ABSTRACT
OBJECTIVE: To compare trends in and rates of elective egg freezing (EF) cycles before and during the COVID-19 pandemic. MATERIALS AND METHODS: We retrospectively identified all appointments for EF from June 2019-February 2020 (group 1, pre-pandemic) and June 2020-February 2021 (group 2, post-pandemic) for comparison. Total numbers of EF consultation appointments and retrievals, time to first EF cycle after initial consultation, as well as patient demographics were collected. Growth rates in EF cycles from pre- to post-pandemic were calculated as a whole, by time to first EF cycle from initial consultation, as well as by age group (<30, 30-34.9, 35-39.9, 40-44.9 and >45). RESULTS: Post-pandemic retrieval volume for EF increased by 39% compared to pre-pandemic despite only a 3% increase in new consultation appointments seen over the same timeframe. Demographics in patients pursuing EF between the two timeframes were similar (average age 36.8 years pre-pandemic vs 36.6 years post-pandemic). There was 44% growth in patients pursuing EF cycles in 90 days or less, primarily driven by increased numbers of EF cycles in the 30-34.9 year-old age group. CONCLUSIONS: Despite stable numbers of patients presenting for EF consultation pre- and post-pandemic, more EF retrieval cycles were observed post-pandemic, notably occurring at earlier timepoints from initial consultation and in patients <35. This may represent pandemic-related reevaluation of life goals, changes in financial status, and/or alterations in workplace flexibility. Qualitative survey data will provide further insight into the motivators and drivers of EF, particularly during a time of national crisis. Research focused on what factors were most responsible for the increase in EF cycles may enable providers and patients to make accommodations in the future. IMPACT STATEMENT: Following the COVID-19 pandemic, we observed growth in EF cycle volume and the rates at which EF cycles were initiated after EF consultation. (Table Presented).
ABSTRACT
Objective: Use of frozen sperm in non-male factor infertility is often needed in donor cycles. Most studies to date examining outcomes of fresh vs frozen sperm are unable to control for oocyte quality. Studies examining sibling oocytes represent a unique model to control for oocyte quality. A recent small study using this model found worse outcomes in the frozen group. We sought to evaluate, in a large cohort, if fresh and frozen ejaculated sperm are associated with similar pregnancy outcomes by analyzing paired donor egg recipient (DER) cycles. Materials and Methods: Retrospective cohort study from 2016-2019 at a large fertility center. Patients who underwent DER cycles where oocytes were split between two couples and one couple used fresh sperm and the other used frozen sperm were included. All patients with uterine factor, male factor or surgically obtained sperm were excluded. Primary outcome was Ongoing pregnancy/Live birth rate (OPR). Secondary outcome included clinical pregnancy rate (CPR) and miscarriage rate. GEE analysis was performed to control for confounding factors and donors providing oocytes to both study cohorts. Results: 1255 donor oocytes cycles were screened. A total of 205 unique oocytes donors were identified with oocytes inseminated with discrepant sperm in different recipient cycles. There were 698 recipient transfer cycles, 405 fresh and 293 frozen. Cohorts were similar in baseline characteristics (table 1). There were no differences in OPR/LBR with fresh vs frozen sperm (53.6% vs 55.6%, p=0.7) or clinical pregnancies (66.4% vs 63.5%, p=0.4). Spontaneous miscarriage (<20 weeks) was significantly higher in the fresh cohort (12.3% vs 6.1%, p=0.01). Conclusions: In this large study uniquely controlling for oocyte quality, there are no differences in live birth rate when fresh or frozen sperm was utilized on the same donor oocytes. This type of comparison is important as it helps control as much as possible the oocyte, thus isolating the discrepant sperm state as a determinant of outcome. There was a significant increase in miscarriage rate when fresh sperm was used. Impact Statement: In this large study comparing paired sibling donor oocytes, no difference in live birth rate was seen when couples utilized fresh or frozen sperm. This is particularly important in large donor or international programs especially during the COVID19 pandemic in which it may be difficult for the partner to be present, and a frozen sample may be needed. [Formula presented]