What is Fertility Preservation?
Fertility preservation saves and protects your embryos, eggs, sperm and reproductive tissues. This helps make it possible for you to have a child sometime in the future. It’s an option for adults and even some children of both sexes. Fertility preservation is common in people whose fertility is compromised due to health conditions or diseases (medically-indicated preservation) or when someone wishes to delay having children for personal reasons (elective preservation). Personal reasons you may want to delay childbirth could involve finding the right partner/spouse or wanting to wait until you’re more established in your career.
Before Fertility Preservation
Why is fertility preservation done?
Your future fertility may be at risk if you have certain diseases and conditions. This could be due to the condition itself or to the surgery or medication used to treat the condition. People who wish to delay having children until their late 30s or 40s may choose to preserve their fertility because studies show aging affects fertility.
You may want to preserve your fertility if you wish to have children and are affected by any of the following:
. Age: If you’re waiting to have children, you may consider preserving your eggs or sperm before fertility declines. Common reasons people delay having children include desires to reach a certain career goal, further their education or wanting to meet the right partner.
. Cancer: Chemotherapy, radiation therapy and surgery for cancer can affect a person’s fertility.
. Autoimmune diseases: Diseases such as lupus and rheumatoid arthritis and their treatments may cause fertility problems.
. Reproductive health conditions: Endometriosis and uterine fibroids can make it more difficult to become pregnant.
. Transgender care: Gender-affirming treatment can alter a person’s reproductive abilities. Saving embryos, eggs or sperm prior to treatment is an option.
Who performs fertility preservation?
Your healthcare provider and a fertility specialist will guide you through the process.
You may receive treatment at a fertility clinic. These facilities usually have treatment areas, a laboratory and equipment needed to maintain frozen specimens for extended periods of time.
What are the types of fertility preservation?
Fertility preservation treatments fall into two categories:
. Removing and freezing eggs, embryos, sperm and tissues for future use.
. Minimizing the impact of cancer treatment on the reproductive tissues.
Fertility preservation methods for women and people designated female at birth (DFAB)
. Egg freezing: You receive treatment with hormones to stimulate egg production in your ovaries. Your provider removes the eggs and freezes and stores them.
. Embryo freezing: Similar to egg freezing, this involves the removal of eggs from your ovaries. Your provider fertilizes the eggs with your partner’s sperm or donated sperm, creating embryos. This procedure is called in vitro fertilization (IVF). Your provider may implant the embryos in your body right away or freeze and store them for future use (embryo cryopreservation).
. Ovarian tissue freezing: If you’re receiving cancer treatment, you may not be able to wait the two to six weeks needed to receive hormone treatment. Instead, you can have your ovarian tissue removed and frozen. After your cancer treatment (once you are medically cleared and are ready to conceive), your surgeon reimplants the thawed tissue. If the tissue regains function, you may be able to become pregnant spontaneously or via IVF.
. Ovarian transposition (oophoropexy): This procedure can help protect your ovaries from radiation treatments. Your surgeon moves your ovaries up out of your pelvis and into your abdomen, away from the treatment area.
. Radiation shielding: A lead shield can protect your ovaries during radiation treatments. Your provider may also use precise radiation technologies that limit the dose of radiation your ovaries receive.
Fertility preservation techniques for men and people designated male at birth (DMAB)
. Radiation shielding: This is similar to radiation shielding for women. Your provider will limit radiation exposure to your testicles by shielding them or by using more precise radiation techniques.
. Sperm freezing: You submit a sample of semen for freezing and storage.
. Testicular tissue freezing: Some men don’t have sperm in their semen. Similarly, prior to puberty, people designated male at birth (DMAB) are unable to produce sperm in semen. In these cases, providers remove a sample of testicular tissue which may contain sperm. Any sperm found are extracted and frozen.
What types of fertility preservation are available for children?
Childhood cancer and other conditions can also affect children’s future fertility. Ovarian and testicular tissue freezing are options for children, with sperm, egg, and embryo freezing available after they reach puberty. Younger children may benefit from radiation shielding and ovarian transposition.
What are the advantages of fertility preservation?
The main advantage is that you may still be able to have a biological child, despite your condition or circumstance.
What are the risks of fertility preservation?
Procedures used in fertility preservation have some risks:
. Some of the procedures that providers use to collect eggs and sperm can cause bleeding or infection.
. In vitro fertilization may increase the risk of multiple births, premature delivery, low birth weight, miscarriage and ectopic pregnancy.
. Laparoscopic procedures can cause infection, bleeding and injury to nearby organs and tissues. Anesthesia used in these procedures can cause medication reactions, nerve damage and postoperative delirium.
. Ovarian stimulation may cause elevated estrogen levels. This can increase your risk of blood clots and the growth of estrogen-dependent cancers.
. Ovarian stimulation can cause ovarian hyperstimulation syndrome.
