Egg freezing debate gets warm reception

The discussants in a debate on the pros and cons of routine egg freezing got a warm reception but ultimately agreed to disagree about the topic at the 65^th Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists in San Diego. Both speakers emphasized that earlier counseling about egg freezing by ob/gyns rather than reproductive endocrinologists should be routine, if not the procedure itself.

Arguing in favor of routine vitrification, Clarisa R. Gracia, MD, characterized the procedure as “transformative” for reproductive medicine and explained that it facilitates preimplantation genetic testing, whereas aneuploidy screening of frozen eggs is more controversial. A 2010 trial by Cobo, et al showed no difference in outcomes for vitrified versus fresh oocytes in egg donors with a mean age of 26.7. In 4 randomized clinical trials involving egg donors including that one, Dr. Gracia said, clinical pregnancy rates with vitrified oocytes ranged from 35% to 60%.  In a 2015 study by Cobo, 8 to 15 eggs were thawed per recipient and the live birth rate per thawed oocyte was 6.5%

Dr. Gracia noted that the biggest risk associated with vitrification is ovarian hyperstimulation syndrome, which occurs in 5% of cases. Other risks include ovarian torsion and infection/bleeding (both 1%). No increased risk of adverse neonatal outcomes has been associated with vitrification compared to in vitro fertilization (IVF). She acknowledged that the procedure is not covered by most insurer and estimate the average cost at $7,000 to $15,000. “Freezing eggs,” she said, “helps reduce women’s stress about reproduction and allows them to move on with their lives.”

Arguing against routine vitrification, Anne Z. Steiner, MD, questioned whether the procedure was preying on the fears of a vulnerable population and applying a medical solution to a social problem. Data on use of donor eggs for IVF are inadequate, she said, and only 10% of women use the eggs they have frozen, raising a question about disposition of the oocytes that go unused. She also noted that the top reason why patients seek vitrification is lack of a partner, yet younger women-in whom use of frozen oocytes is likely to be more successful-are conversely statistically more likely to marry and/or have a partner and thus to conceive naturally. 

Commenting on cost-effectiveness of the procedure, Dr. Steiner said that while the average cost of an oocyte cryopreservation cycle is $9261, medications average $3,000. Other expenditures also must be taken into consideration, such as oocyte storage ($300 to $500 per year) and oocyte warming, intracytoplasmic sperm injection, and embryo culture ($2,208-$6,624). All told, she estimated, oocyte freezing may cost as much as $20,000 per live birth. 

In her rebuttal, Dr. Gracia argued for a need to let women donate to themselves at a younger age, rather than the current norm of younger women donating for other women. She and Dr. Steiner agreed that the discussion about egg freezing with patients should be done during the “well woman” exam. “Please counsel based on a woman’s age and not biomarkers such as AMH,” Dr. Gracia said. “It’s not going to predict fertility. The quality of a woman’s eggs declines with age no matter how many eggs she has.”