Fertility preservation

Fertility preservation is a broad term which involves many procedures to retain fertility in men and women. This mainly applies to people who are being treated for cancer or other illnesses which might prevent them from having children. It may also apply to those who wish to postpone child bearing due to personal or social reasons.

Factors affecting fertility

Age

As the age of a woman advances, her chances of becoming pregnant declines as both the quality and the quantity of her oocytes (eggs) reduce.  The chances of a miscarriage also increase as well as the risk of having an abnormal pregnancy.

Medications

Drug used for treating cancers are life saving, but some of them can cause temporary or permanent damage to the ovaries and testes affecting fertility.

Radiation

Radiation treatment used to treat some cancers can also cause harm to the ovary and testes. The tissues which are responsible for producing eggs and sperms might get damaged and make the person permanently infertile.

Fertility preservation includes the following –

Freezing of sperms

A person who might undergo treatment which might potentially make him infertile - can produce semen by masturbation and get it frozen for future use. It is best to freeze multiple samples (if time permits). In boys who have not yet attained puberty, aspiration of tissue followed by freezing is possible.

Freezing of eggs

Unlike sperms, egg freezing is a more complicated procedure. It involves administration of medications for a period of two weeks or more to stimulate the ovaries to produce multiple eggs, which are then collected by a minor surgical procedure under anaesthesia / sedation.  These eggs are then frozen.

Freezing of embryos

For married women, the eggs collected can be fertilised with the husband’s sperm (IVF or ICSI) and then cultured to form embryos. These embryos are then frozen – usually in groups of 2 – 3. Of all methods, embryo freezing is the most time tested method and successful. When the woman has completed her treatment and is ready to initiate pregnancy, the embryos are thawed and transferred into the uterus for maturation and birth.

Freezing of ovarian tissue

In patients where stimulation of ovaries to produce eggs is not possible because of the age of the person or paucity of time, ovarian tissues can be collected by a surgical procedure and frozen. This is still an emerging technology and we do not offer it at present.

Gonadal shielding 

If you're having radiation applied to an area far from your pelvis, carefully placed shields can reduce your reproductive organs' exposure to radiation and reduce the harmful effects.

Ovarian transposition (oophoropexy)

This surgical procedure is sometimes recommended if radiation is being planned to your pelvis.  The ovaries are surgically repositioned just before radiation therapy so that they are as far away as possible from the planned radiation field.  This though does not always completely protect the ovaries. After completion of the radiation, you might need to have the ovaries repositioned again or use IVF to conceive.

Counselling and consent

It is important that all patients who consider the above mentioned procedures discuss the pros and cons of the procedure with the doctor. In patients with cancer, decision making about future fertility can be difficult and distressing. Counselling might be useful in select cases. Because of the nature of the disease, instructions should be specified about the disposition of stored gametes (eggs / sperms), embryos, or gonadal tissue in the event of the patient’s death, unavailability, or other contingency.