PubMed2004
Embryo cryopreservation has become an ethical necessity due to the way human in vitro fertilization (IVF) infertility therapy has developed. Limited embryonic implantation has by necessity driven IVF therapy to adopt ways to maximize the harvest of oocytes following ovarian hyperstimulation with its attendant risks. Collection of more oocytes has allowed more embryos to be generated to compensate for poor embryonic viability, often leading to transfer of multiple embryos to increase per transfer pregnancy rates. In an era of improving embryonic viability and prevailing trend toward single embryo transfers, production of excessive numbers of surplus embryos appears increasingly inappropriate. At which stage embryo cryopreservation can be undertaken most effectively remains controversial. Embryo cryopreservation nevertheless represents the current solution to the problem of excessive embryo production, but inherently raises ethical concerns for certain couples uncomfortable with what they might perceive to be "experimental" cryostorage, who in extreme circumstances may even choose to limit the number of oocytes inseminated to obviate the production of spare embryos. On a more practical level, cryostored embryos are co-owned by two people who may separate, and as such the embryos then face an uncertain fate, commonly decided in courts of law. Oocyte cryopreservation, if consistent and successful, offers a way to avoid the above complications of routine IVF therapy. Oocytes may need to be cryostored in the event of unforeseen non-production of sperm during IVF therapy, allowing a more measured consideration of donor sperm use or other means of sperm retrieval. Beyond IVF for infertility therapy using a couple's own gametes, oocyte cryopreservation provides a wonderful opportunity to optimize donor oocyte cryo-banking, reducing costs and improving convenience. Meanwhile, frozen embryo donation is an approach that many couples are uncomfortable with, and allows only for retrospective donor screening, and less gametic choice. Advances in ovarian tissue cryopreservation will probably provide the best approach for long term storage of female gametes for women wishing to elect to prolong their reproductive potential, or prior to cancer therapy. However, improved consistency with vitrification technology through standardization of protocols and cell-carrying systems is bringing routine single oocyte cryostorage, at all stages of egg maturity, closer to reality. This, coupled with in vitro maturation, will aid development of oocyte collection protocols using minimal amounts of gonadotropins. All of which will help drive IVF programs to consider cryostorage of excess oocytes and not embryos, inseminating post-thaw/warming only a limited number of oocytes at any one time, in anticipation of the need for only one or two embryos at transfer. The question then is how close are we to being able to provide routine clinical application of human oocyte cryostorage, and when will it be appropriate?