Fertility preservation consists of three basic processes: freezing eggs, freezing sperm, and/or freezing embryos to be used at a later date. Fertility preservation can be done for various reasons, such as: freezing prior to the exposure of gonadotoxic agents such as chemotherapy or radiation; freezing prior to surgical removal of gonads; or freezing eggs at a younger age thus decreasing the natural decline of fertility due to aging in women. Additionally, gametes (sperm or eggs) can be preserved prior to the onset of hormonal treatments used for gender transitioning.
Egg Freezing
Egg freezing provides the opportunity for patients to preserve their fertility until they are ready to start a family. Typically, these women are between the ages of 25 and 40. This could be for several reasons, including: – Women who have been diagnosed with cancer, prior to beginning chemotherapy or radiation treatment – Women with a family history of premature ovarian failure or early onset of menopause – Women who wish to limit the number of eggs they wish to fertilize during an IVF cycle due to ethical or religious reasons – Women who wish to delay childbearing because of personal, economic, or professional reasons-Transmen who will initiate testosterone as part of transgender care.
Fertility in females begins to decline in their late 20s and declines increasingly rapidly after the age of 35. This decrease in fertility is also associated with increased miscarriage rates and increased rates of chromosomal abnormalities. Many women freeze their eggs at a younger age to improve future fertility potential and decrease risk of future miscarriage and chromosomal abnormalities of offspring.
The freezing of eggs enables female patients to pause their biological clock, whether for health or personal reasons, and preserve their eggs at an optimal point in time. When they choose to use those eggs in the future, they will be using younger eggs that can decrease the rates of miscarriage and genetic problems. Egg freezing is no longer considered to be an experimental form of assisted reproductive technology, and excellent pregnancy rates are being achieved at ICRM with this technology.
The Process
The egg freezing process involves taking fertility medication to stimulate multiple ovarian follicles (the homes for the eggs) followed by an egg retrieval procedure. The basic steps of this process include potentially starting birth control pills, this is used to synchronize the cohort of eggs and allow for logistical planning of the stimulation cycle. Typically, a patient is on a birth control pill 2-3 weeks. If time is critical and the ovarian hyperstimulation must be done very quickly due to the need to initiate chemotherapy or surgery, the birth control pill step can be bypassed. Following birth control pills, injectable hormones (gonadotropins, which are follicle stimulating hormones) are used to stimulate the ovaries and grow multiple follicles. Within each mature follicle is a single egg. Once the follicles are mature, a trigger injection is used to complete the final maturation process. Following the trigger, the oocyte retrieval is performed 36 hours later. The oocyte retrieval is a minor surgical procedure which involves ultrasound-guided needle aspiration of each follicle. Intra venous sedation anesthesia is used. This is a same-day procedure that is completed within the clinic and typically lasts 30-45 minutes. The eggs are then immediately frozen through a process called vitrification. This allows the eggs to be stored indefinitely. In all, the patient should anticipate 10 to 14 days to complete this process. If the patient has a male partner with whom they desire future children, then the eggs will be inseminated and frozen approximately 5-7 days later. Similar to frozen eggs, frozen embryos can be stored indefinitely and do well with the freeze/thaw process.
For male patients who desire fertility preservation, sperm can be frozen following ejaculation. If unable to ejaculate, urologists specialized infertility care can assist with surgical extraction of sperm.
The process of egg, sperm, and embryo cryopreservation has enabled numerous patients to achieve families following circumstances that would have otherwise made it very difficult. Fertility preservation is becoming increasingly utilized and is a wonderful option for women and men of all ages.
