Young Women's Attitudes Towards Modern Reproductive Practices: A Survey Study Assessing What Young Women Want.

Objective: To assess young women's preferences and attitudes towards various options to create families at a time when women are increasingly postponing childbearing due to greater career focus and widespread availability of contraceptives. Study Design: Reported data were obtained from an electronic survey distributed over 6 months to approximately 7,000 females enrolled in American universities. Results: Most respondents ranked preferable childbearing modalities as follows: natural conception, assisted reproductive technologies, adoption, anonymous oocyte donation, and directed oocyte donation. The majority would consider using autologous oocyte cryopreservation for childbearing, but only a minority saw oocyte donation as a viable option. When queried about donating oocytes, 61% said they would donate to a sibling/friend, 51% to research, and 40% for clinical usage. Most would prefer to receive donation outcome information and would be comfortable being contacted by offspring. Most believed selecting recipient characteristics would increase their likelihood of donation, and 43% felt donors should receive additional compensation for desirable characteristics. Conclusion: Reproductive autonomy and fertility preservation are important to young educated females, a population sought-after for oocyte donation. Potential donors' desires for additional rights merit consideration as oocyte demand increases and frozen-oocyte banks emerge.

Successful Oocyte Cryopreservation in Reproductive-Aged Cancer Survivors.

OBJECTIVE: To demonstrate that oocyte cryopreservation is a feasible reproductive option for patients with cancer of childbearing age who require gonadotoxic therapies. METHODS: This study is a university-based retrospective review of reproductive-aged cancer patient treatment cycles that included ovarian stimulation, transvaginal oocyte retrieval, oocyte cryopreservation, and, in some cases, subsequent oocyte thaw, in vitro fertilization, and embryo transfer. Outcome measures included ovarian stimulation response, number of oocytes retrieved, cryopreserved, and thawed, and pregnancy data. RESULTS: From 2005 to 2014, 176 reproductive-aged patients with cancer (median age 31 years, interquartile range 24-36) completed 182 oocyte cryopreservation cycles. Median time between consult request and oocyte retrieval was 12 days (interquartile range 10-14). Median peak stimulation estradiol was 1,446 pg/mL (interquartile range 730-2,687); 15 (interquartile range 9-23) oocytes were retrieved and 10 (interquartile range 5-18) metaphase II oocytes were cryopreserved per cycle. Ten patients (11 cycles) have returned to attempt pregnancy with their cryopreserved oocytes. Among thawed oocytes, the cryopreservation survival rate was 86% (confidence interval [CI] 78-94%). Nine of 11 thaw cycles resulted in embryos suitable for transfer. The embryo implantation rate was 27% (CI 8-46%) and the live birth rate was 44% (CI 12-77%) per embryo transfer. Chance for live birth with embryos created from cryopreserved oocytes was similar between the patients with cancer in this study and noncancer patients who underwent the same treatment at our center (44% [CI 12-77%] compared with 33% [CI 22-44%] per embryo transfer). CONCLUSION: Oocyte cryopreservation is now a feasible fertility preservation option for reproductive-aged patients with cancer who require gonadotoxic therapies.

Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth.

OBJECTIVE: To determine whether oocyte cryopreservation for deferred reproduction is cost effective per live birth using a model constructed from observed clinical practice. DESIGN: Decision-tree mathematical model with sensitivity analyses. SETTING: Not applicable. PATIENT(S): A simulated cohort of women wishing to delay childbearing until age 40 years. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Cost per live birth. RESULT(S): Our primary model predicted that oocyte cryopreservation at age 35 years by women planning to defer pregnancy attempts until age 40 years would decrease cost per live birth from $55,060 to $39,946 (and increase the odds of live birth from 42% to 62% by the end of the model), indicating that oocyte cryopreservation is a cost-effective strategy relative to forgoing it. If fresh autologous assisted reproductive technology (ART) was added at age 40 years, before thawing oocytes, 74% obtained a live birth, and cost per live birth increased to $61,887. Separate sensitivity analyses demonstrated that oocyte cryopreservation remained cost effective as long as performed before age 38 years, and more than 49% of those women not obtaining a spontaneously conceived live birth returned to thaw oocytes. CONCLUSION(S): In women who plan to delay childbearing until age 40 years, oocyte cryopreservation before 38 years of age reduces the cost to obtain a live birth.

