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 aims to safeguard reproductive cells or tissues (eggs, sperm, embryos, gonadal tissue) for future use when natural fertility is threatened by medical, surgical, or social factors. This is beneficial for individuals facing risks to their reproductive function, offering the potential for biological children later in life.
- Fertility preservation is recommended for women facing potential loss or reduction in ovarian function due to chemotherapy, radiotherapy, ovarian surgeries, autoimmune diseases, genetic conditions, or social reasons like delaying childbearing. Men may consider it before undergoing chemotherapy, radiotherapy, surgery, or treatments for chronic illnesses that affect fertility, or for non-medical reasons like prior to vasectomy or gender-affirming therapy.
- A case scenario involving a 30-year-old breast cancer patient highlighted the urgency and challenges of fertility preservation, utilizing a random start ovarian stimulation protocol to retrieve and freeze eggs before chemotherapy. Success is measured by age and the number of eggs retrieved, with younger women having higher success rates in terms of survival, clinical pregnancy, and live birth rates.
- Collaboration between multidisciplinary teams is crucial, including male fertility specialists, assisted reproduction experts, fertility preservation specialists, and reproductive surgeons. The male partner should not be overlooked, as male-related fertility issues are increasing, and joint evaluation and coordinated management are important.
- Innovations in male fertility include testicular mapping, micro TESE, micro RNA, and genetic testing of embryos with PGM and PGT. Sperm cryopreservation is a key technique, with outcomes similar to controls, although oncologists typically advise men to avoid conception for a year post-chemotherapy due to DNA damage risks.
- Fertility preservation is safe and effective, especially in women with hormone receptor-positive breast cancer, and does not increase the risk of recurrence. It should be a standard of care, offering options like oocyte freezing (for single women) or embryo cryopreservation (when sperm is available). Testicular tissue freezing is available for pre-pubertal boys.
- Ovarian stimulation protocols aim to recruit multiple mature follicles, reducing the time to egg freezing. Random start protocols initiate stimulation at any point in the menstrual cycle, which is particularly useful for cancer patients requiring immediate treatment, and has similar egg yield compared to conventional protocols.
- Egg retrieval can be done vaginally, abdominally, laparoscopically, or rectally, with the choice dependent on patient preference, anatomy, and clinical circumstances. Collaboration between urologists (evaluating sperm retrieval) and gynecologists (managing ovarian stimulation and storage) is essential for improving future reproductive success.
- Anabolic steroid use can lead to secondary hypogonadism, suppressing spermatogenesis, and causing oligospermia. Early referral for fertility preservation is important, even though recovery may take several months. In cases of severe oligospermia, sperm cryopreservation should be offered, as affected individuals are at risk of progressive testicular failure.
- Ovarian surgery, particularly for endometriosis (endometrioma), can impact ovarian reserve. Endometriomas have a toxic effect on ovarian tissue, leading to reduced ovarian reserve, independent of their size. A balanced approach, considering the risk of progression of endometriosis versus surgical complications, is necessary.
- The decision to operate on endometriomas needs to be weighed against the potential for pelvic abscess, rupture, occult malignancy, retrieval difficulties, and surgical complications. Assessing ovarian reserve with AMH and antral follicle count prior to surgery is crucial, with a lower AMH and AFC increasing the threshold for surgical intervention.
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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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