Should I freeze my eggs?

To freeze or not to freeze… that is a popular question among modern, reproductive age women. Media coverage of egg freezing in an effort to defer childbearing is everywhere. A simple google search clues us in on our society's fascination with this technology. But who is using oocyte cryopreservation and should you learn more about it. 

Oocyte cryopreservation (OC), the process in which a woman’s mature oocytes (commonly referred to as “eggs”) are harvested and preserved for future use, is no longer deemed experimental. The American Society for Reproductive Medicine (ASRM) released a statement in January 2013 stating that “there is good evidence that fertilization and pregnancy rates are similar to IVF/ICSI with fresh oocytes when vitrified/warmed oocytes are used as part of IVF/ICSI in young patients.”

Cue the increase in media attention and the challenges with this topic. There are several caveats here that should be reserved for discussion with an infertility specialist.  

Current uses of OC are:

·       Fertility preservation in patients undergoing gonadotoxic treatments (most notably, women undergoing chemotherapy or radiation treatment for cancer) (MOST COMMON - LITTLE CONTROVERSY)

·       Elective fertility postponement ( VERY CONTROVERSIAL)

·       Alternative to embryo cryopreservation for those individuals who hold religious or ethical objections or live in countries where the legal environment is restrictive 

·       Establishing an oocyte bank for embryo donation 

The decision to do OC is obviously personal and needs to be tailored to a woman’s own social and medical history. For example, it seems like an easy decision for the 34yo female with newly diagnosed breast cancer scheduled to start chemotherapy after her mastectomy in 3 weeks, but the lines become a little more gray when considering the healthy 38yo single attorney whose future aspiration include marriage and family. Eitherway, this conversations are challenging and the lines between medical therapy and boutique service can overlap as OC is not without its risks.

While the use of OC is increasing rapidly, experience still remains in its infancy. That being said, we are learning more about success rates using frozen oocytes. A recent study by Goldman et al found that there is no difference in the live birth rates per IVF cycle when using cryopreserved oocytes versus traditional fresh oocytes. This increase efficiency is attributable to advancements in cryopreservation techniques, most notably the method of vitrification, in which the oocytes is rapidly transitioned into a glass-like state. 

Given the novelty and complexity of OC, we urge patients to seek counseling and guidance from reproductive endocrinologists. With the aid and referrals of general obstetrician/gynecologists and general practitioners, interested women will be able to obtain the information needed and appropriately apply it to their reproductive life plan. 

Contribution by Juliana Verticchio, MD

PGY-3, OBGYN Washington University St Louis, MO