Preservation of Fertility through Egg Freezing in Women with Premature Decline in Ovarian Reserve... a contradiction??

Approximately one percent of women stop ovulating before the age of 40. For most of these women, the only option to have a child is through egg donation whereby the woman would be the birth mother but not the genetic mother of the child.  Until recently, a premature decline in ovarian reserve was diagnosed primarily upon learning of an early menopause when the ovary has already been depleted of eggs. Two new developments in the field of reproductive medicine have expanded the possibility for these women to have their own biological child.

In recent years, it became the goal of research to find a way to recognize when the ovarian reserve is in its initial state of decline to provide some hope for a woman with this condition. Such a test is now widely available in the form of a blood test which identifies and measures a hormone known as “anti-Mullerian hormone” (AMH).  With this recognition, we can now determine when the ovary has many follicles able to produce eggs, and as such the ovarian reserve is normal. When the blood levels of AMH fall below certain levels, it is good medical practice to reassess after six months in order to see if the egg reserve has in fact started to decline. Most OB/GYN specialists have incorporated this test into a wellness visit from about age 25 so that the diagnosis of a decline in ovarian reserve can be diagnosed at the earliest possible time.  That is when a referral to a fertility specialist should be initiated even if a pregnancy is not desired until later. Learning of an early decline in ovarian reserve comes as a shock particularly when women are in a stage of life in which they are not yet ready to have children.

The second development in the field has been egg freezing (oocyte cryopreservation).  Egg freezing to counteract age-related decline in fertility has been available for many years, allowing for the postponement of family building until it is desired.  What is new is that the technologies for egg freezing have advanced to such an extent that pregnancy rates from thawed-out fertilized eggs are now similar to pregnancy rates from fertilized fresh eggs. 

Women with normal ovarian reserve up to age 35 who do oocyte freezing for social reasons, i.e, the wish to delay family building, can readily produce 15 mature eggs for oocyte preservation during one or two treatment cycles.  In such a scenario, one can expect an 85% chance of pregnancy. Currently, the cost is about $4,500 per treatment cycle without medication. In contrast, women who are less than 35 years of age with premature decline in ovarian reserve will have a hard time reaching that number with one to two treatment cycles. In addition many practices will use high dose injectable medication for these women at a cost of $2,500 - 3,500 per cycle even though most of the time the yield of eggs with oral medication like letrozole and clomiphene (about $50 - 60 per cycle) will be similar to injectable medication. In the first scenario, it would mean that younger women with premature decline in ovarian reserve might easily spend $35,000 for 5 treatment cycles to reach the desired number of 15 mature oocytes.  As most insurance companies do not cover oocyte freezing, this becomes an out-of-pocket cost, the sum of which is beyond the means of many patients.

Therefore women with premature decline in ovarian reserve are punished twice: having received the unexpected diagnosis of premature decline in ovarian reserve and not being able to act on it for financial reasons.  Neway is here to help women with premature decline in ovarian reserve who for economic reasons might bypass this time limited chance to conceive with their own eggs. We offer a special modified (letrozole or clomiphene) natural five-cycle package for egg banking whereby we attempt to harvest about 15 mature oocytes for freezing over a five-month time period.  As described above, this offers an 85% chance of achieving a successful pregnancy and the most probable chance for women with premature decline in ovarian reserve to have their own biological child.