Abstract: P-162

A Hurdle in the Egg Freezing Race: Comparison of Donor and Autologous Oocyte Cryopreservation (OC) Outcomes.

Presenter: Sarah Druckenmiller


Abstract


Objective: OC is now a mainstream fertility preservation option, and many women are asking about the chance of live birth with this new technology. Unfortunately, minimal data is available as most women who have undergone OC have not yet returned for thaw. Further, much of our knowledge is based on donor OC (DOC), which may be superior to autologous OC (AOC). Thus, our aim was to compare DOC and AOC thaw outcomes.

Design: Retrospective cohort study

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Objective: OC is now a mainstream fertility preservation option, and many women are asking about the chance of live birth with this new technology. Unfortunately, minimal data is available as most women who have undergone OC have not yet returned for thaw. Further, much of our knowledge is based on donor OC (DOC), which may be superior to autologous OC (AOC). Thus, our aim was to compare DOC and AOC thaw outcomes.

Design: Retrospective cohort study

Materials and Methods: We reviewed all DOC and AOC thaw cycles from 10/2004-1/2017 at a large university-based fertility center. Exclusion criteria included use of PGD/PGS, day-3 embryo transfers, and age at retrieval >43y. Data was mined for: no. of retrieved/thawed/surviving oocytes, 2-pronuclear fertilization (2-PNF), embryo development, implantation and ongoing pregnancy/live birth (LB) rates. Fischer’s exact and Mood’s median tests were used for statistics.

Results: See Table. OC cycles included 131 DOC thaws (119 recipients, median donor age 26, range 21-31) and 137 AOC thaws (123 pts, median age 38, range 25-42), including the subgroup of 24 AOC<35y thaws (23 pts, median age 33, range 25-34). As expected, donors were younger than AOC pts (p<.0001) and fewer MII oocytes per cycle were thawed in DOC cycles (median 8) than in All-AOC (median 11; p<.0001) or AOC<35y (median 13; p<.0001). Oocyte survival, 2-PNF and blastocyst (BL) formation rates (BFR) were higher in DOC than All-AOC (p<.0001) and in AOC<35y (p<0.03), and more All-AOC and AOC<35y patients had no suitable BL for transfer compared to DOC (34% and 33% vs. 7%; p<.01). However, in cycles with BL for transfer, LB rates were not different between DOC and AOC<35y (p=1); albeit, in AOC<35y patients, an additional BL was transferred on average per cycle. Multiple birth rates in the DOC, All-AOC, and AOC<35y groups were 5/84 (6%), 7/38 (18%), and 2/9 (22%), respectively.

Conclusions: As women increasingly rely on AOC for fertility preservation, it is critical to provide realistic expectations about outcomes. Developmental parameters for AOC were inferior to DOC, resulting in production of fewer BL and a higher proportion of patients with no embryos for transfer. In those achieving embryo transfer, LB outcomes in AOC<35y vs. DOC appear comparable, although with an additional blastocyst being transferred on average per cycle in the AOC<35y group. Thus, DOC thaw data is not an appropriate counselling tool for women pursuing AOC; only AOC thaw data should be used.

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