Fertility Preservation

Fertility preservation is a type of procedure used to preserve a person's ability to have children in the future in case of a cancer or other health condition, age and transgender care. Fertility in all such cases is preserved by saving reproductive tissues, embryos, eggs or sperm prior to treatment. This is achieved by cryo-freezing before administration of a medical treatment that may cause infertility, such as radiation therapy or chemotherapy. Cryofreezing may be also required in case of other diseases such as auto-immune diseases or uterine conditions (endometriosis, fibroids) which make it more difficult to achieve pregnancy. Cryofreezing is sometimes also asked by couples who wish to delay having children until their later age. Fertility preservation at Chandigarh is available at your best IVF infertility and IVF center which offers freezing and preservation of all reproductive tissues such as the eggs, sperms and embryos.

Fertility preservation is essentially a three-step process:

• Removal of any of the following from the affected partner: eggs, embryos, sperm or reproductive tissue (e.g. the ovaries) before the cancer treatment is started;
• Cryo-freezing and preserving the removed reproductive tissue for future use.
• Thawing the tissue whenever required for reproduction for use with any of the assisted reproduction technique.

When did Fertility preservation start?

The first pregnancy from cryopreserved embryos was reported in Australia in 1983 (Trounson & Mohr 1983), and the first baby born after blastocyst cryopreservation was reported 2 years later (Cohen et al. 1985). Since then, embryo cryopreservation has become a routine procedure in IVF laboratories (Herrero et al. 2011)

How long does it take to freeze your eggs before chemo?

The good news is that some fertility preservation options, such as egg and embryo freezing, can be fast-tracked for women who are about to undergo cancer treatment. The entire egg freezing process takes 2–4 weeks, a period which studies conclude does not affect survival chances in most cancer cases.

How can I preserve fertility naturally?

7 Habits to Preserve Your Fertility

• Eat real food. It's true, you are what you eat.
• The Elixir of life. Every cell in your body needs it.
• Party sparingly and avoid inflammation. The key is balance.
• Keep Moving. Exercise is FREE healthcare.
• Practice relaxation.
• Acupuncture.
• Don't worry, be happy.'

No, egg freezing will not stop your monthly period. The egg freezing process takes about two weeks, beginning on the first day of your period (what we in the field call “Day 1”)

Can I save my eggs before a hysterectomy?

Even though a hysterectomy doesn't remove your ovaries and fallopian tubes, they can still be affected and can damage ovarian follicles containing eggs. Doctors recommend egg harvesting before hysterectomy recovery or surgery.

Can you get pregnant after having your cervix frozen?

Cryotherapy shouldn't affect your ability to get pregnant in the future, unless a very rare complication occurs. In a small number of cases, cryotherapy doesn't completely remove the abnormal cells. This is more likely if the abnormal cells are deep in your cervix.

Should you freeze sperm before chemotherapy?

Preserving Fertility in Men

It simply involves collecting a sample of semen and freezing it. Sperm must be banked before any chemotherapy or pelvic radiation therapy begins in order to avoid storing damaged sperm. The sperm can be thawed later and used for intrauterine insemination or in vitro fertilization.

How can I protect my ovaries during chemo?

There are currently several options to help women of reproductive age who are undergoing ovary-damaging chemotherapy treatment maintain the possibility of having children. They include two drugs, goserelin and leuprolide, which temporarily shut down the ovaries to protect them during chemotherapy.

Does chemo as a child make you infertile?

Infertility remains one of the most common and life-altering complications experienced by adults treated for cancer during childhood. Surgery, radiation, or chemotherapy that negatively affects any component of the hypothalamic-pituitary-gonadal axis may compromise reproductive outcomes in childhood cancer survivors.

At what age should I freeze my eggs

“Studies suggest that women who freeze their eggs before age 35 have a better chance of a successful pregnancy than those who freeze their eggs after age 35." This is because the more eggs retrieved and frozen, the better the chance of a successful pregnancy.

How many eggs should I freeze at 35?

10 eggs-Number of eggs retrieved at 35

If you are 35, you should aim to freeze at least 10 eggs. One egg freezing cycle resulted in 12 eggs frozen on average for this age group. So many women only needed to do one cycle of egg freezing to achieve the optimal egg number!

Is egg harvesting painful?

