Doage-specific recommendations for elective oocyte cryopreservation provide realistic expectations?

Identify the percentage of women who achieve the recommended number of mature oocytes frozen during elective cryopreservation based on age at egg retrieval. A retrospective cohort study was performed on all autologous oocyte cryopreservation cycles for elective fertility preservation at our institution, 2010-2020. Patients were categorized into four age cohorts: less than 34, 35-37, 38-40, over 40 years. Age cohorts were consistent with a published evidence-based model predicting birth probabilities based on age at egg retrieval and number of mature oocytes frozen. Individuals seeking medically-indicated cryopreservation or oncofertility were excluded. A total of 3504 oocyte cryopreservation cycles were analyzed. Age frequencies were normally distributed: less than 34 years old (22.4%, n=786), 35-37 (42.1%, n=1474), 38-40 (28.6%, n=1002), over 40 (6.9%, n=242). Only 57 women met their recommended oocyte number based on age during their initial cryopreservation cycle, none of which were in the over 40 age cohort. Nine of these 57 women opted to proceed with more than one cryopreservation cycle despite meeting their recommended oocyte number in the initial cycle. In total, only 2.65% of women met their recommended oocyte number (n=93), regardless of how many cycles they elected to undergo. The majority of women proceeded with more than one cycle (70.5%, n=2471). Of these women, 65.5% underwent two cycles with an average time of four months between cycles (n=1618). Fewer women elected to proceed with a third cycle (25.8%, n=588); however, the average timeframe between these cycles was also four months. A minority of women underwent more than three cycles (10.7%, n=265). The vast majority of women who underwent elective oocyte cryopreservation in our study did not reach their recommended number of mature oocytes and therefore did not maximize their chances of achieving live birth. It is yet unclear to what extent this compromises future family-building goals. Evidence-based data on the number of oocyte cryopreservation cycles a woman should undergo must be balanced with realistic expectations, taking into account the time and money invested in fertility preservation attempts.