arrangements of this type undermine the principle of altruistic donation
and risks commercialization.
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Richmann et al:
• Whether and under what conditions infertility should be regarded as a “disease” should be
defined.
• Modern societies had developed a series of new problems, one of which is the inability of
women to build a family during the best age for reproduction. Using fertility preservation
as a solution to that problem might deteriorate the problem further and will not resolve this
critical social issue
Is fertility preservation a way of seeking medical answer to a social problem??
Social issues
Richman K. Ethics and the metaphysics of medicine. Cambridge, Mass. MIT Press. 61-3
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• Cryopreservation would also encourage women to further postpone their pregnancies
and risk the adverse effects of high risk pregnancies in aged mothers.
• Harm to children caused by having older or even elderly parents, there is a great
difference between the misfortune of an early death of a young parent, and choosing
to set up a situation where there is an increased likelihood of a parent's death while
the child is still young .
Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J. 2016;20(4):833-42
O'Neill O. Autonomy and Trust in Bioethics. Cambridge: Cambridge University Press. J R Soc Med. 2002;95(8):423-4.
Cedars MI. Introduction: Childhood implications of parental aging. Fertil Steril. 2015;103(6):1379-80
Rooney B. Facebook, Apple pay to freeze employees' eggs. CNN Money. Retrieved 27 March 2016. Proprietary and confidential-do not distribute
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• Facebook and Apple made headlines by offering to give female employees $20,000 of
cryopreservation benefits. The significance of the Facebook and Apple offer is largely
symbolic but it brings social freezing to the center of public discussions.
• Raising false hopes-The technology is recent. Women should be made aware that the
chances of conceiving naturally within relatively early age is higher than conceiving with
cryopreserved oocyte.
ASRM - The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, (2013). Mature oocyt cryopreservation: a guideline. Asrm.org. Retrieved 27 March 2016.
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Fertility Preservation: the debate
In motion:
It is acceptable to state that oocytes degenerate and deteriorate just like any other organ in the human
body. If a treatment for brain deterioration/dementia is available, why not for infertility due to aging?
Fertility preservation can be termed as "preventive medicine” -The European Society of Human
Reproduction and Embryology declare (ESHRE) that fertility preservation for natural ovarian aging “cannot so
easily be dismissed as a non-healthrelated preference.”
If we consider risk of surgical complication, then they are equally present in –pregnancy termination, plastic
surgery, sterilization.
Harwood K. On the ethics of social egg freezing and fertility preservation for nonmedical reasons. 2015;(5):59-67.
Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, et al. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012;27(5):1231-7
Zhang L, Yan LY, Zhi X, Yan J, Qiao J. Female fertility: is it safe to "freeze?". Chin Med J (Engl). 2015;128(3):390-397. doi:10.4103/0366-6999.150115 Proprietary and confidential-do not distribute
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OHSS in oocyte retrieval can be prevented by using Gonadotropin Releasing
Hormone Agonist (GnRHa) instead of Human Chorionic Gonadotropins (hCG)
to trigger ovulation before egg retrieval.
Pregnancy rates following Oocyte cryopreservation have been reported to be
similar to the results of standard IVF treatments with fresh embryos and about
5000 babies were born from cryopreservation.
There are papers which provide reassuring evidence that pregnancies and
infants conceived following oocyte vitrification are not associated with
increased risk for chromosomal abnormalities.
Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril. 2010;94(2):389-400
Cobo A, Serra V, Garrido N, Olmo I, Pellicer A, Remohí J. Obstetric and perinatal outcome of babies born from vitrified oocytes. Fertil Steril. 2014;102(4):1006-15.
.Wennerholm UB, Soderstrom-Anttila V, Bergh C, Aittomaki K, Hazekamp J, Nygren KG, et al. Children born after cryopreservation of embryos or oocytes: a systematic review of outcome
data. Hum Reprod. 2009;24(9):2158-72
In motion:
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Commercial exploitation: In purview of the very low success rates of cryopreservation for women in their 40s and
nonconfirmed use of eggs at a later stage, the potential for commercial exploitation undeniably exists.1
Deferring pregnancy: Women postpone their pregnancies and risk the adverse effects of endangered pregnancies in
aged mother.2
High Cost & No Insurance Claim : The high expense is a barrier. Cryopreservation generally is not covered by
insurance, unless fertility preservation is done due to disease or cancer cases. As a result, it’s mostly been a luxury
for wealthy women.3
ESHRE-"If society does not pay for elective procedures such as sterilization, why should it pay for fertility
preservation?.4
Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589
Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J. 2016;20(4):833-42.
