Does egg extraction accelerate menopause onset in women?

Egg Extraction and Menopause Onset

Egg extraction for fertility preservation does not accelerate menopause onset in women. Based on current clinical guidelines, there is no evidence that oocyte retrieval procedures hasten the onset of menopause or diminish ovarian reserve beyond what would naturally occur 1.

Understanding Ovarian Reserve and Menopause

• Menopause is diagnosed after 12 months of amenorrhea resulting from permanent cessation of ovarian function, with the average age being around 51 years in North America 2, 3
• Ovarian reserve represents the remaining follicle pool in a woman's ovaries, which naturally declines with age 1, 4
• Premature ovarian insufficiency (POI) is defined as loss of ovarian function before age 40, but this is primarily associated with specific medical treatments or genetic factors, not fertility preservation procedures 1, 5

Fertility Preservation Procedures and Ovarian Function

Oocyte Retrieval Process

• Oocyte cryopreservation involves ovarian stimulation with gonadotropins followed by follicular aspiration 1
• The procedure only retrieves mature follicles that would otherwise naturally undergo atresia (die) during that menstrual cycle 1
• The number of retrieved oocytes varies by age: approximately 15.4 ± 8.8 in women <26 years to 9.9 ± 8.0 in women 36-40 years 1

Impact on Ovarian Reserve

• Fertility preservation procedures target only mature follicles ready for ovulation, not the primordial follicle pool that determines age at menopause 1
• Current clinical guidelines do not list egg extraction as a risk factor for premature menopause 1
• Anti-Müllerian hormone (AMH) levels, a marker of ovarian reserve, may fluctuate after stimulation but typically return to baseline, indicating no permanent effect on ovarian reserve 1

Factors That Actually Affect Menopause Timing

• Genetic factors play a significant role in determining the age of natural menopause 3, 4
• Known risk factors for premature menopause include:
  • Exposure to gonadotoxic chemotherapy agents, particularly alkylating agents 1
  • Pelvic radiation therapy with doses above the sterilizing threshold 1
  • Risk-reducing bilateral salpingo-oophorectomy for cancer prevention 1, 6
  • Certain genetic mutations (e.g., BRCA1, BRCA2) may be associated with earlier menopause 1, 6

Clinical Implications and Counseling

• Women considering egg extraction for fertility preservation should be counseled that the procedure does not accelerate menopause onset 1
• The primary determinant of fertility preservation success is the woman's age at the time of oocyte cryopreservation, not the procedure itself 1
• Recent data reported cumulative live birth rates of 61.9% if 12 oocytes were cryopreserved in women ≤35 years and 43.4% if 10 oocytes were cryopreserved in women >35 years 1
• Women with concerns about their ovarian reserve can be monitored with AMH levels and antral follicle counts, though these are more useful for assessing short-term fertility than predicting age at menopause 1

Special Considerations

• Women with a family history of early menopause may benefit from earlier fertility preservation, but this is due to their baseline risk, not the procedure 5, 4
• For cancer patients, the urgency of fertility preservation before potentially gonadotoxic treatments outweighs theoretical concerns about the impact on menopause timing 1
• Women undergoing multiple stimulation cycles should be reassured that current evidence does not suggest cumulative negative effects on ovarian reserve or menopause timing 1