Successful Pregnancies, Births, and Children Development Following Oocyte Cryostorage in Female Cancer Patients During 25 Years of Fertility Preservation.

The preservation of fertility in cancer patients is a crucial aspect of modern reproductive medicine. Amenorrhea and infertility often occur after cancer therapy, worsening the quality of life. Cryopreservation of oocytes in young cancer patients is a therapeutic option for preserving fertility. A prospective study was conducted on 508 cancer patients who underwent oocyte cryopreservation to preserve fertility between 1996 and 2021 including the COVID-19 pandemic period. Patients underwent ovarian stimulation, followed by egg retrieval, and oocytes were cryopreserved by slow freezing or vitrification. Sixty-four thawing/warming cycles were performed. Survival, fertilization, pregnancy, and birth rate over the thawing/warming cycles were obtained. The data were compared with those from a group of 1042 nononcological patients who cryopreserved supernumerary oocytes. An average of 8.8 ± 6.9 oocytes were retrieved per cycle, and 6.1 ± 4.2 oocytes were cryopreserved. With their own stored oocytes, 44 patients returned to attempt pregnancy. From a total of 194 thawed/warmed oocytes, 157 survived (80%). In total, 100 embryos were transferred in 57 transfer/cycles, and 18 pregnancies were achieved. The pregnancy rate per transfer and pregnancy rate per patient were 31% and 41%, respectively. No statistically significant differences were observed between oncological patients and nononcological patients. A total of 15 babies were born from oncological patients. Children born showed normal growth and development. One minor malformation was detected.

Pfizer SARS-CoV-2 BNT162b2 mRNA vaccination (BNT162b2) has no adverse effect on elective oocyte cryopreservation outcomes.

RESEARCH QUESTION: Do elective oocyte cryopreservation outcomes in women 1-13 months after SARS-CoV-2 vaccination alter compared with unvaccinated women and do different time intervals between vaccination and ovarian stimulation impact these outcomes? DESIGN: This retrospective cohort study, conducted in a university-affiliated IVF centre, included 232 elective oocyte cryopreservation cycles of vaccinated and unvaccinated patients, without previous infection with the SARS-CoV-2 virus, between December 2020 and January 2022. Two control groups - pre-pandemic (January 2019 to February 2020) and intra-pandemic (December 2020 to January 2022) unvaccinated groups - were compared with the vaccinated group, further divided into four subgroups (under 3, 3-6, 6-9 and 9-13 months). The primary outcome was the elective oocyte cryopreservation cycle outcomes - number of retrieved and number of mature oocytes. RESULTS: The vaccinated group demonstrated comparable outcomes with regards to number of retrieved and mature oocytes compared with the pre-pandemic and intra-pandemic unvaccinated groups (12.6 ± 8.0 versus 13.0 ± 8.2 and 12.5 ± 7.4 retrieved and 10.1 ± 6.9 versus 9.5 ± 6.4 and 10.1 ± 6.3 mature oocytes, respectively; not significant for both). Similar results were noted in a comparison between the intra-pandemic unvaccinated group and the four vaccinated subgroups. No correlation was found between the parameter of days from vaccination and cycle outcomes. Similarly, analysis of covariance showed no association between vaccination status and timing and number of mature oocytes. CONCLUSIONS: The SARS-CoV-2 vaccination does not alter the outcomes of elective oocyte cryopreservation procedures. This is true even in a relatively long time interval of 9 to 13 months from vaccination.

American College of Obstetricians and Gynecologists 2022 Annual Clinical and Scientific Meeting

The proceedings contain 344 papers. The topics discussed include: estimating in vivo levonorgestrel release rate and exposure over eight years with levonorgestrel releasing intrauterine system 52 mg use with population pharmacokinetic approach;immediate vs routine postpartum intrauterine device placement after teen pregnancy: a cost-effectiveness analysis;examining the association of immediate postpartum long-acting reversible contraception payment carve-outs and postpartum LARC use in Medicaid;contraceptive congruence: a novel measure of contraceptive use that acknowledges pregnancy ambivalence;charm 2: a gender synchronized family planning intervention for couples in rural India, a cluster randomized trial;telehealth follow-up after medical management for early pregnancy loss;providing mifepristone and misoprostol in emergency departments during the COVID-19 pandemic;and medical students' knowledge of and attitudes towards oocyte cryopreservation.

