Oocyte vitrification as an efficient option for elective fertility preservation.

To provide a detailed description of the current oocyte vitrification status as a means of elective fertility preservation (EFP). Retrospective observational multicenter study. Private university-affiliated center. A total of 1,468 women who underwent EFP because of age or having associated a medical condition other than cancer (January 2007 to April 2015). None. Survival and cumulative live birth rate (CLBR) per consumed oocyte. Mean age was higher with EFP due to age versus having an associated medical reason (37.7 y [95% confidence interval (CI) 36.5-37.9] vs. 35.7 y [95% CI 34.9-36.3]). In total, 137 patients (9.3%) returned to use their oocytes. Overall survival rate was 85.2% (95% CI 83.2-87.2). Live birth rate per patient was higher in women ≤35 years old than ≥36 years old (50% [95% CI 32.7-67.3] vs. 22.9% [95% CI 14.9-30.9]). CLBR was higher and increased faster in younger women. The gain in CLBR was sharp from 5 (15.4%, 95% CI -4.2 to 35.0) to 8 oocytes (40.8%, 95% CI 13.2-68.4), with an 8.4% gain per additional oocyte, in the ≤35-year-old group. The increase was slower with 10-15 oocytes, reaching a plateau CLBR of 85.2%. A milder increase (4.9% gain) was observed in the ≥36-year-old group (from 5.1% [95% CI -0.6 to 10.7] to 19.9% [95% CI 8.7-31.1] when 5-8 oocytes were consumed), reaching the plateau with 11 oocytes (CLBR 35.6%). Forty babies were born. At least 8-10 metaphase II oocytes are necessary to achieve reasonable success. Numbers should be individualized in women >36 years old. We suggest encouraging women who are motivated exclusively by a desire to postpone childbearing because of age, to come at younger ages to increase success possibilities.

Cobo A ，García-Velasco JA ，Coello A ，Domingo J ，Pellicer A ，Remohí J ... -  《-》

Elective and Onco-fertility preservation: factors related to IVF outcomes.

Cobo A ，García-Velasco J ，Domingo J ，Pellicer A ，Remohí J ... -  《-》

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.

To evaluate a single treatment center's experience with autologous IVF using vitrified and warmed oocytes, including fertilization, embryonic development, pregnancy, and birth outcomes, and to estimate the likelihood of live birth of at least one, two, or three children according to the number of mature oocytes cryopreserved by elective fertility preservation patients. Retrospective cohort study. Private practice clinic. Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Indications for oocyte vitrification included elective fertility preservation, desire to limit the number of oocytes inseminated and embryos created, and lack of available sperm on the day of oocyte retrieval. Oocyte vitrification, warming, and subsequent IVF treatment. Post-warming survival, fertilization, implantation, clinical pregnancy, and live birth rates. A total of 1,283 vitrified oocytes were warmed for 128 autologous IVF treatment cycles. Postthaw survival, fertilization, implantation, and birth rates were all comparable for the different oocyte cryopreservation indications; fertilization rates were also comparable to fresh autologous intracytoplasmic sperm injection cycles (70% vs. 72%). Implantation rates per embryo transferred (43% vs. 35%) and clinical pregnancy rates per transfer (57% vs. 44%) were significantly higher with vitrified-warmed compared with fresh oocytes. However, there was no statistically significant difference in live birth/ongoing pregnancy (39% vs. 35%). The overall vitrified-warmed oocyte to live born child efficiency was 6.4%. Treatment outcomes using autologous oocyte vitrification and warming are as good as cycles using fresh oocytes. These results are especially reassuring for infertile patients who must cryopreserve oocytes owing to unavailability of sperm or who wish to limit the number of oocytes inseminated. Age-associated estimates of oocyte to live-born child efficiencies are particularly useful in providing more explicit expectations regarding potential births for elective oocyte cryopreservation.

Doyle JO ，Richter KS ，Lim J ，Stillman RJ ，Graham JR ，Tucker MJ ... -  《-》

Oocyte vitrification for fertility preservation in women with endometriosis: an observational study.

