HOW TO START AN
EGG BANK
FROM IDEA TO EXECUTION
RELEVANT DISCLOSURES
 Shareholder/Co-founder – Donor Egg Bank USA, LLC
OBJECTIVES
 Understand the current cultural climate impacting
women’s decisions to freeze
 Provoke thought regarding variables to successful
egg banking – autologous & donor
 Identify different models for third party egg banking
 Discuss methods of execution
 Review future trends and lessons learned
IDEA TO EXECUTION
 Identify the market
 Manage quality nuances
 Lab
 Clinical
 Set realistic expectations
 Put operational logistics in place
 Consents & Legal documents
 Determine the right model
It seemed so simple…
FROZEN EGG
BASIC MODEL
 Frozen eggs decouple the traditional process of
stimulation followed by transfer.
Frozen Egg
Cycle
Stimulation
Cycle
Storage or
Coordination
Fee
Transfer
Cycle
THE FROZEN EGG MARKET
CULTURAL SHIFTS DRIVE
FROZEN EGG BANKING
 900% increase in women >35
having their first child since 1970
 35% increase among women
ages 40-44
 Autologous: More women
freezing eggs as “insurance
against an uncertain future.”
 Third Party: US Foreign
Adoptions are at the lowest
level since 1982
 (6,441 adopted in 2014 vs. 23,000
in 2004) Source: US State Department
Report to Congress, April 1, 2015
Source: May 2014; www.cdc.gov
REASONS FOR
NOT HAVING CHILDREN EARLIER
100%
90%
88%
80%
Survey of 500 women after
completion
of 1 egg freezing cycle
70%
60%
50%
40%
30%
24%
20%
15%
15%
8%
10%
0%
Lack of Partner
Professional Reasons Financial Reasons
Too Large of a
Commitment
Other
Fertil Steril. 2013;100(5): 1343-49
WHY DO WOMEN FREEZE THEIR EGGS?
Rank in order of importance:
(some women ranked more than one option)
Source: Fertil Steril. 2013;100(3): S24
HOW WOMEN FIRST LEARNED
ABOUT EGG FREEZING
Other
10.4%
Medical Doctor
12.1%
Internet
18.7%
TV/Magazine
23.6%
OB/GYN
25.3%
Friend
50.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Source: Fertil Steril. 2013;100(5): 1343-49
QUALITY
QUALITY FACTORS
1. Oocyte potential
2. Oocyte stimulation
3. Freeze/Thaw Technician
4. Lab environment
5. Device Carrier
6. Storage and handling
7. Endometrial prep
8. Sperm quality
9. Media culture
10. Transfer technique
QUALITY CONSISTENCY
Freeze Tech
#
S-F
TB-S
JL-S
K-R
JG-S
K-S
PD-S
T-C
B-B
B-F
26
26
113
22
52
28
22
7
27
18
Ongoing/ET
2013
27%
39%
51%
41%
56%
61%
59%
57%
41%
22%
#
6
34
16
2
53
45
42
69
9
9
Ongoing/ET
2014
60%
55%
50%
50%
49%
44%
43%
40%
38%
25%
FREEZE VS THAW SKILLSET
© 2014 Pro Baseball Insider, LLC (PBI)
FREEZE VS THAW DIFFERENTIALS
Tech
#
Freeze
#
On-going/ET
Thaw
Ongoing/ET
S-A
12
33%
8
75%
TO-C
62
40%
8
50%
R-F
9
22%
19
43%
S-F
5
60%
15
60%
M-R
43
63%
7
27%
C-R
0
n/a
21
45%
T-R
10
60%
14
50%
N-RS
10
70%
4
0%
J-S
53
49%
12
50%
L-S
22
50%
20
35%
HOW DO YOU KNOW?
 High enough “N” to see trend
 Comparison data
 Between embryologists
 Multiple cohort thaws
 Track everything – device, # of eggs thawed,
media, storage, etc.
 Mechanism to monitor/analyze
 Clinical Impact
Creative Commons Licensing
OTHER LAB CONSIDERATIONS
 Who on the embryology team?
 Vit: Best hands, best adherence to protocol
 Thaw: Highly skilled, best troubleshooter
 Set-up for egg vit vs. thaw




Lab environment and set up
Thermometer
Stop watch (count up function)
Vit/thaw products/devices
 Staffing on day of vit/thaw
 Practice & review of protocol
 Egg storage
DEVICE CARRIER
 Open Systems
 Cryotop
 Cryolock
 Cryotec Etc.
 Closed Systems
 CryoTip
 Rapid-I
 Etc.
OPERATIONAL LOGISTICS
 Freezing –of eggs sets of 1, 2, 4
 Thaw protocols
 Thaw until…
 Set number of eggs – ie. 6
 Guarantee
 Survival/Embryo/Blast
 $$ value on autologous
OPERATIONAL LOGISTICS
 Consents specific to the process
 cryo-preserved eggs to freeze
 cryo-preserved eggs to thaw & make embryos
 Disposition
 Autologous




Eggs not needed
Premature death
Donation
Research






Look backs –eggs not usable
Questionable quality – identifiable track record
Unselectability
Donor updates over time
Abandoned eggs – returnable?
Capital loss from poor quality or lookbacks (recalls)
 Third Party
REALISTIC EXPECTATIONS
 ASRM Guidelines - “There are not sufficient data to
recommend oocyte cryopreservation for the sole
purpose of circumventing reproductive aging in
healthy women. “ ASRM/SART Practice Committees, Mature oocyte
cryopreservation: a guideline, Fertil Steril. 2013;99:37-43
 Egg freezing parties, Google/Facebook, newest
“graduation gift”, 401K
 How fear fuels the business of egg freezing, Danielle
Paquette, Washington Post, March 6, 2015
 Slogan “Lean in. But freeze first.”
EGG THAW OUTCOMES
1.877.411.9292
IR= Implantation Rate
Courtesy of Shady Grove Fertility
THIRD PARTY MODELS
 Independent egg bank
 Shared cycles
 Greater risk - $$ and unused inventory
 Network – open/closed egg banking
 Limits risk
 Increases interdependency
 Minimizes unused inventory
 Agency driven models
 Liability?
LESSONS LEARNED
 More challenging than originally thought
 Lab environments and embryologists are not
equally skilled to freeze/thaw eggs
 Quality tracking is key – you can’t assume all is well.
 Logistics and infrastructure is essential
 Technology continues to evolve and best practices
are becoming known
 Economically beneficial and efficient use of egg
resources
Egg banking is the newest frontier in ART and much
remains unexplored