Mohapatra S. Using Egg Freezing for Non-Medical Reasons: Fertility Insurance or False Hope? - Legal, Ethical, and Policy Considerations. SSRN Electronic Journal. 706-708.
ESHRE Task Force on Ethics and Law, Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, Barri P, Diedrich K. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012
May;27(5):1231-7. doi: 10.1093/humrep/des029. Epub 2012 Feb 21. PMID: 22357771.
Against
motion:
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Against
Motion
• Risks of surgical complications like bleeding and infection in retrieval
procedure.
• OHSS continue to become a common complication, which generates hurdle
for the specialist and patient. There may be a need to cease the process in
between.
• There can be organizations which will promote and encourage oocyte
cryopreservation in future, and who will be the prime beneficiary in that
process(the organization or the candidate), is still to unfold
Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos.
1687-9589
Against
motion:
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Fertility Preservation is getting acceptance
and popularity based on a major factor i.e
Patient Autonomy.
Patient
Autonomy
Cons of Fertility Preservation
Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589
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Thank you
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SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain

  • 1. SOCIAL EGG FREEZING Proprietary and confidential-do not distribute 1 Dr Sharda Jain Dr Poorva Bhargava
  • 2. Introduction • Social egg freezing (oocyte cryopreservation for non- medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years • It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future 1.NIH : https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/fertilitypreservation 2.Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30. doi:10.7759/cureus.47956 Proprietary and confidential-do not distribute 2
  • 3. Introduction Women may save their oocytes when their reproductive potential is at its highest and use them later in life when the conditions are more favorable for motherhood. An important transition from the conventional timetables set by biological clocks and society norms. Women have the chance to have more control over their reproductive processes, which lessens time demands and enables them to make more informed life decisions. The emergence of this trend highlights the complex interactions between developments in medical technology, shifting societal perceptions, and changing ideas about motherhood and gender Inhorn MC, Birenbaum-Carmeli D: Assisted reproductive technologies and culture change . Annu Rev Anthropol. 2008, 37:177-96. Proprietary and confidential-do not distribute 3
  • 4. What do the statistics say? • In the UK, a 460% increase in oocyte cryopreservation cycles has been reported between 2010 and 2016. • Similarly, an 880% and a 507% increase between 2010 and 2015 have been reported in the USA and Australia and New Zealand, respectively. • Advancements in cryopreservation techniques like oocyte vitrification (or ultra-rapid freezing), have led to remarkable improvements in the efficacy of oocyte cryopreservation, post-thaw oocyte survival, fertilization, and pregnancy rates. • Broad acceptability and applicability of this reproductive option is still very less ! Proprietary and confidential-do not distribute 4 Teo, U.L.; Kakkar, P.; El-Toukhy, T. Current Perspectives on Social Oocyte Freezing. J. Obstet. Gynaecol. 2021, 42, 370–378. ASRM. Mature oocyte cryopreservation: A guideline. American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. Fertil. Steril. 2013, 99, 37–43. Johnston, M.; Richings, N.M.; Leung, A.; Sakkas, D.; Catt, S. A major increase in oocyte cryopreservation cycles in the USA, Australia and New Zealand since 2010 is highlighted by younger women but a need for standardized data collection. Hum. Reprod. 2021, 36, 624– 635. Peate, M.; Sandhu, S.; Braat, S.; Hart, R.; Norman, R.; Parle, A.; Lew, R.; Hickey, M. Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol. Womens Health 2022, 18, 17455057221139673. Potdar, N.; Gelbaya, T.A.; Nardo, L.G. Oocyte vitrification in the 21st century and post-warming fertility outcomes: A systematic review and meta-analysis. Reprod. Biomed. Online 2014, 29, 159–176.
