Achieving the “ideal” family size at advanced reproductive ages through oocyte cryopreservation

Women are increasingly delaying pregnancy, and in 2014 the mean age at first birth in the USA had risen from 25.2 years in 2000 to 26.3 years [1]. Despite advances in IVF technology, advanced reproductive age remains a significant impediment to success with a live birth rate of 3.6% per oocyte retrieval in women over 42 years [2]. Concurrent with the trend of delayed childbearing has been an increase in the use of donor oocytes [3] to overcome age-related fertility decline and diminished ovarian reserve. Oocyte cryopreservation (OC), no longer considered experimental for women with medical indications but widely utilized to defer reproduction, is allowing women to conceive using autologous oocytes at ages when donor oocytes would have previously been required. The success of the technology has been demonstrated as women increasingly return for oocyte thaw/warming and embryo transfer [4–7]. Findings from a 2013 Gallup poll indicate that Americans view the ideal family size as two to three children. Among Gallup poll respondents aged 30–49 years, 47% viewed two children as the ideal number of children and 25% viewed three children as ideal [8]. Our experience shows that most women using their cryopreserved oocytes have previously exhausted other conventional methods of ART, suggesting that their cryopreserved oocytes may represent a last resort for pregnancy with autologous oocytes. If patients returning to use their cryopreserved oocytes are among the 72% of Americans 30–49 years who view two to three children as an ideal family size, OC success would thus be defined by aiding patients in achieving their complete family-building goals. Reports of successful deliveries after OC and thaw/warming have certainly been described in the literature; however, to our knowledge there are no published reports of women achieving more than one singleton live birth with previously cryopreserved autologous oocytes. In this case series, we present six women who underwent OC for fertility preservation and subsequently achieved more than one singleton live birth after oocyte thaw/warming and embryo transfer. These representative patients highlight the use of OC technology to build multi-child families through singleton gestations at advanced reproductive ages.