Will egg extraction for fertility preservation accelerate the onset of menopause if it reduces the number of eggs?

Egg Extraction Does Not Accelerate Menopause Onset

Egg extraction for fertility preservation does not accelerate the onset of menopause because the procedure only retrieves mature follicles that would otherwise naturally undergo atresia (die) during that menstrual cycle, not affecting the primordial follicle pool that determines age at menopause. 1

Understanding Ovarian Reserve and Menopause

• Ovarian reserve represents the remaining follicle pool in a woman's ovaries, which naturally declines with age 1
• The ovarian stimulation process used for egg retrieval targets only mature follicles that are already recruited for that cycle, not the primordial follicle pool that determines menopause timing 1, 2
• Menopause typically occurs approximately 10 years after substantial loss of conception potential, around age 40-51 3

How Egg Retrieval Works

• Oocyte cryopreservation involves ovarian stimulation with gonadotropins followed by follicular aspiration 2
• The procedure can be started at any time of the menstrual cycle ('random start stimulation') and completed relatively quickly 2
• 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 2
• Only follicles that have already been recruited for potential ovulation in that cycle are retrieved; the procedure does not affect the dormant primordial follicle pool 1

Scientific Evidence on Egg Retrieval and Ovarian Reserve

• Current clinical guidelines from major organizations like ASRM, ESHRE, and ISFP do not list egg extraction as a risk factor for premature menopause 2
• 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
• Studies examining fertility preservation techniques have not demonstrated long-term negative impacts on ovarian function or reserve 2

Factors That Actually Affect Menopause Timing

• Known risk factors for premature menopause include:
  • Exposure to gonadotoxic chemotherapy agents, particularly alkylating agents 2, 1
  • Pelvic radiation therapy with doses above the sterilizing threshold 1
  • Risk-reducing bilateral salpingo-oophorectomy for cancer prevention 1
  • Certain genetic mutations (e.g., BRCA1, BRCA2) 1
  • Family history of premature menopause 4
  • Certain autoimmune conditions requiring chemotherapy (like lupus) 4

Fertility Preservation Considerations

• The primary determinant of fertility preservation success is the woman's age at the time of oocyte cryopreservation, not the procedure itself 1, 5
• 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 2
• Models predict that to achieve a 70% chance of live birth, women would need 14,15, and 26 mature oocytes at ages 30-34,35-37, and >38 years, respectively 5
• For women concerned about future fertility, earlier egg freezing provides better outcomes, as female fertility declines significantly after age 32 and rapidly after age 37 5, 6

Common Misconceptions

• The misconception that egg retrieval accelerates menopause likely stems from confusion about how ovarian reserve works 1
• While each egg retrieval cycle does remove multiple mature eggs at once, these eggs were already recruited for that cycle and would have been lost through natural processes anyway 1, 2
• Female fertility naturally declines with age regardless of whether egg retrieval has been performed 3, 6
• The biological rather than chronological age of the woman can predict more accurately her fertility potential 3

Clinical Implications

• Women considering egg extraction for fertility preservation should be counseled that the procedure does not accelerate menopause onset 1, 7
• For women with concerns about their ovarian reserve, monitoring with AMH levels and antral follicle counts can be helpful, though these are more useful for assessing short-term fertility than predicting age at menopause 1
• Early referral to fertility specialists is recommended for women interested in fertility preservation, as outcomes are better with younger age at cryopreservation 7, 5