LOCKDOWN UPTICK: DID THE SARS-COV-2 PANDEMIC GENERATE AN INCREASE IN PLANNED OOCYTE CRYOPRESERVATION (POC)?

OBJECTIVE: The rise of the SARS-CoV-2 pandemic and temporary closures of fertility centers made the effect on POC cycles uncertain but garnered national attention1,2. We sought to assess the impact of the pandemic on POC cycles in a pandemic epicenter. MATERIALS AND METHODS: This is a retrospective cohort study of all POC cycles at an academic fertility center in New York City from 1/1/2019- 12/31/2020. Primary outcomes were number of POC patients (pts) and cycles. Secondary outcomes were pt relationship status, payment method, AMH, and cycle parameters;with subgroup analyses by age groups. We also examined the relationship between monthly number of POC cycles and national SaRS-CoV-2 cases. Statistical analyses included z-score analysis, Mann-Whitney, and Chi-squared, with p<0.05 significant. RESULTS: Despite a 5.5 week center closure in 2020, POC pts increased 14% and POC cycles increased 16% from 2019 to 2020 (Table), with a 32% increase seen between June-Dec, 2020 . There was a 28% increase in POC pts <37yo in 2020 (252 pts vs. 323 pts, p<0.04) and no change in pts >37yo in 2020 (p=0.9). Relationship status did not differ between years (16% partnered, 76% single, 8% unknown in 2019 vs. 16% partnered, 73% single, 11% unknown in 2020;p=0.6). Fewer patients in 2020 had insurance coverage (16% vs. 24%, p<0.001). AMH was higher in 2020 (2.3 vs. 2.1, p<0.03), but days of stimulation, oocytes retrieved, oocytes frozen, total gonadotropins, and maximum estradiol (E2) were not different (Table). While national SARS-CoV-2 cases peaked in April, July, and November 2020, monthly POC cycles at our center did not decrease with surges in SARS-CoV-2 after our center reopened in May (p=0.24). In 2020 there were 23 cycles cancelled, none due a positive SARS-CoV-2 test. CONCLUSIONS: POC volume increased at our center in 2020, especially in young patients, despite center closures and SARS-CoV-2 surges. IMPACT STATEMENT: More young people pursued POC despite the SARS-CoV-2 pandemic. Further research is needed to understand POC pt motivations and experiences during a pandemic. (Table Presented).

TRENDS IN ELECTIVE EGG FREEZING BEFORE AND AFTER THE COVID-19 PANDEMIC

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).

DIFFERENCES IN ANXIETY CONCERNING THE COVID-19 VIRUS AND COVID-19 VACCINE BETWEEN WOMEN UNDERGOING INFERTILITY TREATMENT AND THOSE NOT PURSUING TREATMENT

OBJECTIVE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people. With the development and administration of the SARS-CoV-2 vaccines, there is growing evidence to suggest that there has been reduced transmission of the virus. However, the novelty of the vaccine has raised many questions for infertility patients due to the lack of research. This study examines the perceived anxiety level of patients at a fertility clinic in Manhattan who are undergoing infertility treatments, such as Timed Intercourse (TIC), Intrauterine Insemination (IUI), and In-Vitro Fertilization (IVF). Understanding the mental state of patients with infertility problems during the COVID-19 pandemic is vital for fertility clinics in their future patient assessments. MATERIALS AND METHODS: Surveys were administered to approximately 100 patients at a fertility clinic in Manhattan during early April 2021 - a few months after the first Covid vaccine was administered in the USA. The questionnaire asked patients to specify their treatment plan (TIC, IUI, IVF, oocyte cryopreservation, or no infertility problem). The survey included a 20-item Spielberger State-Trait Anxiety Inventory (STAI) assessing their current state of anxiety. For the STAI score cutoff, <40 = not anxious;40+ = high anxiety. Continuous variables were measured as mean and standard deviation and compared with a two-sample t-test or ANOVA. Categorical variables were compared with a Fisher test. A p-value <0.05 was considered statistically significant. Statistics were done with R version 4.0.5. RESULTS: There is no statistical significance in which group was more likely to have received at least one dose of the COVID-19 vaccines. However, the ''undecided'' group had the lowest percentage of individuals receiving the vaccine. There is also no statistical significance in the anxiety levels of the different groups of patients. The group with the greatest percentage of anxiety according to the STAI score is the ''undecided'' group. Fear of the COVID-19 virus being greater than the fear of the COVID-19 vaccine is a commonality between all the groups. CONCLUSIONS: The survey found that the greatest cause of apprehension in patients was the virus's unknown effects on their physical health. Majority of the hesitancy in receiving the vaccine was due to the potential side effects posed by the injection on pregnant women and their fetus. Interestingly, patients not in treatment had a trend towards higher fear and anxiety compared to patients undergoing infertility treatment. When broken down even further, patients who are undecided in their treatment are more anxious about both the COVID-19 virus and the vaccine. This indicates that the patient's treatment plan influences their view of the pandemic. IMPACT STATEMENT: Women with infertility issues experience tremendous amount of emotional turmoil, which can further interfere with their fertility. Recognizing the root of this population's anxiety during the COVID-19 pandemic can assist reproductive endocrinologists in forming treatment plans that integrate management of patient's psychological wellbeing.