  • 5. The Human Fertilization and Embryology Authority (HFEA) in the U.K. approved the use of frozen oocytes in 2000, highlighting that using frozen eggs in infertility treatment is sufficiently safe In 2013, the American Society of Reproductive Medicine (ASRM) Ethics Committee removed the experimental label from planned oocyte cryopreservation Proprietary and confidential-do not distribute 5 Kakkar P, Geary J, Stockburger T, Kaffel A, Kopeika J, El-Toukhy T. Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review. J Clin Med. 2023;12(13):4182. Published 2023 Jun 21. doi:10.3390/jcm12134182
  • 6. Indications for social egg freezing Proprietary and confidential-do not distribute 6 1. “Running out of time” running out of time to find a partner, and secondly running out of time to conceive naturally Ticking biological clock Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 7. Age-related decline in fertility Proprietary and confidential-do not distribute 7 decline in pregnancy rates with advancing maternal age begins as early as age 32, and by age 45 years, as many as 99 percent of women are infertile In India ageing is 5 years early in good 50% cycles that result in pregnancy among older women are less likely to progress to live births because of higher rates of aneuploidy, miscarriage, and stillbirth in this population
  • 8. Proprietary and confidential-do not distribute 8 an, Tse Yeun & Lau, Matthew & Loh, Seong & Tan, Heng. (2014). Female ageing and reproductive outcome in assisted reproduction cycles. Singapore medical journal. 55. 305-9. Comparison of the average number of oocytes collected per cycle among the various age groups
  • 9. 2. Lack of a suitable partner and fear of “panic partnering” • Women need time before considering having a child • Unsure about the potential longevity of their current partnership • Want a clear idea about how they wanted to go about mothering, under what circumstances; with whom and when • a particular ideal of “proper” motherhood • committed partner who had a strong desire to be a father and active in the woman’s pregnancy and the upbringing of children Proprietary and confidential-do not distribute 9 Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 10. 3. Fear of future regret and blame fear of entering into parenthood with the “wrong” male partner fears that may one day experience unwanted childlessness Proprietary and confidential-do not distribute 10 Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 11. 4. Compromised fertility or health endometriosis, polycystic ovary syndrome, blocked fallopian tubes, the loss of an ovary from a previous illness, perception of a risk of premature menopause or a diagnosis of a serious illness. concern that fertility, or general health, may be compromised and that this would affect the ability to conceive. Proprietary and confidential-do not distribute 11 Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 12. 5. Critical events a relationship breakdown, a recent birthday, a recent health scare, or becoming aware for the first time about the efficacy of egg freezing early for older women. Proprietary and confidential-do not distribute 12 Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 13. the media representation of social egg freezing portrays women as undertaking this process because they have chosen to pursue their career and “delay” motherhood. 6. The (in)significance of career Proprietary and confidential-do not distribute 13 Baldwin K, Culley L, Hudson N, Mitchell H. Running out of time: exploring women's motivations for social egg freezing. J Psychosom Obstet Gynaecol. 2019;40(2):166-173. doi:10.1080/0167482X.2018.1460352
  • 14. Medical dimensions of social egg freezing Proprietary and confidential-do not distribute 14
  • 15. Technological Advancements in Oocyte Cryopreservation • The viability of thawed oocytes was impacted by traditional procedures utilizing slow-freezing technology because the formation of ice crystals frequently caused cellular damage. • the development of vitrification, a quick-freezing method that avoids the production of ice crystals, has significantly increased post-thaw survival rates. Proprietary and confidential-do not distribute 15 Rienzi L, Cobo A, Paffoni A, et al.: Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study. Hum Reprod. 2012, 27:1606-12. Cobo A, Kuwayama M, Pérez S, Ruiz A, Pellicer A, Remohí J: Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method. Fertil Steril. 2008, 89:1657-64. Rienzi L, Romano S, Albricci L, et al.: Embryo development of fresh 'versus' vitrified metaphase II oocytes after ICSI: a prospective randomized sibling-oocyte study. Hum Reprod. 2010, 25:66-73.
  • 16. Vitrification has a better chance of maintaining oocyte quality and structural integrity . Pre-freeze evaluation methods have also made improvements in the selection of viable oocytes for freezing. Now, it is possible to discriminate between oocytes with optimum and inadequate developmental potential using morphological and molecular criteria. Improves not just the probability of oocyte survival post-thaw but also the likelihood of conceiving successfully after fertilization and implantation. Proprietary and confidential-do not distribute 16 Cobo A, Diaz C: Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011, 96:277-85.
