No. 356-Egg Freezing for Age-Related Fertility Decline.

OBJECTIVE: To provide a comprehensive review and evidence based recommendations for Canadian fertility centres that offer social egg freezing. OUTCOMES: In social egg freezing cycles we evaluated thawed oocyte survival rates, fertilization rates, embryo quality, pregnancy rates, and live birth rates. We also review how these outcomes are impacted by age, ovarian reserve, and the number of eggs cryopreserved. Finally, we discuss the risks of social egg freezing, the alternatives, the critical elements for counselling and informed consent, and future reporting of egg freezing outcome data. EVIDENCE: Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and using key words ("oocyte cryopreservation," "egg freezing," "egg vitrification," "social egg freezing," and "elective egg freezing"). Results included systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. Expert opinion based on clinical experience, descriptive studies, or reports of expert committees was also included to discuss aspects of egg freezing not currently rigorously studied. VALUES: The evidence obtained was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committees of the Canadian Fertility and Andrology Society (CFAS) under the leadership of the principal authors. BENEFITS, HARMS, AND COSTS: Implementation of this guideline should assist the clinician to develop an optimal approach in providing counselling for egg freezing while minimizing harm and improving patient outcomes during treatment. VALIDATION: These guidelines have been reviewed and approved by the membership of the CFAS and by the CPG Committees of CFAS and The Society of Obstetricians and Gynaecologists of Canada (SOGC). SPONSORS: CFAS and SOGC.

First reported case of sextuplets conceived via letrozole for ovulation induction.

OBJECTIVE: To report the first case of sextuplets conceived via letrozole during ovulation induction. DESIGN: Case report. SETTING: Private fertility clinic. PATIENT(S): A 32-year-old female with a history of secondary infertility and polycystic ovary syndrome. INTERVENTION(S): Letrozole, 7.5 mg, on cycle days 3-7 after a progesterone-induced menses. MAIN OUTCOME MEASURE(S): Clinical pregnancy. RESULT(S): Sexchorionic-sexamniotic pregnancy. CONCLUSION(S): High-order multiple gestations are possible with letrozole ovulation induction, so patients should be counseled appropriately and follicle monitoring considered.