. Ovarian transposition may result in the rotation of the relocated ovaries. Ovarian cysts can also develop. Both conditions require ovary removal (oophorectomy).
During Fertility Preservation
Procedure Details
What should I expect with fertility preservation?
Fertility preservation procedures vary widely. As you consider your options, it’s helpful to know what to expect with each procedure.
Egg and embryo freezing
This process starts with ovarian stimulation. You’ll inject yourself with hormones daily for about 10 days.
Egg removal is performed while you’re under sedation — a type of anesthesia where you are lightly asleep. Your provider:
. Guides a needle through your vagina into your ovary using ultrasound guidance.
. Draws up the eggs through the needle.
. Collects the eggs and either freezes them directly or fertilizes them before freezing.
You shouldn’t feel any pain or discomfort during the procedure, but some women feel bloating or discomfort during the days leading up to the procedure and for several days after it.
Ovarian tissue freezing
You’ll receive a general anesthetic to put you to sleep. During this minimally invasive procedure (laparoscopy), your surgeon:
. Makes two to four small incisions on your abdomen.
. Inserts a thin scope to look inside your abdomen.
. Uses small instruments to collect the tissue.
. Removes the instruments and scope and closes the incisions.
Usually, you can go home about two hours after laparoscopic surgery with specific instructions for follow-up care.
Ovarian transposition
This is also a laparoscopic procedure performed under general anesthesia.
If your fallopian tubes aren’t damaged by surgery or radiation treatment, your ovaries may release eggs in their new location, allowing you to become pregnant naturally. Whether the surgeon is able to move your ovaries without damaging the fallopian tubes depends on your condition, the radiation field planned, and your anatomy. If both of your fallopian tubes are damaged, you may require in vitro fertilization (IVF) to become pregnant.
Radiation shielding
Your provider will try to protect your ovaries or testicles from radiation by using:
. Precise radiation technologies such as intensity-modulated radiation therapy (IMRT). Radiation therapy is usually quick and painless, but it may cause side effects such as hair loss, diarrhea and fatigue.
. Shielding devices are made of lead that absorbs radiation. Ovary shields are plate-like devices, while testicle shields are round cups that surround the testicles.
Sperm freezing
This is a noninvasive procedure where you masturbate and ejaculate semen into a cup. You give the cup to your provider for freezing and storage.
If you’re unable to produce a specimen due to illness, anxiety, pain or cultural or religious reasons, your provider can help using:
. Medication: These include several types of drugs that can help you ejaculate or correct problems preventing ejaculation.
. Vibratory stimulation: Vibration can help trigger ejaculation.
. Electroejaculation: Your provider guides a probe into your rectum. The probe stimulates your prostate with a mild electrical current that causes you to ejaculate. This is done under anesthesia.
Testicular tissue freezing
Your surgeon will collect a testicular tissue. Collection may involve the use of a scalpel to remove the tissue or a needle to draw up the sample.
What happens to the frozen embryos, eggs and sperm?
When you’re ready to pursue pregnancy, your fertility team thaws the frozen specimen. Your provider:
. Completes the fertilization process with your thawed eggs or sperm to create embryos.
. Implants the newly fertilized or thawed embryos into your uterus or someone else’s who will carry your baby for you (surrogate).
After Fertility Preservation
Recovery and Outlook
How successful are fertility preservation procedures?
Fertility preservation procedures don’t guarantee pregnancy. Freezing eggs, sperm and embryos is the most common type of preservation and has a long history of success for some people. Other procedures are not widely used, so their effectiveness isn’t clear.
What is clear is that success varies widely and depends on a variety of health and treatment-related factors. Your provider can help you assess these factors and better understand your chances of a successful pregnancy.
In vitro fertilization
The success of IVF depends on your:
. Age.
. Body mass index.
. Health conditions.
. Past IVF treatments.
. Past pregnancies.
Ovarian tissue transplantation
This procedure is relatively rare but there are reports of 130+ live births occurring after it. The success of ovarian tissue preservation may depend on the number of eggs your ovaries contain at the time of removal. This number decreases with age, so younger tissues have better outcomes. Two live births have been reported from women who were children at the time of ovarian tissue harvest: age 9 years (prepubertal) and age 13 years (pubertal but premenarchal).
Ovarian transposition
Ovarian transposition is not nearly as common as IVF. Ovarian function may be impacted by radiation therapy, even with relocation. However, providers have reported successful egg harvesting and pregnancies after ovarian transposition.
When is the best time to talk to your healthcare provider about fertility preservation?
It’s best to start fertility preservation procedures as soon as possible. The optimal timing is:
. Before cancer treatment begins.
. Before gender-affirming treatment.
. By age 35 for women who have no immediate plans of having children.
. Soon after diagnosis of diseases that may affect your fertility.
If you’ve had past medical treatments that may have decreased your fertility already, talk to your provider about your options for fertility preservation.
Source:
. https://my.clevelandclinic.org/health/treatments/17000-fertility-preservation