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Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use.
Hum Reprod Open. 2017; 2017(1):hox003.HR

Abstract

STUDY QUESTION

What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and 'non-medical') and specific number of cycles?

SUMMARY ANSWER

Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for 'non-medical' OoC.

WHAT IS ALREADY KNOWN

The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries.

STUDY DESIGN SIZE AND DURATION

A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015.

PARTICIPANTS/MATERIALS SETTING AND METHODS

All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, 'other medical' reasons as part of an ART cycle, as well as for 'non-medical reasons' or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire.

MAIN RESULTS AND THE ROLE OF CHANCE

Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was 'serious disease' such as cancer in 10.9% of cycles, other medical indications as 'part of an ART cycle' in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues.

LIMITATIONS REASONS FOR CAUTION

Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC.

WIDER IMPLICATIONS OF THE FINDINGS

There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved.

STUDY FUNDING/COMPETING INTERESTS

The study was supported by ESHRE. There are no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Authors+Show Affiliations

No affiliation info availableReproductive Medicine Unit, New EGA, UCLH, Euston Road, London NW1 2BU, UK.15 Rue Guilleminot 75014 Paris, France.National ART Register, National Centre for Epidemiology, Surveillance and Health Promotion Istituto Superiore di Sanità Viale Regina Elena, 299, 00161 Roma, Italy.Reproductive Medicine Center, Altonaer Str. 59, D-20357 Hamburg, Germany.SISMER Via Mazzini 12, 40138 Bologna, Italy.HM Fertility Center Montepríncipe Boadilla del Monte 28660, Madrid, Spain.European Society of Human Reproduction and Embryology, Meerstraat 60, B-1852 Grimbergen, Belgium.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30895222

Citation

ESHRE Working Group on Oocyte Cryopreservation in Europe, et al. "Oocyte and Ovarian Tissue Cryopreservation in European Countries: Statutory Background, Practice, Storage and Use." Human Reproduction Open, vol. 2017, no. 1, 2017, pp. hox003.
ESHRE Working Group on Oocyte Cryopreservation in Europe, Shenfield F, de Mouzon J, et al. Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use. Human reproduction open. 2017;2017(1):hox003.
Shenfield, F., de Mouzon, J., Scaravelli, G., Kupka, M., Ferraretti, A. P., Prados, F. J., & Goossens, V. (2017). Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use. Human Reproduction Open, 2017(1), hox003. https://doi.org/10.1093/hropen/hox003
ESHRE Working Group on Oocyte Cryopreservation in Europe, et al. Oocyte and Ovarian Tissue Cryopreservation in European Countries: Statutory Background, Practice, Storage and Use. Human reproduction open. 2017;2017(1):hox003. PubMed PMID: 30895222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oocyte and ovarian tissue cryopreservation in European countries: statutory background, practice, storage and use. AU - ,, AU - Shenfield,F, AU - de Mouzon,J, AU - Scaravelli,G, AU - Kupka,M, AU - Ferraretti,A P, AU - Prados,F J, AU - Goossens,V, Y1 - 2017/03/29/ PY - 2017/02/08/received PY - 2017/02/08/revised PY - 2017/03/10/accepted PY - 2019/3/22/entrez PY - 2017/3/29/pubmed PY - 2017/3/29/medline KW - European data KW - access KW - funding KW - medical and non-medical indications KW - oocyte cryopreservation KW - ovarian tissue cryopreservation SP - hox003 EP - hox003 JF - Human reproduction open VL - 2017 IS - 1 N2 - STUDY QUESTION: What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and 'non-medical') and specific number of cycles? SUMMARY ANSWER: Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for 'non-medical' OoC. WHAT IS ALREADY KNOWN: The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries. STUDY DESIGN SIZE AND DURATION: A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015. PARTICIPANTS/MATERIALS SETTING AND METHODS: All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, 'other medical' reasons as part of an ART cycle, as well as for 'non-medical reasons' or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was 'serious disease' such as cancer in 10.9% of cycles, other medical indications as 'part of an ART cycle' in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues. LIMITATIONS REASONS FOR CAUTION: Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC. WIDER IMPLICATIONS OF THE FINDINGS: There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved. STUDY FUNDING/COMPETING INTERESTS: The study was supported by ESHRE. There are no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A. SN - 2399-3529 UR - https://www.unboundmedicine.com/medline/citation/30895222/Oocyte_and_ovarian_tissue_cryopreservation_in_European_countries:_statutory_background_practice_storage_and_use_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30895222/ DB - PRIME DP - Unbound Medicine ER -