The egg retrieval is a 15-minute surgical procedure. No cuts, no stitches. The word “surgery” might seem scary, but the egg retrieval process is quick and essentially painless

Who performs fertility preservation? What are the types of fertility preservation?

Fertility preservation treatments fall into two categories:

Fertility preservation methods for women and people designated female at birth (DFAB)

Egg freezing: You receive treatment with hormones to stimulate egg production in your ovaries. Your provider removes the eggs and freezes and stores them.

Embryo freezing: Similar to egg freezing, this involves the removal of eggs from your ovaries. Your provider fertilizes the eggs with your partner’s sperm or donated sperm, creating embryos. This procedure is called in vitro fertilization (IVF). Your provider may implant the embryos in your body right away or freeze and store them for future use (embryo cryopreservation).

Ovarian tissue freezing: If you’re receiving cancer treatment, you may not be able to wait the two to six weeks needed to receive hormone treatment. Instead, you can have your ovarian tissue removed and frozen. After your cancer treatment (once you are medically cleared and are ready to conceive), your surgeon reimplants the thawed tissue. If the tissue regains function, you may be able to become pregnant spontaneously or via IVF.

Ovarian transposition (oophoropexy): This procedure can help protect your ovaries from radiation treatments. Your surgeon moves your ovaries up out of your pelvis and into your abdomen, away from the treatment area.

Radiation shielding: A lead shield can protect your ovaries during radiation treatments. Your provider may also use precise radiation technologies that limit the dose of radiation your ovaries receive.

Fertility preservation techniques for men and people designated male at birth (DMAB)

Radiation shielding: This is similar to radiation shielding for women. Your provider will limit radiation exposure to your testicles by shielding them or by using more precise radiation techniques.

Sperm freezing: You submit a sample of semen for freezing and storage.

Testicular tissue freezing: Some men don’t have sperm in their semen. Similarly, prior to puberty, people designated male at birth (DMAB) are unable to produce sperm in semen. In these cases, providers remove a sample of testicular tissue which may contain sperm. Any sperm found are extracted and frozen.

What types of fertility preservation are available for children?

Childhood cancer and other conditions can also affect children’s future fertility. Ovarian and testicular tissue freezing are options for children, with sperm, egg, and embryo freezing available after they reach puberty. Younger children may benefit from radiation shielding and ovarian transposition.

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.
• 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.

Usually, you can go home about two hours after laparoscopic surgery with specific instructions for follow-up care.

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:

• Precise radiation technologies such as intensity-modulated radiation therapy (IMRT). Radiation therapy is usually quick and painless, but it may cause side effects such as hair loss, diarrhea and fatigue.
• Shielding devices are made of lead that absorbs radiation. Ovary shields are plate-like devices, while testicle shields are round cups that surround the testicles.

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).

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).

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.

In vitro fertilization

The success of IVF depends on your:

• Age.
• Body mass index.
• Health conditions.
• Past IVF treatments.
• Past pregnancies.

Ovarian tissue transplantation

This procedure is relatively rare but there are reports of 130+ live births occurring after it. The success of ovarian tissue preservation may depend on the number of eggs your ovaries contain at the time of removal. This number decreases with age, so younger tissues have better outcomes. Two live births have been reported from women who were children at the time of ovarian tissue harvest: age 9 years (prepubertal) and age 13 years (pubertal but premenarchal).

Ovarian transposition

Ovarian transposition is not nearly as common as IVF. Ovarian function may be impacted by radiation therapy, even with relocation. However, providers have reported successful egg harvesting and pregnancies after ovarian transposition.

When is the best time to talk to your healthcare provider about fertility preservation?

It’s best to start fertility preservation procedures as soon as possible. The optimal timing is:

• Before cancer treatment begins.
• Before gender-affirming treatment.
• By age 35 for women who have no immediate plans of having children.
• Soon after diagnosis of diseases that may affect your fertility.

If you’ve had past medical treatments that may have decreased your fertility already, talk to your provider about your options for fertility preservation.

A Note from Cleveland Clinic

Cancer and other diseases and circumstances can impact your ability to have a biological child. Through modern medicine, you can preserve your fertility now for a pregnancy (either of your own or through a surrogate) in the future. Some people also wish to preserve their fertility due to their age or their wish to delay starting a family. Early fertility preservation is ideal, so talk to your healthcare provider as soon as possible about your options. This will help you make an informed decision and choose an approach that meets your needs.