Egg Freezing for Fertility Preservation!"##"$%&'()**#(+$,-&./-&012/& /"+3(4+-& 1#+$5&13643+&7+&839+5:(;<3&.35"("63&

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August Robinson
5 years ago
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1 Egg Freezing for Fertility Preservation!"##"$%&'()**#(+$,-&./-&012/& /"+3(4*+-& 1*#*+$5*&13643+&7*+&839+*5:(;<3&.35"("63&

4 +$4)3+&4)$6&$F3&5343+%"63D&%36*9$:D3GH$55I-&JKKLM& N3D4&7*##"(#3D&+3(+:"435&O+D4P&)"F)3+&9+*9*+;*6&*7&9**+3+& Q:$#"4I&**(I43D&$D&R*%36&$F3& S)3&;%3&E34R336&4)3&*6D34&*7&':ET73+;#"4I&GLU-VVV& 7*##"(#3D-&$<3W&XYWU&I+DM&$65&%36*9$:D3GJVVV&7*##"(#3D-&$<3& UJ&I+DM&"D&Z&JX&I+D&

5 JV[&*7&9*9:#$;*6&E3(*%3&%36*9$:D$#&EI& \U& S)3+37*+3-&3D4W&JV[&*7&9*9:#$;*6&$4&+"D]&EI& $F3&XL&7*+&53(#"6"6F&73+;#"4I& H+*%&*6D34&*7&5"$F6*D"D-&73+;#"4I&R"##&6*4&E3& _**+&+3D9*6D3&4*&1=0&

6 Risk factors that suggest early screening H$%"#I&)"D4*+I&*7&3$+#I&%36*9$:D3& 1)3%*4)3+$9I-&+$5"$;*6& _3#<"(&D:+F3+I& _3#<"(&"673(;*6& '3<3+3&365*%34+"*D"D& '%*]"6F&

7 Methods of Ovarian Reserve Assessment N"*()3%"($#^&& H'0-&CD4+$5"*#-&?6;%:##3+"$6&)*+%*63& '*6*F+$9)"(^&?64+$#&7*##"(#3&(*:64-&*<$+"$6&<*#:%3&

$UbK&94D&3<$#:$435&EI&#"73T4$E#3&$6$#ID"D&*<3+&\U&%*& Cumulative Pregnancy Rate 60 50 40 30 20 10 0 10 25 40 Months$

8 _+*D93(;<3&C<$#:$;*6&*7&4)3&111S&& UbK&94D&3<$#:$435&EI&#"73T4$E#3&$6$#ID"D&*<3+&\U&%*& Cumulative Pregnancy Rate Months Normal Abnormal '(*`&34&$#W&!"#$%&'()*$JKKUP&JV^JYVaTJV&

10 Anti-mullerian hormone" Glycoprotein that belongs to TGF-ß superfamily" Expressed in the granulosa cells of preantral and early antral follicles"

11 Loh J S, and Maheshwari A Hum. Reprod. 2011;26: Potential uses of AMH. *Definite evidence available.

13 Answer: Cryopreservation of eggs? Fertility Preservation Medical Social May be biggest advance in reproductive freedom for women since oral contraceptives Allows women to delay marriage, pursue advanced education or strenuous carrier path 6

14 Oocyte Freezing History: Human 1986: Slow freeze, DMSO (Chen, Australia) 1989: Slow freeze, PROH and DMSO (Siebzehnrübl, West Germany) Eight Years 1997: Slow freeze, PROH and Sucrose - ICSI (Porcu, Italy) 2000: Vitrification: EG and Sucrose - electron microscope grid (Yoon, Cha, Korea) 2003: Vitrification, EG, DMSO and Sucrose - Cryotop TM (Kuwayama)

15 Number of Live Births 1986 to 2008 Adapted with permission. Noyes N, Porcu E Borini A. Reprod BioMed Online [e-pub ahead of print on 8 April 2009].