  • 17. Oocyte quality Proprietary and confidential-do not distribute 17 The woman’s age is a determining factor in oocyte quality. As age increases, there is a reduction in the amount of adrenal androgenic hormones, with a reduction in free circulating testosterone, which, in turn, affects the levels of androgens in the follicular fluid, favoring the reduction of granulosa cells by the apoptosis´ process 01 Stress, regardless of the triggering factor, is known to alter cortisol levels, with a reduction in estradiol biosynthesis by follicular cells, resulting in a lower number and worse quality of mature oocytes 02
  • 18. Oocyte morphology • An excellent oocyte morphology has a spherical structure, surrounded by a uniform pellucid zone, with a homogeneous and translucent cytoplasm, free of inclusions, and with an appropriately sized polar corpuscle • Oxidative stress, caused by systemic disorders, is responsible for stopping the cell cycle and stimulating apoptosis in mature and immature oocytes; however, immature oocytes seem to be more susceptible to morphological changes such as shrinkage, membrane defects, cytoplasmic granulations and degeneration Proprietary and confidential-do not distribute 18
  • 19. Improving oocyte quality Given that many lifestyle conditions are responsible for changes to oocyte quality and morphology, some habit changes should be encouraged. Suspension of alcohol consumption during treatment is beneficial in reproductive outcomes. Smoking cessation for a period of 3 to 6 months seems to be beneficial (Meldrum et al., 2016). Proprietary and confidential-do not distribute 19
  • 20. Improving diet, choosing foods rich in antioxidants such as pomegranate, chocolate, licorice, cumin, ginger, oregano, fruits, vegetables and fish can all help reduce free radicals. The use of antioxidant supplements such as vitamin C, vitamin E, Zinc, Selenium, Omega 3 also seems to help balance the oxidative process All obese patients, but especially those with a BMI greater than or equal to 35 kg/m2, should be encouraged to lose weight before starting IVF cycles. Proprietary and confidential-do not distribute 20
  • 21. Assessing Fertility Preservation Options For women considering postponing motherhood, social egg freezing is a feasible alternative alongside embryo freezing and ovarian tissue cryopreservation in the range of fertility preservation techniques. In order to develop embryos that may be frozen and kept, harvested oocytes must be fertilized with sperm. Ovarian tissue cryopreservation entails removing and freezing a piece of the ovary that contains primordial follicles with the goal of reimplanting the tissue in the future. This approach is appropriate for people who may soon undergo fertility- threatening treatments like chemotherapy. Proprietary and confidential-do not distribute 21 Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30.
  • 22. Proprietary and confidential-do not distribute 22 Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30. • The choice of preservation technique is made after taking into account each individual's medical history, marital situation, and long-term family planning objectives. • Women must be able to weigh the benefits and drawbacks of each strategy in order to make judgments that are appropriate for their particular situation.
  • 23. Medical Eligibility and Screening The follicle stimulating hormone (FSH), anti-müllerian hormone (AMH), and antral follicle count (AFC) are three hormones that may be measured to determine the health of the ovaries . Women undertake tests to ascertain their ovarian reserve, which represents the number and quality of their accessible eggs, before beginning social egg freezing. To determine if a person is qualified for the procedure and to uncover any underlying health issues that can compromise the effectiveness of the freezing and thawing process, a thorough medical assessment is crucial. Proprietary and confidential-do not distribute 23 Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30.
  • 24. Assessment of ovarian reserve • In addition to age, assessment of markers of ovarian reserve, including AMH concentration, antral follicle count, and day 3 FSH and E2 concentrations, can help guide counseling. • The best marker of egg quality is chronologic age, • Age at the time of the procedure remains one of the most critical points of counseling. • A cycle day 2 or 3 FSH >10 international units/l, E2 >80 pg/ml, or AMH <1 ng/ml portends a poorer prognosis in terms of oocyte yield at the time of retrieval Proprietary and confidential-do not distribute 24 Scott RT Jr, Elkind-Hirsch KE, Styne-Gross A, et al. The predictive value for in vitro fertility delivery rates is greatly impacted by the method used to select the threshold between normal and elevated basal follicle-stimulating hormone. Fertil Steril 2008; 89:868.
