Oocyte cryopreservation (“egg banking”) is a form of fertility preservation where members may choose to cryopreserve eggs without the immediate intent to transfer. All requests for oocyte preservation for an individual with a history of two previous attempts of oocyte cryopreservation require prior authorization. Authorization will not be granted for oocyte cryopreservation where the total number of banked oocytes have an estimated probability of greater than 90% for a live birth based on current available data unless an exception applies as described herein.

A third cycle of oocyte preservation will be approved if either of the following are true based on a review of the individual medical record.

1. Patient has a medical diagnosis putting them at high risk for iatrogenic infertility, including but not limited to those members undergoing medical or surgical treatment for gender affirmation, some cancers whereby the planned oncologic treatments increase their risk for premature ovarian insufficiency (cessation of ovarian function before age forty), or known genetic mutations that puts them at higher risk for POI (cessation of ovarian functioning before the age of forty).
2. If the total number of banked oocytes have a probability of less than 90% for a live birth based on current available data.
3. Member has previously thawed frozen eggs and had less than fifty percent survive thaw.

A request for authorization must be accompanied by medical records identifying at least one of the following:

• Imminent, planned gender affirming medical or surgical therapy initiation of medical intervention must occur within the next twelve months, documentation from the treating physician is sufficient.
• Records indicating imminent planned medical and or surgical treatment occurring within the next twelve months that puts the individual at high risk for POI.
• Medical records indicating another genetic, medical condition, or other circumstance memorialized in the medical record that substantially increases the individuals risk of POI.

References

1. A, Cobo, Garda-Velasco J, Domingo J, Pellicer A, and Remohf J. Elective and Onco-fertility preservation: factors related to IVF outcomes. Human Reproduction 33,12 (2018).
2. Walker, Z., Lanes, A. & Ginsburg, E. Oocyte cryopreservation review: outcomes of medical oocyte cryopreservation and planned oocyte cryopreservation. Reproductive Biology and Endocrinology 20,10 (2022).
3. Goldman RH, Racowsky C, Farland LV, Munne S, Ribustello L, Fox JH. Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients. Human Reproduction. April, 2017.
4. Dr. Janis Fox, MD, Dr. Randi Goldman MD, Dr. Malinda Lee MD, Brigham Women’s Hospital Egg Freezing Counseling Tool (EFCT) p(Livebirth) = 1- [1- 0.6 x p(Euploid) x p(Blast)] 11. (Number of mature eggs) where p(Blast) = 0.95 x exp(2.8043 – 0.1112 x Age) if Age <36 and p(Blast) = 0.95 x exp(2.8043 – 0.1112 x Age) if Age <36 Published MDCalc Ltd. Inc. October, 2017.
5. Cascante SD, Blakemore JK, Devore S, Hodes-Wertz B, Fino ME, Berkeley AS, Parra CM, Mccaffrey C, Grifo JA. Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center. Fertility and Sterility. July, 2022.