Q7. What is the time limit for use of cryopreserved oocytes/tissue?
A: Under optimal storage conditions, cryopreserved oocytes/tissue can be utilized indefinitely without a negative effect on pregnancy outcomes.
Q8. What does the future hold for fertility preservation?
A: The future holds promise for both the medical and nonmedical (planned) utility of fertility preservation. With the former, we will see that the utility of OTC and orthotopic and heterotopic tissue transplantation increase as success rates improve. Improved neovascularizing agents will make the transplants last longer and enhance pregnancy outcomes.23,24 I see planned fertility preservation increasing, based on the experience gained from cancer patients and some preliminary experience with planned OTC, especially for healthy women who wish to consider delaying menopause.25,26
Because of attrition from apoptosis, approximately 2,000 oocytes are wasted per ovulation. Through calculation models, we predict that if an equivalent of one-third of a woman’s ovarian cortex can be cryopreserved (which may not significantly affect the age at natural menopause) before age 40 years, transplantation at perimenopause may provide sufficient primordial follicles to delay menopause for 5 years or longer.26 Because ovarian tissue can also be transplanted subcutaneously under local anesthesia, as we have shown,27,28 repeated heterotopic transplants can be performed in an office setting at reduced cost, invasiveness, and with enhanced effectiveness. We can expect increasing reports and progress on this planned use of OTC and transplantation in the future.
Dr. Oktay is professor of obstetrics & gynecology and reproductive sciences and director of the Laboratory of Molecular Reproduction and Fertility Preservation at Yale University, New Haven, Conn. Dr. Trolice is director of The IVF Center in Winter Park, Fla., and professor of obstetrics and gynecology at the University of Central Florida, Orlando.
References
1. Lurie S. Eur J Obstet Gynecol Reprod Biol. 1992 Jan 9;43(1):1-7.
2. Oktay K and Karlikaya G. N Engl J Med. 2000 Jun 22;342(25):1919.
3. Sonmezer and Oktay K. Hum Reprod Update. 2004;10(3):251-66.
4. Oktay K et al. J Clin Oncol. 2018 Jul 1;36(19):1994-2001.
5. Goldfarb SB et al. Breast Cancer Res Treat. 2021;185:165-73.
6. Titus S et al. Sci Rep. 2021 Jan 11;11(1):407.
7. Soleimani R et al. Aging (Albany NY). 2011 Aug;3(8):782-93.
8. Titus S et al. Sci Transl Med. 2013 Feb 13;5(172):172ra21.
9. Oktay KH et al. Fertil Steril. 2022 Jan 5:S0015-0282(21)02293-7.
10. Oktay K et al. Fertil Steril. 2022;117(1):181-92.
11. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 2019;112(6):1022–33.
12. Cil A et al. Fertil Steril. 2013 Aug;100(2):492-9.e3.
13. Goldman KN et al. Fertil Steril. 2013 Sep;100(3):712-7.
14. Marin L and Oktay K. Scientific history of ovarian tissue cryopreservation and transplantation. In: Oktay K (ed.), Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation. Elsevier;2022:1-10.
15. Oktay K et al. J Clin Oncol. 2005 Jul 1;23(19):4347-53.
16. Kim JY et al. J Clin Endocrinol Metab. 2016 Apr;101(4):1364-71.
17. Turan V et al. J Clin Oncol. 2021;39:18.
18. Oktay K et al. J Clin Oncol. 2010 Jan 10;28(2):240-4.
19. Lin W et al. J Clin Endocrinol Metab. 2017;102(10):3839-47.
20. Turan V et al. Reprod Sci. 2018;(25):26-32.
21. Oktay K et al. Presence of BRCA mutations and a pre-chemotherapy AMH level of < 2ng/mL strongly predict risk of amenorrhea in women with breast cancer P-291. Presented at the American Society for Reproductive Medicine 78th annual meeting, Anaheim, Calif. Oct. 22-26, 2022.
22. Oktay KH et al. Fertil Steril. 2020;113(6):1251‐60.e1.
23. Soleimani R et al. PLoS One. 2011 Apr 29;6(4):e19475.
24. Marin L et al. Future aspects of ovarian cryopreservation and transplantation. In: Oktay K (ed.). Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation. Elsevier; 2022;223-30.
25. Oktay KH et al. Trends Mol Med. 2021;27(8):753-61.
26. Oktay K and Marin L. Ovarian tissue cryopreservation for delaying childbearing and menopause. In: Oktay, K. (Ed.), Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation. Elsevier;2022:195-204.
27. Oktay K et al. JAMA. 2001 Sep 26;286(12):1490-3.
28. Oktay K et al. Lancet. 2004 Mar 13;363(9412):837-40.