To describe the outcome of fertility preservation (FP) using vitrified oocytes in patients with endometriosis and to determine the impact of ovarian surgery. Retrospective observational study. University-affiliated private in vitro fertilization (IVF) center. Four hundred and eighty-five women with endometriosis who underwent FP from January 2007 to July 2018. Vitrification of metaphase II (MII) oocytes for future use. Oocyte survival rate and cumulative live-birth rate (CLBR). Mean age at vitrification was 35.7 ± 3.7 years. The women undergoing operations were younger than the nonsurgical patients (33.4 ± 3.6 years vs. 36.7 ± 3.7 years). The survival rate and CLBR were 83.2% and 46.4%, respectively. The number of vitrified oocytes per cycle (6.2 ± 5.8) was higher for the nonsurgical patients compared with the unilateral (5.0 ± 4.5) or bilateral (4.5 ± 4.4) surgery groups, but was comparable among the surgical patients. The effect of age (adjusted odds ratio [OR] 0.904; 95% CI, 0.858-0.952), number of oocytes (adjusted OR 1.050; 95% CI, 1.025-1.091), and survival (adjusted OR 1.011; 95% CI, 1.001-1.020) on the CLBR was confirmed. However, the effect of surgery was not observed (adjusted OR 1.142; 95% CI, 0.778-1.677). Nonetheless, the ovarian response (vitrified oocytes = 8.6 ± 6.9 vs. 5.1 ± 4.8) and CLBR (72.5% vs. 52.8%) were higher in young (≤35 years) nonsurgical patient versus the surgical patients; older women showed similar outcomes. Fertility preservation gives patients with endometriosis a valid treatment option to help them increase their reproductive chances. We suggest performing surgery after ovarian stimulation for FP in young women. In older women, an individualized treatment should be considered.

Cobo A ，Giles J ，Paolelli S ，Pellicer A ，Remohí J ，García-Velasco JA ... -  《-》

Six years' experience in ovum donation using vitrified oocytes: report of cumulative outcomes, impact of storage time, and development of a predictive model for oocyte survival rate.

To describe the clinical outcomes achieved after 6 years' experience in ovum donation conducted with vitrified oocytes; to attempt to find predictors of survival; and to provide information about the probability of having a baby according to the number of oocytes consumed. Retrospective, observational study. Private university-affiliated in vitro fertilization center. Recipients of vitrified oocytes (January 2007-March 2013), including all the warming procedures (n = 3,610) and all the donations made during the same period (n = 3,467). None. Survival rate per warming procedure, cumulative delivery rates (CDR) per single donation cycle, oocyte-to-baby rate, and cumulative live birth rate (CLBR) per oocyte consumed. Oocyte survival rate was 90.4%. It was not possible to develop a predictive model for survival owing to the lack of prognostic value of the studied variables. Implantation, clinical, and ongoing pregnancy rates per donation cycle were 39.0% (95% confidence interval [CI], 37.8-40.5), 48.4% (95% CI, 46.7-50.1), and 39.9% (95% CI, 38.3-41.5), respectively. Statistical differences were found when comparing blastocysts versus day 3 ETs (42.5%; 95% CI, 40.4-45.2 vs. 37.5%; 95% CI, 35.3-39.7 ongoing pregnancy rate). The CDR/donation cycle, including cryotransfers, was 78.8% (95% CI, 73.5-84.1). The oocyte-to-baby rate was 6.5%. CLBR increased progressively according to the number of oocytes consumed. We provide detailed information about the high efficiency of using vitrified/warmed oocytes. There is currently no way of estimating donors' oocytes survival when considering baseline characteristics, storage time, or controlled ovarian stimulation parameters. The probability of achieving a baby using vitrified oocytes increases progressively with the number of oocytes consumed.

Cobo A ，Garrido N ，Pellicer A ，Remohí J ... -  《-》