16 !"#$%&'()$"*)&+&),-%."/'

elevation of viscosity during the cooling

17 WHAT IS VITRIFICATION? Vitrification is a process that produces a glasslike solidification of living cells not by crystallization but by an extreme elevation of viscosity during the cooling Base medium + Cryoprotectant Base medium COOLING RATE x VISCOSITY VOLUME

18 !"#$%&#'()Techniques Vitrification Slow Freezing Physiological solution Before cooling Cryoprotectant solution Vitrification solution Ice seeding During cooling 0.3ºC/min Slow cooling Ultra rapid cooling 20,000ºC/min Rapid cooling Closed carrier OK In LN2 Open carrier

19 Comparing Slow freezing with Vitrification *+,-)./%%0$&1) 2$3/$4#56,&)?:4)*+D& ':+<"<$#& _+3F6$6(I&?:4)*+D& ':+<"<$#&& _+3F6$6(I& 1)36&34&$#& GJKYUTJKbVM& YU[& XX[& c:r$i$%$&34& $#&GLVVUM& KV[& \J[& 1)"$6&34&$#& GLVVUM& K\[& \Y[& N*+"6"&34&$#& GLVVaM& Y\[& K[& 2:(36$&34&$#& GLVVaM& b\[& UY[&?6;6*+"&34&$#& GLVVYM& KK[& XX[& _$+%3F"$6"&34& $#&GLVVbM& YU[& JK[& 1*E*&34&$#& GLVVbM& KY[& \b[& Chen and Yang, 2009

20 CryoTop CryoTip VTF Devices Cryo Loop EM Grid Cryopette Rapid-i microsecure OPS/CBS CryoLeaf

21 Metabolome and Proteome d:$6;o($;*6& *7& 4)3& %34$E*#*%3& $65& 9+*43*%3& *7& 4)3& **(I43& ) $ D& + 3 < 3 $ # 3 5& 4 ) $ 4& R)3+3$D&D#*R&7+33e"6F&)$D& $& 5+$%$;(& 3f3(4& *6& (3##& 9)ID"*#*FI-& <"4+"O($;*6& $993$+D& 4*& )$<3& #"%"435& 3f3(4W& S)"D& "D& 9#$:D"E#I& $()"3<35& EI& 4)3& #"%"435& 3 g 9 * D : + 3 & 4 *& (+I*9+*43(4$64D& Gardner et al.,2007

22 +),-.&$/0.(01,23)4$*)&5$4).$04,(&25&$.6&$(057$)8$&#9(-)40,$24&"':)0*-$;$2$'20(&*$(24*)#0<&*$ Forman, Fertility and Sterility , 644

23 !"#$%&#'( Results

24 Oocyte Vitrification: A Meta-analysis -Cobo and Diaz, Fertil Steril 2011; 96: Meta-analysis of 5 randomized controlled trials involving 4282 vitrified oocytes, 3524 fresh oocytes and 361 slow-frozen oocytes from No differences in fertilization, cleavage or ongoing pregnancy rates between vitrified and fresh oocytes Vitrified vs. slow-frozen:!survival rate (OR 2.46, )! fertilization rate (OR 1.5, )! top-quality embryo rate (22.4% vs. 8.0%, OR 3.32, )

$,&,/>)) @5&A$&1) B)C'#+%>) LX& Lb& D%5&)D53%/&5+)E1%) LYW\&I+D& X\WK&I+D&G_hVWVJM& D53F/%),,#'3%>) <$3/$4%G) JYWVK&$ $JLWJb&G_hVWVJM& H);,#'3%)>F/<$<5+) KJWba[& blw\[&g_hvwvjm& I%/6+$056,&)/53%) YUWVa[& YYWLL[& C+%5<51%)/53%) KXWYX[&$ $%//%G) LWV& LWXa& ONP+5&356,&)/53%)Q>5#R) UV[& XKWXK[& ONP+5&356,&)/53%)QIS7R) \XW\b[& XKWXK[&$

25 Oocyte Vitrification Liquid Nitrogen Rapid Warming 1M Sucrose B)C'#+%>) LX& Lb& D%5&)D53%/&5+)E1%) LYW\&I+D& X\WK&I+D&G_hVWVJM& D53F/%),,#'3%>) <$3/$4%G) JYWVK& JLWJb&G_hVWVJM& H);,#'3%)>F/<$<5+) KJWba[& blw\[&g_hvwvjm& I%/6+$056,&)/53%) YUWVa[& YYWLL[& C+%5<51%)/53%) KXWYX[& bkwba[&?j)7/5&>.%/>) JJ& Jb&?K)7/5&>.%/>) JL& K& L,)7/5&>.%/) J& D%5&)B)7/5&>.%//%G) LWV& LWXa& ONP+5&356,&)/53%)Q>5#R) UV[& XKWXK[& ONP+5&356,&)/53%)QIS7R) \XW\b[& XKWXK[& C+$&$#5+)T/%1&5&#')/53%) QIS7R) UaWUL[& UXWUY[& V& V& U$<%)S%5+3=')O&.5&3>) JX&& JK& '()**#(+$,-&8N.*6#"63&