  • 25. • Early follicular phase follicle-stimulating hormone (FSH), estradiol and inhibin B, anti-Müllerian hormone (AMH), and antral follicle count, providing age-specific ranges that should ideally recognize early ovarian depletion. • However, due to wide variations across individuals, these tests provide only partial sensitivity in discriminating the specific reproductive lifespan of the patient. Proprietary and confidential-do not distribute 25 Poli M and Capalbo A (2021) Oocyte Cryopreservation at a Young Age Provides an Effective Strategy for Expanding Fertile Lifespan. Front. Reprod. Health 3:704283. doi: 10.3389/frph.2021.704283
  • 26. • A thorough medical history is taken to uncover any existing illnesses or prescription drugs that can influence the ovarian response to stimulation. • Egg quality and quantity can be affected by conditions, including polycystic ovarian syndrome (PCOS), endometriosis, and certain drugs. • Candidates are put through testing to rule out infectious disorders that may jeopardize the security of the freezing procedure for eggs. • Human immunodeficiency virus, hepatitis B, and hepatitis C screens. Proprietary and confidential-do not distribute 26
  • 27. • Additional tests include psychological tests to make sure that individuals are psychologically prepared for the procedure and its potential results due to the emotional and psychological effects of egg freezing. • Comprehensive explanations from doctors gives women the ability to make well-informed decisions about whether to move forward and offers a chance to resolve any concerns. Proprietary and confidential-do not distribute 27 Lahoti U, Pajai S, Shegekar T, Juganavar A. Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts. Cureus. 2023;15(10):e47956. Published 2023 Oct 30.
  • 28. • Clinicians create customized stimulation protocols to get the best egg production based on the findings of the ovarian reserve evaluation. • Multiple follicles can be stimulated to grow and mature at the same time using drugs such as gonadotropins. Proprietary and confidential-do not distribute 28
  • 29. Prognosis-Fertility awareness • For fertility preservation, the main prognostic factor for success rates is the age at egg freezing. • The best results are achieved if eggs are cryopreserved before 36 years of age according to a metaanalysis . • A woman wishing to become pregnant in her 40s with her own fresh eggs has a 6.6% estimated success rate, but if she had frozen her eggs at the age of 30, the success rate would jump to > 40% per transfer. • However, most patients proceed with cryopreservation at the age of 36–39, with the mean age at the time of freezing being 37–38 and 80% of patients being above 35 Proprietary and confidential-do not distribute 29
  • 30. Scientific evidence-outcomes of thaw cycles Proprietary and confidential-do not distribute 30 Kakkar P, Geary J, Stockburger T, Kaffel A, Kopeika J, El-Toukhy T. Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review. J Clin Med. 2023;12(13):4182. Published 2023 Jun 21. doi:10.3390/jcm12134182
  • 31. • Lack of Evidence • Uncertain Outcomes • Lower cost-effectiveness • Unjustified/Misused Intent • Unquantified Risk Vs Benefit ratios • Unclear Recommendations from leading organizations Social, ethical and legal issues
  • 32. • Beneficence Value : Social egg preservation doesn’t meet the beneficence value compared to the risks involved. • Against Hippocratic oath: Egg social freezing is the application of medical techniques for non- medical purposes, opposed to Hippocrates oath ("Primum non nocere"). • Risk of OHSS –due to repeated cycles of stimulation(since women prefer higher number of oocyte preserved) • Postoperative complications :Surgical risk of oocyte retrieval(bleeding/infection) • Non-confirmed utility : Uncertainty that a women will eventually use her preserved egg in future- chances of turning into medical waste. Klemetti R, Sevon T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod. 2005;20(12):3293-300. Bennett SJ, Waterstone JJ, Cheng WC, Parsons J. Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures. J Assist Reprod Genet. 1993;10(1):72-77. Doyle JO, Richter KS, Lim J, Stillman RJ, Graham JR, Tucker MJ. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril. 2016;105(2):459-66 Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589. Ethical issues Proprietary and confidential-do not distribute 32
