What is Fertility Preservation?

If a young man or women is diagnosed with cancer and a chemotherapy or a radiation in the region of the pelvis is needed, then there is a high risk, that this treatment will have a negative impact on the future fertility of this patient.

Fertility preservation treatments offer possibilities for men and women to preserve their fertility for the time, when cancer treatment is complete and health is restored. Advances in reproductive medicine have made various options available.

When to consider fertility preservation?

Once a patient is diagnosed with cancer, survival is foremost on the patient’s mind. However even in this difficult situation it is important to keep the possible side effects of the anticipated treatment in mind and try to avert the negative impact of the cancer treatment on the future life of the patient. One important issue of life-quality for long-term cancer survivors is the possibility to have their own family.

As many cancer treatments have a negative impact on the fertility it is important to discuss the matter of fertility preservation before starting the cancer treatment and to plan the implementation of the fertility preservation techniques into the cancer treatment in close collaboration with the oncologist.

Fertility Preservation in Women

Egg (Oocyte) Freezing

The vitrification (this is a special way of freezing) of oocytes allows the mature eggs obtained following ovarian stimulation and egg retrieval to be cryopreserved so that they can be used at a later date, whenever the patient decides that she is ready.

In this process, the unfertilized egg will be frozen and fertilization process has to be done once the patientwishes to achieve a pregnancy. The chance for pregnancy will be the same as the point when the eggs had been vitrified.

Egg (oocyte) freezing success has significantly improved and is now more readily available than it was just a few years ago. According to the American Society for Reproductive Medicine, it is no longer considered experimental.

Ovarian Tissue Cryopreservation

Another technique used for preserving fertility is the cryopreservation of the ovarian cortex. Even years after a woman is cured of her cancer, and wants to have her own family, this ovarian tissue can be thawed and re-implanted.

This technique enables spontaneous pregnancy as ovarian function is restored. Also, secondary effects linked to early menopause - osteoporosis, hot flushes and cardiovascular problems; can be avoided as the hormone levels would be restored to normal levels.

Worldwide, there have been few reported cases of multiple births from re-implantation done using cryopreserved ovarian tissue, which is why it still may be considered as an experimental procedure.

In Vitro Maturation (IVM)

IVM is a procedure that involves a short period of hormonal stimulation of the ovaries; the follicular aspiration of the eggs from the ovaries and the culturing of immature eggs (oocytes) in an attempt to mature them in the laboratory.

At this point they may be frozen for later use. This technique is an option when the start of cancer treatment cannot be postponed and there is no time available to perform a conventional hormonal stimulation to retrieve mature oocytes.

Fertility Preservation in Men

Sperm freezing

Sperm banking is a simple way to preservemale fertility, with a generally high success rate. Specimens are collected through masturbation. Multiple collections (2-3) with 48 hour abstinence between collections is the ideal. Collection of the sample should be done before treatment begins.

Testicular Epididymal Sperm Extraction (TESE)

TESE is a method of sperm retrieval involving needle biopsy to obtain individual sperm from the testes and/ or the epididymis or a micro-dissection of the testicular tissue itself. If sperm cells are found they are removed and frozen for future use. This kind of procedure has to be done in men with blockage of their vas deferens, spinal cord injuries, Multiple Sclerosis or impotence due to other reasons.

Testicular Tissue Freezing

An outpatient procedure, testicular tissue freezing is a process by which surgically removed testicular tissue is frozen for future use.

In case banking is done for young boys, their tissue would contain stem cell which could start sperm production (spermatogenesis). But, it should be noted that this method has not yet reported any live births and is still experimental. So, it may be a suitable option only for pre-pubescent boys or older.

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