What advice should we give our patients to preserve their fertility and avoid needing oocyte donation in the future? - A Social Fertility Preservation program.

OBJECTIVE: To describe our fertility preservation program focusing on the number of oocytes vitrified by age. METHODS: From January 2015 to December 2016, 686 oocyte vitrification cycles were performed in our units for the social fertility preservation program. In total, 288 were donors who donated their oocytes for our oocyte-banking program, and 398 were patients who underwent elective fertility preservation. RESULTS: The mean numbers of COCs retrieved and vitrified oocytes were similar among the donor cycles (women under 30 years). In those patients over 36 years of age the mean numbers of COCs retrieved and vitrified oocytes were significantly lower. We also estimated the association between age and cancelation rates. Odd ratios (OR) for total cancelation was calculated between patients of 31-35 years and 41-45 years; the OR was 5.17 (95% CI 1.89 - 14.17) and increased up to 25.67 (95% CI 5.01 - 131.42) between patients 31-35 y and those older than 45 years. No differences were found between patients of 31-35 years and 36-40 years. The OR for total cancellation increased 3.83 (95% CI 2.06 - 7.11) and 19.00 (95% CI 4.56 - 79.11) between women 36-40 years and 41-45 years, and those older than 45 years, respectively. Finally, the oocyte survival rate in patients under 36 years of age was similar to that of our donor program (94% vs. 95%). CONCLUSIONS: Based on this study, we encouraged our patients under than 36 years of age to preserve their fertility for the future.

Efficacy of oocyte vitrification combined with blastocyst stage transfer in an egg donation program.

BACKGROUND A successful oocyte vitrification program is important for women with various indications for assisted reproduction technology. The objective of this study was to report the outcome of vitrification of oocytes, obtained through an oocyte donation program, by evaluating the embryo development, pregnancy and implantation rates (IRs) after blastocyst transfer. METHODS A total of 1098 oocytes were obtained from 78 donors. There were 312 oocytes used in the study group (vitrified oocytes) and 786 used in the control group (fresh oocytes). There were 34 recipients who received blastocysts obtained from vitrified oocytes and 58 recipients who received blastocysts from fresh oocytes. The fertilization rate, cleavage rate, embryo quality, pregnancy rate (PR) and IR were compared between groups. RESULTS Vitrified oocytes showed a survival rate of 89.4%. There was no difference in the fertilization rate (76.1 and 87.5%), Day 2 cleavage rate (96.3 and 98.0%) or blastocyst formation rate (41.3 and 45.3%) for the study and control groups, respectively. PRs, IRs and miscarriages rates (MRs) were similar for the study group compared with the control group (PR: 61.8 versus 60.0%; IR: 43.9 versus 42.9%; MR: 9.5 versus 5.9%). CONCLUSIONS The developmental competence of embryos obtained from vitrified oocytes is not affected by the vitrification procedure, since they preserve the potential to be fertilized and to develop into high-quality blastocysts, similar to embryos from fresh oocytes. The successful clinical outcome indicates the use of this procedure for oocyte donation programs and for oocyte storage in general.

In vitro development and pregnancy outcomes for human embryos cultured in either a single medium or in a sequential media system.

OBJECTIVE: To compare a single medium, with medium renewal on day 3, with a sequential media system for development of human embryos to the blastocyst stage and subsequent pregnancy outcome. DESIGN: Prospectively randomized study using donor oocytes. SETTING: Private infertility clinic. PATIENT(S): Oocytes were collected from 47 donors (mean +/- SD age = 25.6 +/- 3.5 years) from March to October 2006 and used for 79 patients (40.6 +/- 5.4 years). The patients were prospectively randomized to have their embryos cultured in a single medium or in a sequential media system. INTERVENTION(S): The donor oocytes were fertilized with fresh patient partner sperm and the resultant zygotes cultured in either a single medium or a sequential media system from day 1 until the blastocyst stage. After endometrial preparation the embryos were transferred to the patients on day 5 or day 6. MAIN OUTCOME MEASURE(S): In vitro embryo developmental characteristics and pregnancy and implantation rates. RESULT(S): In vitro development rates on days 3, 4, and 5 and implantation rates were significantly greater for embryos cultured in the single medium than for those cultured in the sequential media system. CONCLUSION(S): A single medium was as good as or better than a sequential media system for human embryo culture from the zygote to blastocyst stage. The idea that a sequential media system is required for optimal development of the human embryo to the blastocyst stage is highly questionable.

Effect of letrozole at 2.5 mg or 5.0 mg/day on ovarian stimulation with gonadotropins in women undergoing intrauterine insemination.

OBJECTIVE: To determine the effect of combined therapy of letrozole (2.5 mg or 5.0 mg) with recombinant follicle-stimulating hormone (FSH) in comparison with the administration of recombinant FSH alone in an intrauterine insemination (IUI) program. DESIGN: Retrospective study. SETTING: Assisted fertilization program in a specialized infertility center. PATIENT(S): 110 women undergoing IUI and gonadotropin therapy. INTERVENTION(S): Recombinant FSH alone administered from day 3 or combined with letrozole, 2.5 or 5.0 mg/day, on days 3 to 7, and gonadotropins starting on day 7 of the menstrual cycle. Transvaginal ultrasound examinations were done until the dominant follicle reached 18 mm in diameter. Ovulation was triggered with 10,000 IU of human chorionic gonadotropin (hCG), and IUI performed 30 to 40 hours later. MAIN OUTCOME MEASURE(S): Recombinant FSH dose required, number of follicles greater than 14 mm and 18 mm, endometrial thickness, pregnancy rates, miscarriages, and characteristics of newborns. RESULT(S): Women treated with FSH and 5.0 mg/day of letrozole required a lower dose of FSH than the group cotreated with 2.5 mg/day of letrozole or with FSH alone. Throughout most of the follicular phase, the endometrial thickness was statistically significantly less in both letrozole cotreatment groups compared with the FSH control group. By the day of hCG administration, the endometrial thickness was comparable among all the groups. The pregnancy rates were the same with recombinant FSH alone or combined with letrozole. CONCLUSION(S): In terms of cost-effectiveness, 5.0 mg/day of letrozole is more effective than the 2.5 mg/day in cotreatment with no adverse effect on pregnancy rate or outcome.