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Optimal Preparation Prior to the Use of Cryopreserved Oocytes

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Preventing Age Related Fertility Loss

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Abstract

The early 1980s saw the first cases of live births after the transfer of autologous frozen embryos be reported [1, 2]. These preliminary reports were met with reasonable resistance by the scientific community owing to the limited efficacy of earlier cryopreservation methods and concerns regarding the overall safety of embryo cryopreservation. This uncertainty effectively relayed embryo cryopreservation at its genesis to the status of an “adjuvant method” for cycles in which the number of embryos produced was deemed too excessive for simultaneous replacement during the fresh embryo transfer (ET) attempt. However, following the advent of more efficient cryopreservation strategies [3] (i.e. vitrification) and reassuring safety data [4, 5], the use of embryo cryopreservation has progressively increased, currently accounting for up to one third of all children born after assisted reproductive technologies (ART) in the United States [6]. Furthermore, cryopreservation has now become an indispensable tool in everyday clinical practice, providing the necessary means to assure the safe storage of embryos while minimizing the many risks associated to the multiple pregnancies [7]. For this reason, an increasing amount of scientific societies and governments have encouraged [8] or even enforced [9, 10] elective single ET policies to ART clinics, progressively changing the benchmark of ART from pregnancy rates to Birth Emphasizing a Successful Singleton at Term (BESST) [11]. These considerations have set the stage for a new stance on embryo cryopreservation in modern-day medicine, which is no longer viewed as a simple adjuvant of fresh ET [12], a mindset that has transpired across to oocyte donation and/or embryo cryopreservation programs as well. In parallel, an increasing number of women are currently opting to electively cryopreserve oocytes in anticipation of age-related gamete exhaustion. Since the first live birth following the transfer of a cryopreserved oocyte occurred already in 1986 [13], physicians have the possibility to extrapolate from the abundance of data already existent from both fresh/frozen oocyte donation and embryo cryopreservation programs in order to determine the best ET strategy for women thawing electively cryopreserved oocytes. In this chapter, we give a detailed explanation on how the preparation of the uterus for the transfer of embryos deriving from cryopreserved oocytes is generally performed, followed by a brief overview of which methods one may consider to optimize the safety and pregnancy/neonatal outcomes of these treatment cycles.

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Authors and Affiliations

  1. Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, 1090, Belgium

    Shari Mackens M.D., Arne van de Vijver M.D., PhD & Samuel Santos-Ribeiro M.D.

  2. Department of Obstetrics, Gynaecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, 1649-035, Portugal

    Samuel Santos-Ribeiro M.D.

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  1. Shari Mackens M.D.
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  2. Arne van de Vijver M.D., PhD
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  3. Samuel Santos-Ribeiro M.D.
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Correspondence to Shari Mackens M.D. .

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  1. Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium

    Dominic Stoop

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Mackens, S., van de Vijver, A., Santos-Ribeiro, S. (2018). Optimal Preparation Prior to the Use of Cryopreserved Oocytes. In: Stoop, D. (eds) Preventing Age Related Fertility Loss. Springer, Cham. https://doi.org/10.1007/978-3-319-14857-1_9

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