#5 Fertility Preservation Through Oocyte Cryopreservation

Overview

While a healthy male can produce sperm throughout life and father a child at an advanced age, women have not
been as fortunate—until now.

Oocyte (egg) cryopreservation, or egg freezing, can be used effectively to put a healthy woman’s biological clock on hold until years later when she is eventually ready to conceive. This cutting-edge reproductive procedure also allows women at risk of losing their fertility due to medical circumstances the chance to circumvent sterility brought on by cancer treatment or other medical maladies that seriously damage childbearing potential.

Female fertility is linked to age. Born with six million eggs, by the time she reaches puberty, a young girl has half a million, and subsequently loses 30 at each menstrual cycle. By her late 20s, a woman’s fertility begins to decline dramatically, with the quality and quantity of her eggs falling off rapidly after age 35. By 40, odds of conception plummet to as low as 5% per month.

Enter the oocyte cryopreservation. This rapidly-improving reproductive technology has been borrowed from
experimental laboratories that once worked exclusively with women suffering from cancers and illnesses that could make them infertile and has moved into local clinics nationwide. Here the eggs of a healthy woman can be safely frozen and stored, ready to be thawed and later fertilized and implanted in her womb whenever she is ready for motherhood.

Oocyte cryopreservation is straightforward. Hormones are first taken by a woman to stimulate ovulation. The “young” eggs are extracted surgically (eight or more mature eggs are needed to ensure a pregnancy) with an ultrasound needle, carefully frozen with a new process, and stored in liquid nitrogen. Years later, when a woman wishes to start or expand her family, the eggs can be safely thawed without the formation of ice crystals that can destroy the eggs structure and then fertilized and placed in her uterus (or that of a surrogate).

Egg freezing has opened a new frontier for women who desperately want to have children but cannot. For decades, frozen sperm and embryos (fertilized eggs) have successfully been used by infertile couples for the purposes of extended fertility preservation, but it wasn’t until recently that the freezing and thawing of unfertilized eggs had been successfully perfected.

“The problem is that eggs, which are the largest cells in the body, are mostly made of water,” says Tommaso Falcone, MD, Professor and Chairman, Department of Obstetrics and Gynecology, Chair, OB/GYN & Women’s Health Institute at the Cleveland Clinic. “Unlike sperm, which is all cellular material and freezes nicely, ice crystals form when eggs are refrozen and they burst when thawed.”

Thanks to new cryopreservation techniques developed in Italy and elsewhere, however, these major impediments have been successfully sidestepped and the egg can now be protected from the dangers of “freezer burn” that previously compromised the integrity of the egg during freezing and thawing.

Many new mothers are jubilant. Although deemed investigational by the American Society for Reproductive Medicine, at latest count there have been more than 900 healthy births worldwide as a result of this novel egg-banking technology.

Where Are They Now

Thanks to the new cryopreservation techniques developed in Italy and elsewhere, this novel reproductive technology is now allowing eggs of a healthy woman to be safely frozen and stored, ready to be thawed and fertilized at a later date.

Currently, oocyte cryopreservation is offered in more than 50% of assisted reproductive technology clinics in the United States. There have been 1,000 to 2,000 healthy births as a result of this novel egg-banking technology. This technique has become popular not only for patients with medical reasons to postpone starting a family, but even more so with women who want to focus on their career in their 20s and 30s.  In a 2016 editorial physicians felt that patients undergoing cancer treatment should be routinely referred to an oncologist as more and more patients are interested in oocyte cryopreservation. Recently, there has been a demand for oocyte cryopreservation in young cancer patients as research has shown fertility difficulty for adults who had cancer treatment at a young age. In 2014, a newer, ‘quick freeze’ method of oocyte cryopreservation has been explored and shown a successful clinical pregnancy rate 4 times higher than that from traditional egg freezing methods. In 2017, it was estimated that nearly 5% of the country’s major employers now offer egg freezing in their employee health plan. Adaptation of the coverage continues to grow as major tech companies pilot coverage of the technology.

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