Faculty Bibliography

OBJECTIVE:To evaluate the outcomes of planned oocyte cryopreservation patients most likely to have a final disposition. DESIGN/METHODS:Retrospective cohort study of all patients who underwent at least 1 cycle of planned oocyte cryopreservation between Jan 2005 and December 2009. SETTING/METHODS:Large urban University-affiliated fertility center PATIENT(S): All patients who underwent ≥1 cycle of planned oocyte cryopreservation in the study period. INTERVENTION(S)/METHODS:None MAIN OUTCOME MEASURE(S): Primary outcome was the disposition of oocytes at 10-15 years. Secondary outcomes included thaw/warming types, laboratory outcomes, and live birth rates. Outcomes and variables treated per patient. RESULT(S)/RESULTS:A total of 231 patients with 280 cycles were included. The mean age at the first retrieval was 38.2 years (range 23-45). A total of 3,250 oocytes were retrieved, with an average of 10 metaphase II frozen/retrieval. To date, the oocytes of 88 patients (38.1%) have been thawed/warmed, 109 (47.2%) remain in storage, 27 (11.7%) have been discarded, and 7 (3.0%) have been transported elsewhere. The return rate (patients who thawed/warmed oocytes) was similar by Society for Assisted Reproductive Technology age group. The mean age of patients discarding oocytes was 47.4 years (range, 40-57). Of the 88 patients who thawed/warmed oocytes, the mean age at the time of thaw/warming was 43.9 years (range, 38-50) with a mean of 5.9 years frozen (range, 1-12). Nine patients (10.2%) thawed/warmed for secondary infertility. A total of 62.5% of patients created embryos with a partner, and 37.5% used donor sperm. On average, 14.3 oocytes were thawed/warmed per patient, with 74.2% survival (range, 0%-100%) and a mean fertilization rate of 68.8% of surviving oocytes. Of 88 patients, 39 (44.3%) planned a fresh embryo transfer (ET); 36 of 39 patients had at least 1 embryo for fresh ET, and 11 had a total of 14 infants. Forty-nine of 88 patients (55.7%) planned for preimplantation genetic testing for aneuploidy, with a mean of 4.2 embryos biopsied (range, 0-14) and a euploidy rate of 28.9%. Of the 49 patients, 17 (34.7%) had all aneuploidy or no embryos biopsied. Twenty-four patients underwent a total of 36 single euploid ET with 18 live births from 16 patients. Notably, 8 PGT-A patients had a euploid embryo but no ET, affecting the future cumulative pregnancy rate. Overall, 80 patients with thaw/warming embryos had a final outcome. Of these, 20 had nothing for ET (arrested/aneuploid), and of the 60 who had ≥1 ET, 27 had a total of 32 infants, with a live birth rate of 33.8% (27/80). CONCLUSION(S)/CONCLUSIONS:We report the final outcomes of patients most likely to have returned, which is useful for patient counseling: a utilization rate of 38.1% and a no-use rate of 58.9%, similar across age groups. Further studies with larger cohorts as well as epidemiologic comparisons to patients currently cryopreserving are needed.

Objective Improvements in oocyte cryopreservation(OC) have led to successful oocyte banking and more readily available cryopreserved donor oocytes(DO). Simultaneously, preimplantation genetic screening(PGS) has increased, even with DO. Using OC, DO, and PGS together is less common, but now occurs. Reservations include increased technological and financial cost ($1,100/oocyte). Our goal was to determine whether adding PGS increases implantation and live birth rates in DOT. Design Retrospective cohort study. Material and Methods We conducted a retrospective analysis of DOT performed 10/2004-1/2017 at a university-based fertility center. To remove bias, we conducted a sub-analysis of single embryo transfers(SET). Data was mined for: number of oocytes thawed/survived/fertilized, embryo development/transfer/implantation, and ongoing pregnancy/live birth. Mood's median and Fischer's exact tests were used for statistical analysis. Results Within the 130 non-PGS DOT (118 pts, median age:26y), 1138 oocytes (median:8/cycle) were thawed. Within the 15 PGS DOT (15 pts, median age:24y), 180 oocytes (median:11/cycle) were thawed a mean of 3 blastocysts(BL) were biopsied. Oocyte survival, 2-PN fertilization, BL formation, implantation, and ongoing pregnancy/live birth rates were not significantly different between the groups. The multiple birth rate in the non-PGS group was 6% (5/84 births). When controlling for SET, no differences were found in implantation or ongoing pregnancy/live birth rates with and without PGS (p>.1). When comparing embryo quality in the non-PGS group, a higher ongoing pregnancy/live birth rate was noted among SETs with excellent-quality Gardner's >2Bb (62% 50 births/81 transfers) when compared with SETs with poor-quality Gardner's <2Bb (35% 8 births/23 transfers p=.03). Conclusions Due to this study's small sample size, it is difficult to conclude whether PGS improves implantation/live birth rates in a young donor population. In DO cycles with excellent-quality BL for transfer, morphology alone predicts a high live birth rate. Given the financial and technological burden of PGS, larger studies are needed to determine whether the costs of PGS outweigh the benefits in DO cycles