26 Non-donor Oocyte Vitrification CCRM Outcomes through 3/14 All cases with Kuwayama Cryotop technique Oocytes of 48 patients warmed, 84 embryos transferred (mean 1.8 embryos transferred) Oocyte survival: 85.5% Fertilization: 76.8% Pregnancy rate: 60.5% Implantation rate (cardiac activity): 43.8%

27 Oncofertility

28 Fertility Preservation in Reproductive Age Women with ($6(3+&"6&R*%36&R$D&$99+*g"%$43#I&bVV-VVV&$65&ZJV[&*7& 4)3D3&($D3D&R3+3&"6&R*%36&h\U&I3$+D&*#5W&?5<$6(3D&"6&($6(3+&4)3+$9I&*<3+&4)3&9$D4&4R*&53($53D&)$<3& #35&4*&$&+3%$+]$E#3&"%9+*<3%364&"6&D:+<"<$#&+$43DW&& i67*+4:6$43#i-&4+3$4%364d&d:()&$d&()3%*4)3+$9i-& +$5"*4)3+$9I&$65j*+&D:+F3+I&($6&"65:(3&9+3%$4:+3&*<$+"$6& 7$"#:+3&G_=HMW&

29 Impact of Cancer Treatment S)3&*<$+"3D&$+3&<3+I&D36D";<3&4*&(I4*4*g"(&5+:FD-&3D93("$##I& $#]I#$;6F&$F364D-&R)"()&$+3&#"]3#I&4*&($:D3&F*6$5$#& 5ID7:6(;*6W&1I(#*9)*D9)$%"53&"D&4)3&$#]I#$;6F&$F364&4)$4& ($:D3D&4)3&%*D4&5$%$F3&4*&**(I43D&$65&F+$6:#*D$&(3##D&"6&$& 5*D3T &%$663+W&& _3#<"(&+$5"$;*6&4)3+$9I&"D&$#D*&]6*R6&4*&($:D3&_=H-&$D& 3g9*D:+3&4*&UkJV&B+$I&"D&4*g"(&4*&**(I43DW&& C<$#:$;6F&4)3&#"]3#")**5&*7&_=H&$,3+&()3%*4)3+$9I&*+& +$5"*4)3+$9I&"D&*,36&9+*E#3%$;(W&.*+3*<3+-&"4&D)*:#5&E3& D4+3DD35&4)$4&*<$+"$6&+3D3+<3&<$+"3D&36*+%*:D#I&7+*%&*63& R*%$6&4*&4)3&63g4&&

30 =6#I&$&D%$##&7+$(;*6&*7&9$;364D&$4&+"D]&*7&_=H&$+3& &4*& D93("$#"D4D&4*&5"D(:DD&73+;#"4I&9+3D3+<$;*6&*9;*6D& =7&4)"D&F+*:9-&*6#I&$&73R&R*%36&$(4:$##I&:653+F*&73+;#"4I& 4*&#$43+&"6&#"73&7*+&D*("$#&*+&O6$6("$#&+3$D*6D-&$65&4)3&"6("536(3& *7&%*D4&($6(3+D&"6(+3$D3D&R"4)&$F3&

31 @6&l:#I&LVJX-&4)3&?%3+"($6&'*("34I&*7&1#"6"($#&=6(*#*FI&G?'1=M& :95$435&4)3"+&F:"5$6(3&7*+&)3$#4)T($+3&9+*<"53+DW&& 03$#4)T($+3&9+*<"53+D&G"6(#:5"6F&FI63(*#*F"(&*6(*#*F"D4D-& 935"$4+"(&*6(*#*F"D4D&$65&)3%$4*#*F"D4DM&D)*:#5&$55+3DD&4)3& 9*DD"E"#"4I&*7&"673+;#"4I&R"4)&9$;364D&+3Q:"+"6F&4+3$4%364&R"4)& F*6$5*4*g"(&5+:FD&$65j*+&"++$5"$;*6&$D&9$+4&*7&4)3&"67*+%35& (*6D364&9+*(35:+3&$65&$5<"D3&4)3%&$D&4*&$<$"#$E#3&%34)*5D& *7&73+;#"4I&9+3D3+<$;*6-&+373++"6F&4)3%&4*&$99+*9+"$43& +39+*5:(;<3&D93("$#"D4DW&&

