Who Should Do Fertility Preservation?

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What is Fertility Preservation?

Fertility preservation, also known as cryopreservation or gamete preservation, is the process of storing eggs, sperm, or embryos for later use. This technique is primarily intended to provide individuals with the option to have biological children at a time when they might face obstacles to natural conception, such as age-related fertility decline, medical treatments, or other factors affecting reproductive health. By preserving their reproductive cells, individuals can potentially achieve parenthood in the future, even if their fertility would have otherwise declined or been compromised.

Why is Fertility Preservation Done?

Fertility preservation is performed for a variety of reasons, including:

Medical Treatments: Many medical treatments, such as chemotherapy, radiation therapy, or surgery, can have adverse effects on reproductive organs and gametes. Fertility preservation offers a way for individuals facing these treatments to maintain their fertility options, especially if they wish to have children after the treatments are completed.
Age-Related Fertility Decline: Fertility naturally decreases with age, especially for women. Fertility preservation can be a proactive step for women who want to delay parenthood but are concerned about age-related fertility decline. Storing eggs or embryos while they are younger can increase the chances of successful pregnancy later in life.
Premature Ovarian Insufficiency (POI): POI, a condition where the ovaries stop functioning before the age of 40, can lead to infertility. Fertility preservation can be a crucial option for women diagnosed with POI, enabling them to use their preserved eggs or embryos when they are ready to start a family.
Gender Transition: Individuals undergoing gender transition may wish to preserve their gametes before hormonal treatments or surgeries to maintain their ability to have genetically related children in the future.
Cancer Survivors: Cancer treatments can negatively impact fertility. Fertility preservation allows cancer survivors to pursue their dreams of parenthood post-treatment.

Types of Fertility Preservation

Several methods are available for fertility preservation:

Egg Freezing (Oocyte Cryopreservation): Egg freezing involves the extraction and freezing of a woman’s eggs. These eggs can be stored for years and then fertilized with sperm to create embryos when she decides to start a family.
Sperm Freezing (Sperm Cryopreservation): Sperm freezing is a relatively simple process where a man’s sperm is collected and stored. It is a popular option for men facing medical treatments or those concerned about age-related fertility decline.
Embryo Cryopreservation: In embryo cryopreservation, eggs are extracted, and fertilized with sperm, and the resulting embryos are frozen. This method is often chosen by couples undergoing in vitro fertilization (IVF) who have surplus embryos.
Ovarian Tissue Cryopreservation: Ovarian tissue cryopreservation involves removing a piece of ovarian tissue, which contains immature eggs. This tissue is then frozen and can be re-implanted or matured into eggs in the future.
Testicular Tissue Cryopreservation: Similar to ovarian tissue cryopreservation, testicular tissue cryopreservation involves preserving testicular tissue containing sperm-producing cells. This can be an option for prepubertal boys or men who are unable to ejaculate sperm.

Fertility Preservation for Iatrogenic Infertility

“Iatrogenic infertility” refers to infertility caused by medical interventions or treatments. Fertility preservation plays a vital role in addressing iatrogenic infertility by providing a way to mitigate or prevent the fertility-reducing effects of medical procedures. Cancer treatments, for example, can be lifesaving but often result in infertility. Through fertility preservation, cancer patients can maintain hope for parenthood post-recovery.

Moreover, iatrogenic infertility isn’t limited to cancer treatments; it can also result from surgeries involving reproductive organs, radiation therapy, and medications used for various medical conditions. Fertility preservation empowers individuals to make informed choices about their reproductive health, reducing the emotional burden associated with potential fertility loss due to necessary medical procedures.

How Can Women Preserve Fertility Before Cancer Treatment?

Egg Freezing (Oocyte Cryopreservation):

Before beginning cancer treatments such as chemotherapy or radiation, women can undergo egg freezing. This process involves stimulating the ovaries to produce multiple eggs, which are then retrieved, frozen, and stored.
The stored eggs can be used in the future for in vitro fertilization (IVF) to create embryos when the woman is ready to start a family.

Embryo Cryopreservation:

Women in a stable relationship or seeking to utilize a partner’s sperm can consider embryo cryopreservation.
The process involves harvesting and fertilizing the eggs with sperm to create embryos, which are then frozen for later use.
Embryo freezing is a popular choice for couples who plan to undergo IVF or for women who have a suitable partner’s sperm available.

Ovarian Tissue Cryopreservation:

Ovarian tissue cryopreservation involves surgically removing a piece of ovarian tissue, which contains immature eggs, before cancer treatment.
The tissue is frozen and can be re-implanted or matured into eggs in the future, potentially restoring fertility.

What Can Men Do to Preserve Fertility Before Cancer Treatment?

Sperm Freezing (Sperm Cryopreservation):

Men can preserve their fertility by banking their sperm before undergoing cancer treatments.
The process is relatively simple, involving the collection of sperm, which is then frozen and stored for future use.
Sperm freezing is a common and effective method, ensuring that men have the option to have biological children after treatment.