  • 33. Mertes and Penning G: Investigated ethics and moral aspects of ART and social cryopreservation Analogy : They compared oocyte freezing to preoperative autologous blood storage for elective surgeries. They claimed that: "the basic structure in both situations is the storage of body material to treat possible future health problems.“ They suggested: "Rather than viewing egg freezing as the alternative to reproducing at a younger age, it should be viewed as the alternative to using a donor egg. From this perspective, egg freezing becomes a form of preventive medicine". Mertes H, Pennings G, Dondorp W, de Wert G. Implications of oocyte cryostorage for the practice of oocyte donation. Hum Reprod. 2012;27(10):2886-93 Proprietary and confidential-do not distribute 33
  • 34. • Chance of Medical Waste development? A woman may not necessarily use their cryopreserved oocytes, many of these oocytes stored in "oocyte banks" will never be used- Is it going to be commercialized??Is it going to turn up as medical waste?? • Guarantee of a successful conception? There are no guarantees. Preservation is a relatively new technology and the number of children born as a result of this technique is still limited. • What does the data say? Follow-up data regarding any possible offspring health risks are still being collected and long-term studies are not yet available. The probabilities to conceive from cryopreservation had recently increased significantly, but the chances of conceiving through natural reproduction at a relative early age are much higher Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589. Legal issues Proprietary and confidential-do not distribute 34
  • 35. Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589. Mohapatra S. Using Egg Freezing for Non-Medical Reasons: Fertility Insurance or False Hope? - Legal, Ethical, and Policy Considerations. SSRN Electronic Journal. 706-708. • Commercialization Given the very low success rates of cryopreservation for women in their 40s, the potential for commercial exploitation undeniably exists.1 • High costs Cryopreservation generally is not covered by insurance, unless fertility preservation is done due to disease or cancer cases.2 • Altruistic Donation and Potential Exploitation: Freeze and share’ arrangement as developed by a British fertility Center (The London Egg Bank) offered a solution for the high cost. Under this arrangement selected women get free ovarian stimulation, harvesting and one year storage in exchange for donating half of their oocytes to program another woman that can get pregnant only with donated eggs. Arrangements of this type undermine the principle of altruistic donation and risks commercialization. Proprietary and confidential-do not distribute 35
  • 36. Richmann et al: • Whether and under what conditions infertility should be regarded as a “disease” should be defined. • Modern societies had developed a series of new problems, one of which is the inability of women to build a family during the best age for reproduction. Using fertility preservation as a solution to that problem might deteriorate the problem further and will not resolve this critical social issue Is fertility preservation a way of seeking medical answer to a social problem?? Social issues Richman K. Ethics and the metaphysics of medicine. Cambridge, Mass. MIT Press. 61-3 Proprietary and confidential-do not distribute 36
  • 37. • Cryopreservation would also encourage women to further postpone their pregnancies and risk the adverse effects of high risk pregnancies in aged mothers. • Harm to children caused by having older or even elderly parents, there is a great difference between the misfortune of an early death of a young parent, and choosing to set up a situation where there is an increased likelihood of a parent's death while the child is still young . Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J. 2016;20(4):833-42 O'Neill O. Autonomy and Trust in Bioethics. Cambridge: Cambridge University Press. J R Soc Med. 2002;95(8):423-4. Cedars MI. Introduction: Childhood implications of parental aging. Fertil Steril. 2015;103(6):1379-80 Rooney B. Facebook, Apple pay to freeze employees' eggs. CNN Money. Retrieved 27 March 2016. Proprietary and confidential-do not distribute 37
  • 38. • Facebook and Apple made headlines by offering to give female employees $20,000 of cryopreservation benefits. The significance of the Facebook and Apple offer is largely symbolic but it brings social freezing to the center of public discussions. • Raising false hopes-The technology is recent. Women should be made aware that the chances of conceiving naturally within relatively early age is higher than conceiving with cryopreserved oocyte. ASRM - The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology, (2013). Mature oocyt cryopreservation: a guideline. Asrm.org. Retrieved 27 March 2016. Proprietary and confidential-do not distribute 38
