Fertility Preservation

by Elli Kachpani, updated on April 30, 2019


Fertility Preservation

A type of procedure used to help keep a person’s ability to have children. Fertility preservation involves freezing and storing sperm or eggs (gametes), ovarian reproductive material or embryos for use in a person’s future fertility treatment. Although most of the articles about Fertility preservation are related to oncology patients, there are other diseases and situations such as autoimmune diseases, genetic conditions that can cause premature ovarian insufficiency in women or hypogonadism and azoospermia/oligozoospermia in men. Moreover, other circumstances exist in which Fertility preservation must be considered, such as sex reassignment surgeries or a variety of social reasons that may end up hampering or delaying parenthood to otherwise perfectly fertile couples. Below, we will outline the currently fertility preservation options for both women and men.

Male fertility preservation

Nowadays, two options for Fertility preservation in males can be found: sperm or testicular tissue cryopreservation and gonadal shielding. The most effective method of preserving a man’s fertility is sperm freezing (cryopreservation). This process involves the man providing samples of his semen, usually collected by masturbation, or by other methods including testicular sperm extraction (TESE) or electroejaculation. Both methods mentioned above are commonly applied in cases in which the previous approach is not possible due to specific reasons, such as certain physical/psychological conditions or even religious beliefs. Then the samples frozen in liquid nitrogen and stored for future use. On the other hand, in cases in which radiotherapy is unavoidable, gonadal shielding may result helpful since it seems to mitigate the effects of radiation, especially in children. This procedure consists in covering the testes with a lead block or apron to avoid direct exposure to radiation, however, it does not completely prevent from radiation damage. Therefore, the best option for Fertility preservation in pubertal and adult males is most likely sperm cryopreservation.

Female fertility preservation

Many options are currently available for Fertility preservation in women patients, including oocyte and embryo cryopreservation, ovarian transposition or gonadal shielding. These options are more invasive and time-consuming than for the man, and so it is important to choose the appropriate procedure according to the treatment. Between oocyte and embryo cryopreservation technique, the first one is usually and the most preferred. Even though embryo cryopreservation is offered to women with a partner and shows great results, it may result in issues past some years, for instance, if the couple divorces or the patient does not recover from the disease. Both methods require medical ovarian stimulation at the beginning, as well as follicular monitoring and transvaginal oocyte retrieval. The whole process can take approximately two weeks. Sometimes, harvesting of immature oocytes and the subsequent in vitro maturation may be indicated for those patients who cannot undergo controlled ovarian stimulation, like prepubertal girls or women suffering from polycystic ovarian syndrome (PCOS). Once the oocyte matures, it will be eventually cryopreserved. In those cases, in which oocyte/embryo cryopreservation is not possible due to the urge to commence the treatment, patients may also resort to the other methods. Both gonadal shielding and ovarian transposition are indicated when radiation on the pelvic area is necessary. In ovarian transposition method, one or both ovaries and fallopian tubes are separated from the uterus and attached to the wall of the abdomen away from where the radiation will be given. In the gonadal shielding the pelvic area is covered with a lead shield, to protect the ovaries from radiation.

Fertility is an important part of heritage and survival for many women, men and children, but it is not always considered when faced with a life-limiting disease or a longterm medical condition.  Increased survival rates, together with advances in assisted reproduction technologies, offer greater opportunities for people whose fertility has been affected by treatment or for those who have made the decision to delay reproduction.

Newlife IVF Greece offers a variety of oncofertility or social freezing programs and our team will be happy to assist you if for any reason you're considering your options regarding fertility preservation.

References

  1. Crawshaw M (2013) Male coping with cancerfertility issues – putting the ‘social’ into biopsychosocial approaches, Reproductive Biomedicine Online 27, 3, 261-170.
  2. King J, Roche N, Davies M, Abraham J and Jones A (2012) Fertility preservation in women undergoing treatment for breast cancer in the UK: a questionnaire study, The Oncologist 17(7):910-6.
  3. Loren AW, Mangu PB, Nohr Beck L, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH and Oktay K (2013) Fertility Preservation for Patients with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update, Journal of Clinical Oncology 31(19): 2500-2510.
  4. Jeruss JS, Woodruff TK. Preservation of Fertility in Patients with Cancer. N Engl J Med. 2009;360(9):902-911.
  5. Daniluk JC, Koert E. Childless women's beliefs and knowledge about oocyte freezing for social and medical reasons. Hum Reprod. 2016;31(10):2313-2320.
  6. (2016). Fertility concerns and preservation for men. Retrieved May 31, 2016
  7. (2016). Fertility concerns and preservation for women. Retrieved May 31, 2016

Elli Kachpani is embryologist in the IVF laboratory and part of the scientific team in Newlife IVF Unit.
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