Fertility Preservation
Fertility preservation protects your reproductive tissues so you can have a child in the future. People choose this treatment due to cancer and other health conditions, age and transgender care. Many people have healthy babies after fertility preservation treatment.
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.
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 of a woman is more and if you are waiting to have children, you may consider preserving your eggs or sperm before fertility declines. Common reasons people delay having children include desire to reach 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 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 further use.
-Minimizing the impact of cancer treatment on the reproductive tissues.
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
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
- 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.
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: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).
Risks / Benefits
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).
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.