Fertility Preservation

What is fertility preservation?

Fertility preservation saves and protects your embryos, eggs, sperm and reproductive tissues. This helps make it possible for you to have a child sometime in the future. Fertility preservation is common in people who need medical treatment that may harm their future fertility or when someone wishes to delay having children for personal reasons. Treatment usually involves removing and freezing eggs, embryos, sperm and tissues so you can use them in the future.

Why is it done?

Your future fertility may be at risk if you have certain diseases and conditions. This could be due to the condition itself or to the surgery or medication your healthcare provider uses to treat the condition.

As fertility declines around age 35, people who wish to delay having children until they’re in their late 30s or 40s may want to preserve their fertility.

You may want to preserve your fertility if you wish to have children and any of the following affect you:

• Age: If you’re waiting to have children, you may consider preserving your eggs before fertility declines. Common reasons people delay having children include desires to reach a certain career goal, further their education or wanting to meet the right partner.
• Cancer: Chemotherapy, radiation therapy and surgery for cancer can affect fertility. The goal of preservation is to minimize the impact of cancer treatments on reproductive tissue and to freeze eggs or embryos ahead of treatment.
• Autoimmune diseases: Certain treatments for diseases, such as lupus and rheumatoid arthritis, may cause fertility problems.
• Reproductive health conditions: Endometriosis and uterine fibroids can make it more difficult to become pregnant.

For women, options for preserving your fertility include:

• Egg freezing: You receive treatment with hormones to stimulate egg production in your ovaries. Your provider removes the eggs, then freezes and stores them.
• Embryo freezing: Just like with egg freezing, this process involves retrieving eggs from your ovaries. But instead of freezing the eggs alone, they’re fertilized with sperm from your partner or a donor, creating embryos. This procedure is called in vitro fertilization (IVF). Your provider freezes and stores the embryos for future use (embryo cryopreservation).
• Ovarian tissue freezing: If your cancer treatment needs to start right away, and you don't have time for the hormone treatment required for egg freezing, you have another option. Your provider can remove one of your ovaries or part of an ovary and freeze small pieces of ovarian tissue for future use. After treatment, your surgeon can reimplant the thawed tissue. If the tissue regains function, you may be able to become pregnant naturally or with IVF.
• Ovarian transposition: This procedure can help protect your ovaries from radiation treatments for cancer. Your surgeon moves your ovaries up out of your pelvis and into your abdomen so it’s away from the radiation field.
• Uterine transposition: This is a new procedure that protects your uterus from radiation treatments by moving it temporarily out of the radiation field.

For men, options for preserving your fertility include:

• Sperm freezing: You submit a sample of semen for freezing and storage.
• Radiation shielding: Your provider will limit radiation exposure to your testicles by shielding them or by using more precise radiation techniques during cancer treatment.
• Testicular tissue freezing: Some men don’t have sperm in their semen. In these cases, providers remove a sample of testicular tissue, which may contain sperm. Your provider extracts and freezes any sperm they find.

Fertility preservation for children

Childhood cancer and other conditions can also affect children’s future fertility. Ovarian and testicular tissue freezing are options for children. Sperm and egg freezing are only available after they reach puberty. Younger children may benefit from radiation shielding and ovarian transposition.

What should I expect with fertility preservation?

Fertility preservation procedures vary widely. As you consider your options, it’s helpful to know what to expect with each procedure.

Egg and embryo freezing

This process starts with ovarian stimulation. You’ll inject yourself with hormones daily for about 10 days.

Egg removal happens while you’re under sedation — a type of anesthesia where you’re lightly asleep. Your provider:

1. Guides a needle through your vagina into your ovary using an ultrasound.
2. Draws up the fluid in your ovaries that has eggs through the needle.
3. Collects the eggs and either freezes them directly or fertilizes them before freezing.

You shouldn’t feel any pain or discomfort during the procedure. Some women feel bloating or discomfort during the days leading up to the procedure and for several days after it.