  • 39. Fertility Preservation: the debate In motion: It is acceptable to state that oocytes degenerate and deteriorate just like any other organ in the human body. If a treatment for brain deterioration/dementia is available, why not for infertility due to aging? Fertility preservation can be termed as "preventive medicine” -The European Society of Human Reproduction and Embryology declare (ESHRE) that fertility preservation for natural ovarian aging “cannot so easily be dismissed as a non-healthrelated preference.” If we consider risk of surgical complication, then they are equally present in –pregnancy termination, plastic surgery, sterilization. Harwood K. On the ethics of social egg freezing and fertility preservation for nonmedical reasons. 2015;(5):59-67. Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, et al. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012;27(5):1231-7 Zhang L, Yan LY, Zhi X, Yan J, Qiao J. Female fertility: is it safe to "freeze?". Chin Med J (Engl). 2015;128(3):390-397. doi:10.4103/0366-6999.150115 Proprietary and confidential-do not distribute 39
  • 40. OHSS in oocyte retrieval can be prevented by using Gonadotropin Releasing Hormone Agonist (GnRHa) instead of Human Chorionic Gonadotropins (hCG) to trigger ovulation before egg retrieval. Pregnancy rates following Oocyte cryopreservation have been reported to be similar to the results of standard IVF treatments with fresh embryos and about 5000 babies were born from cryopreservation. There are papers which provide reassuring evidence that pregnancies and infants conceived following oocyte vitrification are not associated with increased risk for chromosomal abnormalities. Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril. 2010;94(2):389-400 Cobo A, Serra V, Garrido N, Olmo I, Pellicer A, Remohí J. Obstetric and perinatal outcome of babies born from vitrified oocytes. Fertil Steril. 2014;102(4):1006-15. .Wennerholm UB, Soderstrom-Anttila V, Bergh C, Aittomaki K, Hazekamp J, Nygren KG, et al. Children born after cryopreservation of embryos or oocytes: a systematic review of outcome data. Hum Reprod. 2009;24(9):2158-72 In motion: Proprietary and confidential-do not distribute 40
  • 41. Commercial exploitation: In purview of the very low success rates of cryopreservation for women in their 40s and nonconfirmed use of eggs at a later stage, the potential for commercial exploitation undeniably exists.1 Deferring pregnancy: Women postpone their pregnancies and risk the adverse effects of endangered pregnancies in aged mother.2 High Cost & No Insurance Claim : The high expense is a barrier. Cryopreservation generally is not covered by insurance, unless fertility preservation is done due to disease or cancer cases. As a result, it’s mostly been a luxury for wealthy women.3 ESHRE-"If society does not pay for elective procedures such as sterilization, why should it pay for fertility preservation?.4 Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589 Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J. 2016;20(4):833-42. Mohapatra S. Using Egg Freezing for Non-Medical Reasons: Fertility Insurance or False Hope? - Legal, Ethical, and Policy Considerations. SSRN Electronic Journal. 706-708. ESHRE Task Force on Ethics and Law, Dondorp W, de Wert G, Pennings G, Shenfield F, Devroey P, Tarlatzis B, Barri P, Diedrich K. Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012 May;27(5):1231-7. doi: 10.1093/humrep/des029. Epub 2012 Feb 21. PMID: 22357771. Against motion: Proprietary and confidential-do not distribute 41
  • 42. Against Motion • Risks of surgical complications like bleeding and infection in retrieval procedure. • OHSS continue to become a common complication, which generates hurdle for the specialist and patient. There may be a need to cease the process in between. • There can be organizations which will promote and encourage oocyte cryopreservation in future, and who will be the prime beneficiary in that process(the organization or the candidate), is still to unfold Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589 Against motion: Proprietary and confidential-do not distribute 42
  • 43. Fertility Preservation is getting acceptance and popularity based on a major factor i.e Patient Autonomy. Patient Autonomy Cons of Fertility Preservation Tosin Ajala, Junaid Rafi, Peter Larsen-Disneyet al:Fertility Preservation for Cancer Patients: A Review; Obstetrics and Gynecology International Volume 2010, page nos. 1687-9589 Proprietary and confidential-do not distribute 43
  • 44. Thank you Proprietary and confidential-do not distribute 44

Editor's Notes

  1. The issues can emerge in a medical decision making secondary to multiple factors, which can be assessed in different ways.