Fertility Preservation Options
Fertility preservation is utilized by patients who are diagnosed with cancer and require treatments that may impair their fertility. It can also be utilized by military personnel before being deployed to active duty and also women or men who may want to delay starting their family until later in life. Eggs and sperm that are frozen (cryopreserved) are actually “suspended in time” and do not age as our bodies do over time.
A diagnosis of cancer is always very scary. However, medical advances have increased survival rates significantly. On average, most childhood cancers have an 80 percent survival rate. In addition, 20- to 49-year-old patients with cancer have over a 70 percent survival rate after five years. As cancer treatments become more successful, longterm plans for having a family in the future need to be considered. American Society of Clinical Oncology (ASCO) recently published treatment and counseling guidelines for fertility preservation. These guidelines advise oncologists to discuss fertility options before patients begin their cancer treatment. Unfortunately, surveys show less than half of oncologists are actually discussing fertility preservation with their patients.
Many cancer treatments, including radiation and chemotherapy, may harm a person’s future fertility potential. If radiation treatments occur near the testes or the ovaries, there is typically a decline in a person’s fertility. Damage to the ovaries or testes for patients who receive chemotherapy varies, and is dependant on chemotherapy dose, treatment, duration and type of chemotherapy.
In general, the older a woman is at the start of her cancer treatment, the higher the chance is that the treatment can cause premature menopause. After chemotherapy, if a woman does not restart her menses approximately one year after chemotherapy, she is unlikely to regain ovarian function. Currently, there are no scientifically known risks to the future children of men or women who receive chemotherapy before achieving a pregnancy. Patients should always discuss this aspect in detail with their oncologist before beginning treatment.
For men, the best method of fertility preservation is to cryopreserve their sperm. Sperm cryopreservation can be done any time after puberty. Typically, men are able to produce samples to be frozen approximately every 2-3 days before they start cancer treatment or until they are deployed for active military service. When the gentleman is ready to begin his family, he and his partner have options to use the cryopreserved sperm and should consult a reproductive endocrinology specialist. At this time, they typically can utilize the cryopreserved sperm for intrauterine insemination (IUI) or in vitro fertilization (IVF) procedures.
For women, options for preserving their fertility, either due to a cancer diagnosis or their desire to delay starting a family, had previously been very limited. Basically, the only way for a woman to preserve her fertility was to have embryos created (with her current partner or donor sperm) and then cryopreserved for future use. Until recently, oocyte (egg) cryopreservation was considered experimental and physicians were not offering this option as a way for patients to preserve their fertility. However, in 2012, the American Society of Reproductive Medicine (ASRM) announced that the freezing (vitrification) of a women’s eggs was no longer experimental and has been scientifically proven to be a fertility preservation option for women. Currently, pregnancy rates using frozen eggs are very similar to pregnancy rates using fresh (not frozen) eggs.
For a woman to have her eggs frozen for future use, she needs to see a reproductive endocrinology specialist who will be able to provide services to obtain the eggs. It is important to note that this treatment typically takes several weeks to be accomplished and could possibly cause a delay in a patient’s cancer treatment. Patients should discuss this possible delay with their oncologist.
The techniques for freezing tissue from a testes or an ovary may advance over the next decade and allow for fertility preservation in children (prior to puberty) with cancer and also for patients who have a very limited time before cancer treatment begins or are deployed for active military duty. The use of donor sperm, donor egg, and adoption continue to remain viable options for patients who desire children but are unable or unwilling to cryopreserve their sperm or eggs.
Sperm, embryo, and now egg cryopreservation have become standard procedures for fertility preservation. As scientific advancements occur, the options for individuals to preserve their fertility will undoubtedly increase. However, even with the current options, there is significant hope for patients in various situations to preserve their fertility and eventually have the family of their dreams. There have been documented cases where pregnancies have occurred when patients had specimens cryopreserved for 20 years. This fact only emphasizes the need for individuals to consider fertility preservation.
WENDY SCHILLIGNS, MD, FACOG
Dr. Schillings is a board certified reproductive endocrinologist, obstetrician and gynecologist. She leads all aspects of patient care at RMAPA. In addition, she formerly led the medical team at RE & I Specialist with the Lehigh Valley Physician Group. Dr. Schillings is chief of the Division of Reproductive Endocrinology and Infertility at Lehigh Valley Hospital Health Network and Clinical Associate Professor of Obstetrics and Gynecology at Penn State College of Medicine.