Elective oocyte freezing for fertility preservation in endometriosis: Opportunity or resource wastage?

Background: With the introduction of vitrification and the improvement in clinical outcomes, oocyte freezing for fertility preservation is currently proposed for an increasing number of indications. In this review, we have addressed the rationale to propose oocyte cryopreservation in women with endometriosis, the incremental benefit for future childbearing possibly deriving from the procedure and to which subgroups of patients it should be proposed. Methods: A search in PUBMED with a specific string for the peer-reviewed papers published in English from 1990 through December 2022 was conducted to identify articles related to egg freezing for fertility preservation in women with endometriosis. Main findings: Oocyte cryopreservation is an option for fertility preservation in women with endometriosis. However, the incremental benefit deriving from the strategy compared to a conventional path of seeking pregnancy once these women are interested in parenthood seems limited. Based on current data and probably overestimating the benefit, 14 (number needed to be treated) women would have to undergo oocytes cryopreservation to have one additional pregnancy. Conclusions: The identification of women with a higher risk to be infertile in their future is critical for the validity of fertility preservation in women with endometriosis. This would allow to restrict the recommendation for oocyte freezing to the subgroup of women with the highest possibility of using their eggs, thus improving the cost-benefit balance. More evidence is needed before the integration of the strategy in the public healthcare systems.