The use of oocyte cryopreservation for fertility preservation in patients with sex chromosome disorders: a case series describing outcomes.

PURPOSE: Characterize outcomes among adolescents and young adults (AYAs) with sex chromosome disorders (SCDs) after oocyte cryopreservation (OC) consultation. METHODS: Retrospective case series of all AYA (< 25 years) patients with SCDs seen for OC consultation from 2011 to 2019 at a large, urban, academic fertility center. All AYA patients with an SCD seen for OC consult in the study time period were reviewed and included. Data collected included patient age, SCD type, number of patients who attempted OC, number of cycles attempted, and cycle outcomes. RESULTS: Twenty-two patients were included: 9 with Turner syndrome, 12 with mosaic Turner syndrome, and 1 with 47,XXX. Mean age at consult was 14.7 ± 3.5 years. Fourteen patients elected for OC: 5 with Turner syndrome, 8 with mosaic Turner syndrome, and 1 47,XXX who pursued 31 OC cycles total. Of those 14 patients, 10 underwent retrieval, 9 froze oocytes, and 8 froze mature (MII) oocytes. Seven patients underwent > 1 cycle and 7 had ≥ 1 cancelation. 3/3 patients who pursued cycles after 1st cancelation never got to retrieval. Age, SCD type, and baseline FSH did not predict ability to freeze MIIs. One patient returned after OC and attempted 4 ovulation induction cycles and 2 IVF cycles; all were canceled for low response. CONCLUSIONS: AYA patients with SCDs have a high risk of poor response and cycle cancelation but the majority froze MIIs. Thus, setting expectations is important. A larger sample size is needed to evaluate possible clinical predictors of success.

ART outcomes during the COVID-19 pandemic

Background: To evaluate whether the ongoing coronavirus disease 2019 (COVID-19) pandemic has had an impact on assisted reproductive technology (ART) outcomes and assess the possible role of geographic differences in the pandemic's trajectory on these outcomes. Methods: Multi-center retrospective cohort study involving patients who underwent oocyte cryopreservation, in vitro fertilization (IVF), embryo cryopreservation, or frozen euploid embryo transfer in 2019 and 2020 at two academic fertility centers located in regionally distinct areas of the US with high coronavirus infection rates. Patients were screened for infectious symptoms, exposure to sick contacts, and fevers, and tested with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing within 5 days of oocyte retrieval. The primary outcomes were the number of oocytes retrieved, embryos fertilized, blastocyst or euploid embryos produced in oocyte retrieval and IVF cycles, and rates of embryo implantation, biochemical pregnancy or no pregnancy following frozen embryo transfer (FET). Results: We found no consistent significant differences in the number of oocytes retrieved, embryos fertilized, blastocysts or euploid embryos produced at either institution over the study period. Furthermore, we did not detect any differences in FET outcomes, including rates of embryo implantation, biochemical pregnancy, or no pregnancy, at either institution during the study time period. Conclusions: There were no significant differences in ART outcomes in patients who received fertility treatment during the pandemic at our centers. Patients and providers can be reassured that with proper testing, sanitizing, and distancing measures, treatments can continue safely during the pandemic without compromising outcomes. © 2022 S.O.G. CANADA Inc.. All rights reserved.

