Hammersmith amp St Marys Hospital Imperial College Healthcare NHS Trust Egg Freezing amp IVF add ons Everything you need to know Egg freezing Egg freezing Collection and storage of eggs from a woman for use at a later date ID: 1032930
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1. 1Rehan Salim MD MRCOGConsultant Gynaecologist & Subspecialist in Reproductive MedicineHammersmith & St Mary’s HospitalImperial College Healthcare NHS TrustEgg Freezing & IVF “add ons”Everything you need to know!
2. Egg freezing
3. Egg freezingCollection and storage of eggs from a woman for use at a later dateProvides an “insurance” for when natural fertility declinesMeans egg donation will not be neededAllows women to concentrate on priorities other than getting pregnant without compromise
4. Can we predict declining fertility?Ovarian reserve assessment“empowerment”?FSH levelsAMH levels
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7. Egg freezingAim to freeze as many eggs as can safely be collectedHFEA data = approx 12 eggs for best chance of pregnancy from infertile couples
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9. Egg freezingEssentially an IVF cycle without the embryo transferDay 1 of periodStart FSH injections dailyFrom Day 5/6 start GnRH antagonistApprox 10-12 days stimulation and then egg collectionEggs collected under sedationFrozen by vitrification same day
10. Vitrification vs Slow FreezeVitrificationHigh level of cryoprotectantsExtremely fast rate of cooling (>20,000C/min)No ice crystal formation (straight to glass like state)No special equipment neededSlow freezingLow level of cryoprotectantsSlow controlled rates of cooling (0.1-0.3C/min)Slow dehydration to minimise ice crystal formationRequires special equipment
11. Vitrification vs Slow Freeze
12. VitrificationASRM (American Society for Reproductive Medicine) lifts label of “experimental technique” from egg vitrification in 2012expert committee formed their view based on 80 peer reviewed articles concerning the effectiveness of freezing eggs, and 32 concerning safety
13. VitrificationASRM Expert committee (2012)There were only 4 randomized controlled trials which found that success rates using fresh or frozen eggs in IVF were similar. All 4 of these trials were conducted on healthy YOUNG women under the age of 30Only two studies were referenced looking into the short term risks to babies born from frozen eggs. 1100 babies were included in these studies combined
14. VitrificationASRM Expert committee (2012)The ASRM also noted that the randomized controlled trials were only published by the best and most successful fertility clinics, and hence the results should not necessarily be generalized across ALL clinics. This recommendation was repeated when the ASRM looked at the actual success rate statistics from fertility clinics in the US as opposed to specific clinical trial results.
15. Egg Freezing
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17. AgeAverage # of Mature EggsMost Per PatientLeast Per Patient3014.752663116.24153213.72743313.23223413.15003513.03913612.34713710.34403810.1370399.6370408.5350418.6351427.9331439.3200446.3141453.991Number of Oocytes Obtained By Age For Cryopreservation at One Clinic 2007 - 2014 Source: NYU
18. # of Eggs3035374042111%11%7%4%2%544%4429%16%11%1069%6950%30%20%2090%9075%51%37%4099%99%94%76%60%Predicted Egg Freezing Success Rates By Retrieval Age and Volume Source: Goldman, Fox et al
19. Egg freezing success rates
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21. Egg Freezingcosts – 1 cycleCost of Egg Freeze cycle + medications£4500Cost of Storage each year£350Cost of Thaw + ICSI£2000- £3000+/- donor sperm£500Total4500+ (350 x 5) + 2500 + 500 = £9250
22. Egg freezingIs it “fertility insurance”?Does it all women to “take control”Gives a chance with own eggs when there may be no chanceIs an option to be consideredBeware hidden costs!
23. IVF Add Ons
24. IVF Add onsAdditional techniquesAim to improve pregnancy rateCommercially availableHFEA viewTraffic light systemRed, amber, greenwww.hfea.gov.uk
25. IVF Add onsProblemInflate cost of IVF cycleNo good evidence they work“why not just try it”“it might work”Regret
26. IVF Add OnsSolutionDo not charge for experimental techniquesAdd ons Assisted HatchingTime lapse incubatorEmbryoglueAcupunctureNutritional support“Holistic therapies”
27. Assisted HatchingLaser used to break shell around embryosSome embryos may have thicker shellOlder womenRecurrent IVF failuresTheoretically helps embryo implant
28. Assisted HatchingCochrane review
29. Assisted hatching
30. Time lapse incubatorStudyYearSample SizeStatistically Significant ImprovementKahraman201364NoRubio2014204YesMatyas201549NoGoodman2016180NoKaser20172015NoStudies Comparing Outcomes With and Without Time Lapse
31. Embryoglue
32. What’s the evidence for embryo glue?Research from the Cochrane review shows that embryo glue containing hyaluronan increases pregnancy and live birth rates by around 10%. There is one high quality study in this review which shows that the use of embryo glue improves pregnancy and live birth rates, other studies in the review were of moderate quality. Further high quality studies are needed before doctors can be confident of the benefits of embryo glue.Embryoglue
33. Acupuncture
34. Acupuncture
35. Acupuncture
36. Add onsNo evidence most workAdd considerable cost to an IVF cycleIf offered – should only be part of a research trial at presentpatients should not pay to take part in research