Page 17 - FSANZ WINTER -2022

Perspectives on egg freezing outcomes
A total of 128 nurses attended the Fertility Nurses of Australasia (FNA) workshop in Adelaide in May to participate in a wide-ranging program.
FNA Chair, Margie Parry, said it was exciting to see many new nurses attending the workshop with participants from South Australia, Victoria, NSW and Queensland and two from New Zealand.
“It was such a welcome opportunity to get together to enjoy a stimulating program with excellent speakers,” she said.
One of the memorable presentations was from
Adelaide fertility specialist and gynaecologist, Dr Juliette Koch, who posed the question: Can we protect against future infertility? Her address explored a range of factors to consider in egg freezing whether for oncological or other medical reasons or for elective purposes.
Dr Koch highlighted that Australian women today are delaying childbearing and having less children.
She presented data showing that fertility rates among women aged 20-24 and 25-29 had fallen significantly since the 1960s to levels comparable with the Great Depression of the early 1930s. Reasons for this decline are multifactorial including deferring childbirth because of debt associated with personal education and career development along with relationship issues.
In July 2019, the Australian & New Zealand Society for Reproductive Endocrinology and Infertility (ANZSREI) issued a consensus statement that oocyte cryopreservation could preserve reproductive potential for women and expand future family building options.
Dr Koch said egg freezing allowed women to reduce pressure on their biological clock while potentially eliminating the need for third party donors.
However, she said arguments against the procedure included relatively low usage rates of stored eggs, the high cost of treatment and potential impacts of older parenthood for those who proceed to fertilisation via IVF, pregnancy and live birth using their cryopreserved eggs.
Data on costs of a standard first cycle in a calendar year varied significantly, according to July 2021 figures presented by Dr Koch. For example, most procedures for oncology patients – including scans, embryology, day surgery, anaesthetist and hospital fees, and oocyte retrieval – could be bulk billed with total out of pocket expense of $125.00.
Approximate out-of-pocket costs based on insured patients with hospital cover, Medicare eligibility and no health care card concessions amounted to $5,184.
For those not eligible for Medicare rebate and no health care card concession, the cost escalated to $10,291.
Dr Koch presented outcomes of a study among 156 Australian women who sought egg cryopreservation between 2010 and 2020, and who then underwent procedures to thaw the frozen oocytes, fertilising them and transferring resulting embryos.
Juliette Koch posed the question:
Can we protect against future infertilty?
She said the average number of embryos transferred among the study participants was 1.2 resulting in an accumulated clinical pregnancy rate of 26.3 per cent and live birth rate of 22.5 per cent.
Dr Koch said issues to consider included:
• not over-estimating the success of egg freezing recognising that more than one cycle is often required to gain enough eggs to cryopreserve;
• potential risks including anaesthetic complications, pain, bleeding, infection or ovarian hyperstimulation syndrome (OHSS); and
• need to make treatment more affordable and equitable.
She said there was also a need for better education, particularly information on clinic relevant success rates regarding thawing and creating embryos, and improved data regarding uptake of frozen eggs and outcomes.
Meanwhile, registrations are closing fast for the FNA workshop at the International Convention Centre in Sydney on Saturday 30 July.
FNA NSW representative, Linda Robinson, said it was exciting to look forward to the face-to-face meeting in Sydney for a program that will range across topics including:
• surgical approaches to male infertility;
• getting the best of out of your ultrasound machine;
• obesity and reproductive health;
• genetic screening;
• mitochondrial disease and donation;
• adolescent gynaecology and future fertility;
• fertility tracking apps; and
• improving knowledge among young women about the menstrual cycle.
FNA would like to thank their pharma sponsors that enable us to provide and facilitate exceptional educational events.
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