Fertility Preservation: Personal and Medical Considerations
Reasons for Elective Fertility Preservation
Women are increasingly looking into fertility preservation for various reasons, both personal and medical. Many are postponing family planning and are concerned about potential fertility challenges later on. However, fertility preservation is particularly crucial for women facing serious health issues, allowing them to secure their reproductive options prior to medical treatments. Key groups that may benefit include:
– Women advised to undergo surgical removal of part or all of their reproductive organs due to conditions such as ovarian, cervical, or uterine cancer, or severe endometriosis.
– Women diagnosed with various cancers, as chemotherapy and radiation can impair fertility or lead to sterility.
– Women with autoimmune conditions like lupus or rheumatoid arthritis, whose medications may adversely affect ovarian function.
– Women with a family history of premature menopause.
– Women undergoing in vitro fertilization (IVF) who, based on ethical or religious beliefs, prefer not to freeze embryos.
Regardless of the circumstances, fertility preservation offers a viable option for many women and couples. A recent article in the New England Journal of Medicine evaluates two prominent methods for elective fertility preservation: egg freezing and ovarian tissue freezing.
Cryopreservation: Egg Freezing
The initial phase of egg freezing involves conducting blood tests and ultrasounds to assess a woman’s candidacy for the procedure. If deemed suitable, she will receive medication to elevate hormone levels naturally produced by the body, stimulating the ovaries to mature multiple eggs. Following this, the eggs are retrieved and subsequently frozen using either a slow or flash-freeze technique. These frozen eggs can be thawed, fertilized, and implanted into the uterus when desired. Research suggests that egg freezing does not increase the risk of birth defects.
Cryopreservation: Ovarian Tissue Freezing
Ovarian tissue freezing entails the removal and freezing of a portion of ovarian tissue containing egg follicles. In situations where there’s a risk of reintroducing potentially cancerous tissue, individual follicles may be harvested instead. When the woman is ready to conceive, the tissue is reintroduced into the body. In approximately 95% of cases, this ovarian tissue can produce viable eggs for four to five years, although it may last longer. Similar to egg freezing, this method is considered safe, with the added benefit of facilitating spontaneous pregnancy.
Conclusion: Exploring Options for Fertility Preservation
Advancements in reproductive medicine have expanded the options available for women considering fertility preservation. The authors of the review urge women contemplating delayed pregnancies or those diagnosed with specific health conditions to engage with their healthcare providers early to effectively plan for their reproductive health future.
Written by Debra A. Kellen, PhD
Review Citation: Fertility Preservation in Women. N. Engl. J. Med 2017 Oct 26;377(17)1657-1665, J Donnez, MM Dolmans
DOI: 10.1056/NEJMra1614676