Testicular Tissue Cryopreservation:

For prepubertal boys or men who cannot ejaculate sperm, testicular tissue cryopreservation is an option.
A small piece of testicular tissue containing sperm-producing cells is surgically removed and frozen.
In the future, the tissue can be used to retrieve sperm for assisted reproduction techniques.

What Happens to the Frozen Embryos, Eggs, and Sperm?

Frozen embryos, eggs, and sperm are carefully stored in specialized cryopreservation facilities. These facilities maintain the quality and viability of the preserved gametes for an extended period, often several years or even decades. Here’s what happens to these preserved reproductive cells:

Storage and Monitoring:

Embryos, eggs, and sperm are securely stored in cryogenic tanks filled with liquid nitrogen. These tanks maintain the cells at extremely low temperatures, typically around -196 degrees Celsius (-320 degrees Fahrenheit).
The facilities regularly monitor and maintain the tanks to ensure the cells remain viable.

Thawing and Usage:

When an individual or couple is ready to use the preserved gametes, the cells are thawed under carefully controlled conditions.
Thawed eggs or sperm can be used for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), while embryos can be transferred to a woman’s uterus during an IVF cycle.

Assisted Reproduction:

The thawed sperm, eggs, or embryos are used in assisted reproduction techniques, where they are combined to facilitate fertilization.
The resulting embryos are transferred into the uterus, where they can implant and potentially lead to a successful pregnancy.

Quality Assurance:

The facilities performing fertility preservation and storage follow strict quality assurance measures to ensure that the preserved gametes maintain their quality and viability.
Continuous monitoring, stringent protocols, and highly controlled environments are used to safeguard the cells.

Advantages of Fertility Preservation

Cancer Patients: One of the most significant advantages of fertility preservation is its role in providing hope to cancer patients. Cancer treatments, such as chemotherapy and radiation, can significantly impact fertility. Preserving eggs, sperm, or embryos before treatment allows cancer survivors to pursue parenthood post-recovery.
Delayed Parenthood: As more individuals choose to delay starting families for various personal, educational, or career-related reasons, fertility preservation offers the opportunity to combat age-related fertility decline. Women can freeze their eggs while they are younger, potentially increasing their chances of successful pregnancy when they are ready to become parents.
Gender Transition: Fertility preservation is invaluable for individuals undergoing gender transition. Hormone therapy and surgeries can affect reproductive health, making it crucial to preserve eggs or sperm before transitioning. This allows them to have genetically related children after their transition is complete.
Fertility Challenges: Some medical conditions, like premature ovarian insufficiency (POI) and conditions that affect sperm production, can lead to infertility. Fertility preservation methods offer a solution, allowing individuals with these conditions to maintain the hope of having children.
Embryo Banking for IVF: Fertility preservation is an integral part of in vitro fertilization (IVF) treatments. Couples undergoing IVF can benefit from freezing and storing surplus embryos, which can be used for future pregnancy attempts, reducing the need for repeated IVF cycles.
Choice and Control: Fertility preservation provides individuals with greater control over their reproductive futures. It allows them to make informed decisions about when and how they want to start a family, ensuring more flexibility and peace of mind.

Read About: What is Egg Freezing Cost in India?

Risks of Fertility Preservation

Emotional and Financial Costs: Fertility preservation procedures can be emotionally and financially demanding. The process may involve hormone stimulation, invasive procedures, and ongoing storage costs, which can be a financial burden.
No Guarantee of Success: While fertility preservation methods have shown promising results, there is no absolute guarantee of success. The ability to achieve a pregnancy in the future depends on various factors, including the quality of preserved gametes and the individual’s overall health.
Ethical and Legal Considerations: In some cases, issues related to ownership, disposal, or the use of preserved gametes or embryos can be complex and ethically challenging. Legal frameworks may also impact these considerations.
Health Risks: The hormonal medications used for egg or sperm retrieval can have side effects and health risks. It’s essential for individuals to discuss these risks with their healthcare providers before undergoing fertility preservation.
Storage Risks: The long-term storage of frozen gametes and embryos may come with risks, such as equipment failures or storage facility issues. These risks are typically mitigated through rigorous quality control and monitoring procedures.

Success Rate of Fertility Preservation in India

The success rate of fertility preservation in India, as in any other country, varies depending on several factors. These include the individual’s age, the quality of preserved gametes, the chosen preservation method, and the expertise of the medical team. However, fertility preservation has shown promising success rates, and India has experienced growth in its fertility preservation services.

Egg Freezing: Egg freezing success rates in India have been steadily improving. Success largely depends on the woman’s age at the time of freezing, with younger women experiencing higher success rates. Generally, success rates for egg freezing in India range from 30% to 50%.
Embryo Cryopreservation: The success rate for embryo cryopreservation is relatively high, as the embryos are typically of high quality. Success rates for frozen embryo transfer can range from 40% to 60% in India.
Sperm Freezing: Sperm freezing is highly successful, with a high rate of sperm survival upon thawing. Success rates are typically over 90%, making it an effective method for preserving male fertility.
Ovarian Tissue Cryopreservation: Ovarian tissue cryopreservation is a relatively new technique, and success rates may vary. The ability to restore fertility depends on the woman’s age and the success of tissue transplantation.