Title: Oocyte cryopreservation for fertility preservation: the first 149 patient consults and their subsequent cycle outcomes
Abstract: Elective fertility preservation through oocyte cryopreservation (OC) has recently become a viable option for women. Adoption of this technology has been slow and cautious, with careful attention paid to the medical, ethical, and psychological parameters surrounding its introduction. We set out to evaluate a cohort of patients presenting a request for OC at a single facility. Retrospective analysis. Patients presenting for elective fertility preservation between January 2005–March 2007. Variables analyzed included age, day 3 FSH, cancellation rate, number of retrieved oocytes, and number of cryopreserved oocytes. Patients were categorized by age groups: A <35; B 35–37; C 38–40; D >40. Statistical analysis was performed using X2 and Student's t-test. Initial consultations for 149 patients, with 62 (41.6%) proceeding to initiate a total of 84 OC cycles. Forty three patients underwent 1 cycle, 16 attempted 2 cycles, and 3 initiated 3 cycles. Sixteen (19.1%) cycles were cancelled after starting stimulation due to poor ovarian response (<4 dominant follicles), 75% of which occurred in the first cycle and 25% in a second cycle. Two patients were cancelled twice. The mean age of patients who completed an OC cycle was 37.8 ± 3.3. The mean age of those cancelled was 38.7 ± 1.8 (NS). The mean day 3 FSH of patients who completed a cycle (8.8 ± 4.1 IU/L) was significantly lower than those cancelled (15.6 ± 7.5 IU/L, P<0.0001). In the 68 completed cycles, the mean oocytes retrieved was 13.0 ± 7.2 and the mean cryopreserved oocytes was 12.8 ± 6.9. A negative correlation was identified between oocyte age and mean number of frozen oocytes: A:14.1 ± 7.3; B:13.6 ± 6.4; C:12.9 ± 8.9; D:10.7 ± 4.1. Nearly 60% of patients who completed an initial consultation for OC do not proceed to a stimulation cycle. This utilization rate is notably low, considering that it is being identified in a self-motivated, selected, and educated patient population. In those patients who did proceed to a stimulation protocol, almost 20% were cancelled due to low oocyte production, and the mean day 3 FSH level of these cycles demonstrated that a significant number of clients had already experienced diminished ovarian reserve. A decline in the number of cryopreserved oocytes as age increased was also demonstrated. Information about fertility preservation techniques needs to reach both patients and health care providers, in hopes that an increased number of women will benefit from these new technologies.