Impact of the COVID-19 pandemic on the perception of planned oocyte cryopreservation in the United States.

Objective: To assess the impact of the COVID-19 pandemic on attitudes toward planned oocyte cryopreservation (OC). Design: Cross-sectional study. Setting: Internet-based survey questionnaire distributed nationally. Patients: One thousand women aged 21-45 years, stratified by age ≤35 or >35 years. Interventions: None. Main Outcome Measures: Change in the likelihood of considering OC because of the pandemic. Results: Of the participants who reported that the pandemic altered their likelihood of considering OC (15.2%, n = 152), 52.6% (n = 80) reported an increased and 47.3% (n = 72) reported a decreased likelihood of considering OC. Vaccination status did not affect the likelihood of considering OC. In multivariable analysis, history of COVID-19 infection (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.00-2.45), government-subsidized insurance (OR 1.47; 95% CI 0.97-2.21), loss of health insurance because of the pandemic (OR 2.32; 95% CI 1.15-4.66), working more (OR 2.99; 95% CI 1.62-5.51) or less (OR 2.54; 95% CI 1.65-3.90) because of the pandemic, and relationship status (divorced, separated, or widowed [OR 0.44; 95% CI 0.20-0.99]) were significantly associated with a change in the likelihood of considering OC because of the pandemic. Of those who believed that the COVID-19 pandemic influenced their childbearing plans (28.3%, n = 283), 64.0% (n = 181) deferred childbearing and 29.7% (n = 84) expedited childbearing. The pandemic's economic impact, concerns regarding safety of pregnancy/childbirth, and safety of childrearing were cited as most influential on childbearing (67%, 70%, 58%, respectively) and on the likelihood of considering OC (47%, 45%, and 34%, respectively). Conclusions: Through its negative impact on financial security and perceived safety, the COVID-19 pandemic has altered the likelihood of considering OC in >15% of reproductive-aged women and reproductive timelines in 30%. Vaccination has not significantly modified these changes.

Oocyte and Sperm Cryopreservation In Oncological Patients During Covid-19 Pandemic

During the pandemic, most infertility and IVF Units decided to keep fertility preservation active as an urgent procedure. It is well established that chemotherapy is gonadotoxic and impact negatively on quality of life. The American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) recommend to offer fertility preservation before cancer treatment. Oocyte cryopreservation and sperm cryopreservation are the best treatments of the choices to preserve fertility in cancer patients. This is a prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from February 2020 to January 2021. 149 cancer patients underwent gamete cryopreservation to preserve their fertility. All patients tested for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2 48 hours before cryopreservation. The viral RNA detection was provided only in case of positive swab and no treatment was interrupted. 59 women underwent ovarian stimulation with gonadotropins followed by oocyte retrieval. Women’s basal characteristics were: Age (m±sd) 31.0 ± 7.0 years, FSH (m±sd) 14 ±9IU/l, AMH (m±sd) 2.4 ± 1.3 ng±ml, AFC (m±sd) 9 ±5. 90 men underwent spermatozoa rapid cryopreservation. Men’s basal characteristics were: Age (m±sd) 34±7 years;Total Sperm count x 106 (m±sd) 52.3±49.6, Sperm x 106/ml 28.1±25.5, Total motility (m±sd) 48.0±26.7 %, Progressive motility (m±sd) 22.2±20.5 %, normal morphology (m±sd) 22.3±11.1 %. 296 oocyte were cryopreserved: 5.5±4.3 (mean±sd per patient). Vitrification with closed devices (High-Security Vitrification™ - HSV) was used for oocyte cryopreservation to minimize the risk of viral contamination. 403 Sperm samples were frozen with slow freezing: 5.7±2.1 (m±sd) per patient. All patients tested negative for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2. The oncofertility activity must be maintained even in pandemic periods by implementing adequate safety measures to protect the health of patients and healthcare professionals. Funding: Supported by Italian Ministry of Health "Fertility Preservation in gonadotoxic treatments” project code RF-2011-02348826 Conflict of Interest: None to disclose