Description
Fertility preservation techniques have advanced rapidly, offering new hope to individuals wishing to safeguard their reproductive potential. From egg and sperm freezing to ovarian tissue preservation and innovative lab-based maturation methods, these technologies are becoming more accessible and effective. Such advancements are particularly crucial for patients undergoing cancer treatment, individuals with genetic risks, and those choosing to delay parenthood. Despite the progress, challenges remain in ensuring equitable access, improving long-term success rates, and addressing ethical considerations. As research continues to evolve, fertility preservation stands at the forefront of protecting future parenthood options.
Summary Listen
- Fertility preservation is a medical and laboratory technique employed to protect and store reproductive cells or tissues (eggs, sperm, embryos, or gonadal tissues) for future use, enabling individuals to have biological children when natural fertility is threatened by medical, surgical, or social factors. It is recommended for women at risk of ovarian function loss due to chemotherapy, radiotherapy, ovarian surgery, autoimmune diseases, genetic conditions, or social reasons like delaying childbearing. Men may require it due to medical conditions impairing spermatogenesis (chemotherapy, surgery, chronic illness, trauma) or non-medical reasons (vasectomy, gender-affirming therapy).
- A case study of a 30-year-old breast cancer patient highlighted the clinical challenges of urgently starting ovarian stimulation. A random start protocol was selected, and 20 oocytes were successfully retrieved and frozen after vaginal guided oocyte retrieval under conscious sedation. Success is measured based on age and oocyte number, with studies showing a decline in survival and clinical pregnancy rates with increasing age at vitrification (freezing).
- Collaboration between a multidisciplinary team is crucial, including male fertility specialists, assisted reproduction experts, and those specializing in fertility preservation, endometriosis effects, and reproductive surgery. The male partner should not be overlooked, as male-related fertility issues are increasing, requiring joint evaluation and realistic outcome discussions. Innovations like testicular mapping and micro TESE are used for non-obstructive azoospermia, along with micro RNA and genetic testing of embryos (PGM/PGT).
- Fertility preservation matters due to increased demand from cancer patients, career planners, and those with genetic risks. It safeguards reproductive potential before gonadotoxic treatments or age-related decline. For females, oocytes can be frozen if there's no male partner, or embryos can be cryopreserved when eggs are fertilized. For males, sperm cryopreservation is used before chemotherapy, and testicular tissue can be frozen for pre-pubertal boys.
- Studies demonstrate that fertility preservation does not increase the risk of breast cancer recurrence, even in estrogen receptor-positive cases. However, a significant percentage of women express fertility concerns that are ignored, with barriers including counseling costs, timing, referral delays, and MDT referral challenges. Egg cryopreservation involves ovarian stimulation protocols to recruit multiple mature follicles, using agonist or antagonist medications and triggering ovulation with HCG or GnRH agonist. Random start protocols can initiate stimulation at any point in the menstrual cycle.
- Oocyte retrieval is commonly performed vaginally under conscious sedation or local anesthesia, but can also be done trans-abdominally or laparoscopically. Chemotherapy can damage male fertility by disrupting spermatogenesis through pre-testicular, testicular, or post-testicular mechanisms. Emerging techniques include fertile protection agents, secondary tissue culture grafting, spermatogonial stem cell transplantation, and cleorepotent stem cell-derived chemids.
- In cases of severe oligospermia, genetic testing and sperm cryopreservation are recommended due to the risk of progressive testicular failure. A private history should always be taken, considering anabolic steroid use as a cause of secondary hypogonadism, with recovery potentially taking 6-12 months. Steroids can suppress the hypothalamic-pituitary axis, leading to oligospermia, and recovery can be aided with HCG and selective estrogen receptor modulators. The role of ovarian surgery, particularly for endometriosis/endometriomas, impacts fertility, requiring a balance between the risk of progression and surgical complications. Lower AMH and AFC increase the threshold to operate.
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About the Speakers
Dr. Radwan Faraj
Professor in Obstetrics, Qatar University, Senior Consultant Obstetrician and Gynaecologist, AI Shahhen Medical Centre, Qatar
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