What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?

OBJECTIVE: To better understand women's beliefs, priorities, and attitudes toward oocyte cryopreservation, to appreciate the extent of their reproductive education, and to track the reproductive paths of women who chose to undergo oocyte cryopreservation treatment. DESIGN: An anonymous 30-question survey. SETTING: Not applicable. PATIENT(S): From 2005-2011, 478 women completed ≥1 oocyte cryopreservation treatment cycle at our center to defer reproduction. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Demographics, motivations, desires, fertility knowledge, and outcomes related to oocyte cryopreservation. RESULT(S): A total of 183 patients (38%) completed the survey with >80% being aged ≥35 years; white; having no partner at time of oocyte cryopreservation; undergoing oocyte cryopreservation after an optimal reproductive age; feeling they had improved their reproductive future after oocyte cryopreservation and being empowered by the process; aware of age-related infertility; sensing popular media falsely portrayed the upper age limit for natural conception; and recorded lack of partner as the primary rationale for not yet starting a family. Nineteen percent of respondents added that workplace inflexibility contributed to their reproductive dilemma. Half stated they learned about oocyte cryopreservation from a friend; others became aware through a medical provider, the media, and the internet. Most patients (93%) have not yet returned to use their frozen oocytes; 11 stated they had. Overall, 20% reported a successful conception after oocyte cryopreservation. CONCLUSION(S): Surveying oocyte cryopreservation patients provides a glimpse into the knowledge base and motivations surrounding current female reproductive practices. Oocyte cryopreservation technology may prove to bridge the gap between reproductive prime and when a woman is realistically "ready" to have children.

Experiences in fertility preservation: lessons learned to ensure that fertility and reproductive autonomy remain options for cancer survivors.

PURPOSE: Assess fertility preservation (FP) measures chosen by patients newly diagnosed with malignancy and their outcomes. METHODS: Reproductive-age patients referred for FP underwent counseling and elected cryopreservation vs. no treatment. Outcome measures included ovarian stimulation, FP choice, oocytes/zygotes retrieved/cryopreserved and pregnancy outcome. RESULTS: From 2005 to 2012, 136 patients were counseled with 124 electing treatment: 83 oocyte-only, 21 oocyte + zygote and 20 zygote-only cryopreservation. Age, partnership and financial status factored into FP choice. Treatment was completed in 12 ± 2 days with 14 ± 11 metaphase-II oocytes harvested and cryopreserved/cycle. Eight patients returned to attempt pregnancy; three succeeded. CONCLUSIONS: Our data demonstrate that oocyte and/or zygote banking are feasible FP options for women with malignancy; given the choice, the majority elected oocyte cryopreservation, highlighting desire for reproductive autonomy. Continued growth and research, combined with interdisciplinary communication, will ensure that appropriate candidates are offered FP and the potential for future parenthood, an important quality-of-life marker for survivors.

Human oocytes reprogram somatic cells to a pluripotent state.

The exchange of the oocyte's genome with the genome of a somatic cell, followed by the derivation of pluripotent stem cells, could enable the generation of specific cells affected in degenerative human diseases. Such cells, carrying the patient's genome, might be useful for cell replacement. Here we report that the development of human oocytes after genome exchange arrests at late cleavage stages in association with transcriptional abnormalities. In contrast, if the oocyte genome is not removed and the somatic cell genome is merely added, the resultant triploid cells develop to the blastocyst stage. Stem cell lines derived from these blastocysts differentiate into cell types of all three germ layers, and a pluripotent gene expression program is established on the genome derived from the somatic cell. This result demonstrates the feasibility of reprogramming human cells using oocytes and identifies removal of the oocyte genome as the primary cause of developmental failure after genome exchange.