Oocyte Banking and Future Relational and Reproductive Choices
Study Question What is the nature of the relational status, reproductive choices and possible regret of a pioneer cohort of women that either considered or actually performed oocyte banking for anticipated gamete exhaustion (AGE)?.
Summary Answer Only half of the women who banked oocytes anticipate using them in the future but the experience with oocyte banking is overwhelmingly positive, with the majority of AGE bankers preferring to have it performed at a younger age.
What is Known Already Most women who choose to cryopreserve oocytes for the prevention of age-related fertility decline are single and are hoping to buy time in their search for a suitable partner. The question of why some candidates actually embark on such treatment while others eventually prefer not to freeze remains unclear. There are no follow-up data available either on post-freezing changes in relational status, or on attitude towards the undergone treatment and the reproductive outcome.
Study Design, Size, Duration A retrospective cohort study was performed with 140 women who visited the outpatient clinic between 2009 and 2011. All women (mean age 36.7 ± SD 2.62) considered oocyte preservation for age-related infertility. At least 1 year after their initial visit (range 12–45 months), women were contacted by phone to participate in a standardized questionnaire developed to evaluate their actual relational and reproductive situation, their attitude towards banking and future reproductive plan.
Participants/Materials, Setting, Methods Eighty-six women (61.4%) completed at least one cryopreservation cycle. The non-bankers included 54 women who either preferred no treatment (n = 51) or attempted stimulation but cancelled because of poor response (n = 3). The response rate among bankers was 75.4% (65/86) while 55.8% (29/52) of the non-bankers were reached for interview.
Main Results and the Role of Chance Among bankers, 50.8% of women think they will use the oocytes at some point, while 29.2% indicated that they currently consider the use of frozen oocytes less likely than anticipated at time of oocyte retrieval. However, although 95.4% would decide to do it again, the majority (76.0%) would prefer to do it at a younger age. Among bankers, 96.1% would recommend the treatment to others. Women who banked accept a higher maximum age for motherhood when compared with non-bankers (43.6 versus 42.5 years; P < 0.05). Almost all bankers and 89.6% of the non-bankers still have a desire for a child. Bankers and non-bankers did not differ in terms of experiencing steady relations (47.7 versus 55.2%), attempting conception (35.4 versus 44.8%) and not conceiving within 1 year (17.4 versus 15.4%).
Limitations, Reasons for Caution The study has a limited follow-up of 1–3 years and therefore does not provide information on the reproductive outcome of the cryopreserved oocytes. Although most women appear to be realistic about their chances of pregnancy, the outcome of such treatment could affect the attitude of women towards the treatment. Furthermore, the findings of non-bankers cannot be generalized to the general population because the control group of non-bankers in this study actually visited a centre as a potential candidate for banking.
Wider Implications of the Findings Bankers and non-bankers have a surprising congruent relational status and reproductive choices, indicating that freezing oocytes does not appear to influence the life choices of the women. The study provides insights into the important psychological aspect of reassurance associated with preventive oocyte banking, expressed by high satisfaction after banking in combination with a decreased intention of ever using the eggs.
Study Funding/Competing Interest(S) We have no study funding, nor competing interests to declare.
The introduction of efficient oocyte cryopreservation offers women the opportunity to safeguard part of their reproductive potential (Garcia-Velasco et al., 2013). The relative chance of live birth per thawed egg is age-dependent and about 5.9% for women aged 30–39 years (Chang et al., 2013). Healthy women who do not face an immediate gonadotoxic event also decide to cryopreserve oocytes in order to anticipate a more gradual exhaustion of their ovarian reserve over time (Gold et al., 2006; Homburg et al., 2009; Gorthi et al., 2010; Knopman et al., 2010).
Egg freezing is not a guarantee for future reproduction, and remains an emergency a measure of last resort, whatever its indication (ESHRE Task Force on Ethics and Law, 2012). However, the absence of an immediate gonadotoxic threat significantly alters a women's decision-making whether and when to embark on such preventive treatment. The timing of such a treatment, the number of treatment cycles and the amount of time available are not determined by the diagnosis or advice of an oncologist. It is this patient-based decision-making that has led to the dichotomy between the so-called medical and the social freezing. The authors therefore prefer not to refer to 'social' or 'non-medical' oocyte cryopreservation but to call it oocyte banking for anticipated gamete exhaustion (AGE) (Stoop et al., 2014). The acronym AGE refers to both the preventive nature of the oocyte banking as well as to the indication being the reproductive 'age'-ing.
The need to collect data about the psychological aspects of fertility preservation for ovarian ageing, including women's motives for choosing this option, has been put forward in the recommendations by the European Society for Human Reproduction and Embryology (ESHRE) Task Force on Ethics and Law (2012). Women who need more time or just want more time before starting motherhood might benefit from the experiences of others who have pioneered in undergoing preventive oocyte cryopreservation for AGE. In recent years, several centres published the experiences of women's opinion at the time of freezing; however, little is known about how oocyte preservation affects their future life (Gold et al., 2006; Nekkebroeck et al., 2010; Hodes-Wertz et al., 2013; Schuman et al., 2013; Vallego et al., 2013). Therefore, we performed a follow-up study of a cohort of women who considered banking for AGE. Most of these women eventually had oocyte cryopreservation, while others decided not to proceed. The objective of the study was to find an answer to the following four research questions: (i) why did the candidate for AGE banking choose to perform the treatment or not, and how do the candidates feel about alternative options to achieve motherhood? (ii) How do these women look back to their own experience in terms of regret? (iii) How did their relational status and reproductive history change since their initial visit? (iv) How do AGE bankers feel about the use of their stored oocytes in order to achieve a pregnancy?
