For more than a quarter century, medical scientists have attempted to defy the biological clock by freezing a woman’s eggs to preserve her fertility. Most of these efforts have failed. Consider the fact that since the birth of the world’s 1st “frozen egg baby” in the mid 1980’s, fewer than 800 such births have been reported worldwide. Compare this to more than 3 million IVF babies born in the same time period and approximately 25,000 IVF births per year from frozen embryos.

Until very recently, the statistical chance of a frozen/thawed egg ultimately resulting in a baby has been under 4%. There are two major reasons why egg freezing has been such a dismal failure. The first is the fact that even in young women; more than 60% of eggs are chromosomally defective (aneuploid) and thus non-viable, making egg freezing a hit and miss gamble to begin with. The second reason is that prior methods used to slowly freeze human eggs, caused ice crystals to form within the egg, damaging it to the point that a high percentage of frozen eggs did not survive the freezing process (let alone make it to the viable embryo stage).
In October, 2008 we reported in the Journal, “RBM Online” on a process that dramatically improves the frozen egg birthrate 7-8 fold. It involves identifying and selecting chromosomally normal eggs using a genetic test known as Comparative Genomic Hybridization (CGH), and then applying a newultra-rapid( 600 times faster) freezing method called vitrification to preserve these chromosomally normal (euploid) eggs safely and indefinitely in a state of suspended animation.

The process of combining CGH testing with selective egg vitrification and banking of only euploid eggs has several potential applications, the most obvious of which are: a) Fertility Preservation (FP) for women who want to defer childbearing to a later date; b) Fertility Rescue (FR) for women who want to store and preserve their eggs prior to fertility-threatening cancer treatment and, c) Donor Egg Banking (DEB), where selected viable eggs would be stored and subsequently made commercially available for IVF and embryo transfer to women for whom egg donor-IVF provides the only means by which they can go from infertility to family.

We are about to establish the world’s first CGH-based commercial DEB, using this combined CGH/vitrification technology.

Rather than waiting (often on a long waiting list) to access a preferred fresh egg donor, the woman using a CGH-DEB would choose one or more eggs from a web-based catalogue where she would access detailed information on the background of the egg donor(s) that produced the eggs she purchases Then following a medical/psychological screening process the recipient begin hormonal preparation for frozen her embryo transfer. In the interim the chosen frozen eggs would be thawed and fertilized. Finally the viable embryo(s) would be transferred to the recipient’s hormonally prepared uterus. The entire process from beginning to end should not take longer than 4-6 weeks to complete.

So, what advantages would a CGH-DEB have over a DEB that does not selectively bank only chromosomally normal eggs? First, each CGH-normal egg, upon being thawed is about 7 times more likely to result in a live birth. Second, given this improved viability, pregnancies resulting from resulting from such embryos are 3- 4 times less likely to miscarry than embryos derived from non-CGH tested eggs. Third, because the baby rate per CGH-normal embryo transferred is about 60% (more than 80% of embryos derived from CGH-normal eggs will likewise be chromosomally normal or euploid), there is no need to ever transfer more than 2 such embryos at one time. As a result, the risk of triplets or greater is negligible. Fourth and finally, given that such embryos are derived from eggs that have been chromosomally tested as normal, there is a minimal risk of chromosomal birth defects such as Down’s syndrome.

The cost in the U.S. of donor egg IVF is the highest in the world (all told, about $25,000-$30,000 per cycle). As a consequence, many women/couples travel abroad for lower cost treatment. In fact such “medical tourism” is fast becoming a significant industry in Europe, Asia, Africa, Australia and South America.

In the United States, much of the cost of donor egg IVF relates to the amount paid as donor stipends. As currently conducted, IVF using donor eggs is both complex and cumbersome. It requires a) donor selection which is often a tedious process that takes months to complete, independent consultation and medical evaluations of both the recipient and the egg donor, thorough microbiologic and genetic testing of all parties involved, followed by synchronization of the recipient’s menstrual cycle with that of the chosen egg donor. Thereupon the donor is stimulated with fertility drugs and monitored. At precisely the right time she receives a trigger shot with human chorionic gonadotropin and the recipient’s hormone treatment regime is altered to coincide. About 36 hours later, the recipient’s eggs are harvested under anesthesia and fertilized with designated sperm. The embryos are cultured and when, 3 to 65 days later they reach a certain stage of development, are transferred to the recipient’s uterus.

The creation of a frozen DEB, stocked with a diverse CH-normal donor egg inventory would markedly simplify this process. By allowing customers to purchase one or more banked eggs (derived from fully pre-tested donors) for fertilization and subsequent transfer of the resulting embryo(s) to a hormonally prepared uterus markedly improve efficiency without compromizing success rates. Since a single young egg donor often will produce 5-8, CGH normal eggs at a time, cost can be spread across several recipients, thereby significantly decreasing the costs for each couple.

A few IVF programs and egg donor agencies already offer their clients access to DEB services. However, the dismal reported average baby rate per non-CGH tested frozen egg (i.e.) means that the recipient would need to purchase numerous eggs to have any real chance of a successful pregnancy. With a CGH-DEB, the recipient would not need to purchase more than 2-3 eggs for about $6,000-$9,000 dollars at a time. Since each CGH-normal egg would likely yield about a 27%-28% baby rate (i.e. a 7 to 8-fold improvement), the birth rate following the transfer of 2 resulting embryos should be about 60%. That is as high as the highest birth rate reported using conventional IVF-egg donation.