32 Fertility Preservations Options!*%36&R"4)&($6(3+&)$<3&D3<3+$#&*9;*6D&4*&9+3D3+<3&4)3"+& 73+;#"4I&$65&36$E#3&4)3%&4*&(*6(3"<3&R)36&4)3I&)$<3& +3(*<3+35^&& *<$+"$6&4+$6D9*D";*6& 3%E+I*&(+I*9+3D3+<$;*6& "%%$4:+3&*+&%$4:+3&**(I43&(+I*9+3D3+<$;*6& *<$+"$6&;DD:3&(+I*9+3D3+<$;*6W& &1:++364#I-&3%E+I*&$65&%$4:+3&**(I43&(+I*9+3D3+<$;*6& 365*+D35&EI&4)3&?%3+"($6&'*("34I&*7&839+*5:(;<3&.35"("63& G?'8.MW&&

33 S*&5$43-&6*&"6(+3$D35&+"D]&*7&E+3$D4&($6(3+&+3(:++36(3&)$D&E336&*ED3+<35& "6&9$;364D&R"4)&E+3$D4&($6(3+&4+3$435&R"4)&4)3&(*%E"635&9+*4*(*#& G6$%3#I&#34+*e*#3&$65&F*6$5*4+*9"6MW&&?&%34$T$6$#ID"D&*7&D3<36&+34+*D93(;<3&D4:5"3D&+3<3$#35&4)$4&R*%36&R"4)& %$#"F6$6("3D&)$5&#*R3+&6:%E3+D&*7&**(I43D&$,3+&1='&G7*+&73+;#"4I& 9+3D3+<$;*6M&4)$6&5"5&)3$#4)I-&$F3T%$4()35&(*64+*#&"65"<"5:$#D& "67*+%35&4)$4&4)3&3g93(435&6:%E3+&*7&**(I43D&+34+"3<35&$,3+&1='&%"F)4& E3&#*R3+&4)$6&4)$4&*E4$"635&7+*%&)3$#4)I&9$;364D&*7&$&D"%"#$+&$F3W&

34 Conclusions?FF+3DD"<3&()3%*4)3+$9I&$65j*+&+$5"*4)3+$9I&$65&E*63& %$++*R&4+$6D9#$64$;*6&($6&(:+3&mKV[&*7&F"+#D&$65&I*:6F& R*%36&$f3(435&EI&5"D3$D3D&+3Q:"+"6F&D:()&4+3$4%364W& A3<3+4)3#3DD-&4)3&+"D]&*7&"%9$"+"6F&F*6$5$#&7:6(;*6&"D&)"F)-& 9$+;(:#$+#I&R)36&F*6$5*4*g"(&5+:FD&G3D93("$##I&$#]I#$;6F& $F364DM&$+3&:D35W& C%E+I*&$65&**(I43&(+I*9+3D3+<$;*6&$+3&4)3&*9;*6D&*7& ()*"(3&G$65&$+3&365*+D35&EI&4)3&?'8.M&"7&()3%*4)3+$9I&($6& E3&53#$I35-&F"<"6F&9$;364D&R"4)&($6(3+&4)3&)*93&*7&$& 4+3$4%364-&*<$+"$6&;DD:3&(+I*9+3D3+<$;*6&"D&4)3&*6#I& $<$"#$E#3&%34)*5W&

35 Thank You

The 5th World congress of the INTERNATIONAL SOCIETY FOR FERTILITY PRESERVATION Vienna, Austria November 16-18, 2017

Vitrification: "Robots" versus Human Comparing automated vitrification outcomes The 5th World congress of the INTERNATIONAL SOCIETY FOR FERTILITY PRESERVATION Vienna, Austria November 16-18, 2017 Zsolt