Abstract and Introduction
Abstract
Study Question What is the nature of the relational status, reproductive choices and possible regret of a pioneer cohort of women that either considered or actually performed oocyte banking for anticipated gamete exhaustion (AGE)?.
Summary Answer Only half of the women who banked oocytes anticipate using them in the future but the experience with oocyte banking is overwhelmingly positive, with the majority of AGE bankers preferring to have it performed at a younger age.
What is Known Already Most women who choose to cryopreserve oocytes for the prevention of age-related fertility decline are single and are hoping to buy time in their search for a suitable partner. The question of why some candidates actually embark on such treatment while others eventually prefer not to freeze remains unclear. There are no follow-up data available either on post-freezing changes in relational status, or on attitude towards the undergone treatment and the reproductive outcome.
Study Design, Size, Duration A retrospective cohort study was performed with 140 women who visited the outpatient clinic between 2009 and 2011. All women (mean age 36.7 ± SD 2.62) considered oocyte preservation for age-related infertility. At least 1 year after their initial visit (range 12–45 months), women were contacted by phone to participate in a standardized questionnaire developed to evaluate their actual relational and reproductive situation, their attitude towards banking and future reproductive plan.
Participants/Materials, Setting, Methods Eighty-six women (61.4%) completed at least one cryopreservation cycle. The non-bankers included 54 women who either preferred no treatment (n = 51) or attempted stimulation but cancelled because of poor response (n = 3). The response rate among bankers was 75.4% (65/86) while 55.8% (29/52) of the non-bankers were reached for interview.
Main Results and the Role of Chance Among bankers, 50.8% of women think they will use the oocytes at some point, while 29.2% indicated that they currently consider the use of frozen oocytes less likely than anticipated at time of oocyte retrieval. However, although 95.4% would decide to do it again, the majority (76.0%) would prefer to do it at a younger age. Among bankers, 96.1% would recommend the treatment to others. Women who banked accept a higher maximum age for motherhood when compared with non-bankers (43.6 versus 42.5 years; P < 0.05). Almost all bankers and 89.6% of the non-bankers still have a desire for a child. Bankers and non-bankers did not differ in terms of experiencing steady relations (47.7 versus 55.2%), attempting conception (35.4 versus 44.8%) and not conceiving within 1 year (17.4 versus 15.4%).
Limitations, Reasons for Caution The study has a limited follow-up of 1–3 years and therefore does not provide information on the reproductive outcome of the cryopreserved oocytes. Although most women appear to be realistic about their chances of pregnancy, the outcome of such treatment could affect the attitude of women towards the treatment. Furthermore, the findings of non-bankers cannot be generalized to the general population because the control group of non-bankers in this study actually visited a centre as a potential candidate for banking.
Wider Implications of the Findings Bankers and non-bankers have a surprising congruent relational status and reproductive choices, indicating that freezing oocytes does not appear to influence the life choices of the women. The study provides insights into the important psychological aspect of reassurance associated with preventive oocyte banking, expressed by high satisfaction after banking in combination with a decreased intention of ever using the eggs.
Study Funding/Competing Interest(S) We have no study funding, nor competing interests to declare.
Introduction
The introduction of efficient oocyte cryopreservation offers women the opportunity to safeguard part of their reproductive potential (Garcia-Velasco et al., 2013). The relative chance of live birth per thawed egg is age-dependent and about 5.9% for women aged 30–39 years (Chang et al., 2013). Healthy women who do not face an immediate gonadotoxic event also decide to cryopreserve oocytes in order to anticipate a more gradual exhaustion of their ovarian reserve over time (Gold et al., 2006; Homburg et al., 2009; Gorthi et al., 2010; Knopman et al., 2010).
Egg freezing is not a guarantee for future reproduction, and remains an emergency a measure of last resort, whatever its indication (ESHRE Task Force on Ethics and Law, 2012). However, the absence of an immediate gonadotoxic threat significantly alters a women's decision-making whether and when to embark on such preventive treatment. The timing of such a treatment, the number of treatment cycles and the amount of time available are not determined by the diagnosis or advice of an oncologist. It is this patient-based decision-making that has led to the dichotomy between the so-called medical and the social freezing. The authors therefore prefer not to refer to 'social' or 'non-medical' oocyte cryopreservation but to call it oocyte banking for anticipated gamete exhaustion (AGE) (Stoop et al., 2014). The acronym AGE refers to both the preventive nature of the oocyte banking as well as to the indication being the reproductive 'age'-ing.
The need to collect data about the psychological aspects of fertility preservation for ovarian ageing, including women's motives for choosing this option, has been put forward in the recommendations by the European Society for Human Reproduction and Embryology (ESHRE) Task Force on Ethics and Law (2012). Women who need more time or just want more time before starting motherhood might benefit from the experiences of others who have pioneered in undergoing preventive oocyte cryopreservation for AGE. In recent years, several centres published the experiences of women's opinion at the time of freezing; however, little is known about how oocyte preservation affects their future life (Gold et al., 2006; Nekkebroeck et al., 2010; Hodes-Wertz et al., 2013; Schuman et al., 2013; Vallego et al., 2013). Therefore, we performed a follow-up study of a cohort of women who considered banking for AGE. Most of these women eventually had oocyte cryopreservation, while others decided not to proceed. The objective of the study was to find an answer to the following four research questions: (i) why did the candidate for AGE banking choose to perform the treatment or not, and how do the candidates feel about alternative options to achieve motherhood? (ii) How do these women look back to their own experience in terms of regret? (iii) How did their relational status and reproductive history change since their initial visit? (iv) How do AGE bankers feel about the use of their stored oocytes in order to achieve a pregnancy?
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