Ovarian tissue freezing

You’ll receive general anesthesia to put you to sleep. During this minimally invasive procedure (laparoscopy), your surgeon:

1. Makes two to four small incisions in your abdomen.
2. Inserts a thin scope to look inside your abdomen.
3. Uses small instruments to collect the tissue.
4. Removes the instruments and scope and closes the incisions.

Usually, you can go home about two hours after laparoscopic surgery with specific instructions for follow-up care.

Ovarian transposition

This is also a laparoscopic procedure performed while you’re asleep. Your surgeon makes a small incision in your abdomen and looks inside your pelvis with a tiny camera called a laparoscope to locate your ovaries. Then, they detach your ovaries from your fallopian tubes and move them higher up in your pelvis. They secure your ovaries in the new location.

When treatment is over, your healthcare provider will assess if your ovaries need to be moved back to their normal position. It can be hard to protect your ovaries, fallopian tubes and uterus during radiation treatment. Your options for pregnancy after this method may be limited to IVF or surrogacy.

Radiation shielding

Your provider will try to protect your ovaries or testicles from radiation by using:

• Precise radiation technologies, such as intensity-modulated radiation therapy (IMRT).
• Shielding devices made of lead that absorb radiation. Ovary shields are plate-like devices, while testicle shields are round cups that surround the testicles.

Sperm freezing

This is a noninvasive procedure where you masturbate and ejaculate into a cup. You give the cup to your provider for freezing and storage.

If you’re unable to produce a specimen due to illness, anxiety, pain or cultural or religious reasons, your provider can help using:

• Medication: Drugs that can help you ejaculate or correct problems preventing ejaculation.
• Vibratory stimulation: Vibration can help trigger ejaculation.
• Electroejaculation: Your provider guides a probe into your rectum. The probe stimulates your prostate with a mild electrical current that causes you to ejaculate. You’re asleep for this procedure.

Testicular tissue freezing

Your surgeon will collect testicular tissue. Collection may involve the use of a scalpel to remove the tissue or a needle to draw up the sample.

What happens to the frozen embryos, eggs and sperm?

When you’re ready to pursue pregnancy, your fertility team thaws the frozen specimen. Your provider:

• Completes the fertilization process with your thawed eggs or sperm to create embryos.
• Implants the newly fertilized or thawed embryos into your uterus or your gestational carrier’s uterus.

What are the risks and benefits of fertility preservation?

The main benefit of preservation is that it gives you a chance to have a biological child, despite your condition or circumstance. This can offer peace of mind to people who think they may want to have a baby in the future, even if that future is uncertain.

Procedures used in fertility preservation have some risks:

• Some of the procedures that providers use to collect eggs and sperm can cause bleeding or infection.
• IVF may increase the risk of multiple births, premature delivery and low birth weight.
• Laparoscopic procedures can cause infection, bleeding and injury to nearby organs and tissues.
• Ovarian stimulation may cause elevated estrogen levels. This can increase your risk of blood clots and the growth of estrogen-dependent cancers.
• Rarely, ovarian stimulation can cause ovarian hyperstimulation syndrome.
• Ovarian transposition can lead to ovarian torsion and ovarian cysts.

How successful are fertility preservation procedures?

Fertility preservation procedures don’t guarantee pregnancy. Freezing eggs, sperm and embryos is the most common type of preservation and has a long history of success for some people.

What is clear is that the success of each method varies based on factors like:

• Your age
• If you have cancer or other health conditions/diseases
• Number of eggs/embryos you freeze
• The experience of the fertility clinic

Your provider can help you assess these factors and better understand your chances of a successful pregnancy.

When is the best time to talk to your healthcare provider about fertility preservation?

It’s best to start fertility preservation procedures as soon as possible. The optimal timing is:

• Before cancer treatment begins
• By age 35 for women who have no immediate plans of having children
• Soon after diagnosis of diseases that may affect your fertility

If you’ve had medical treatment that may have decreased your fertility already, talk to your provider about your options.

How long does fertility preservation take?

It depends on the method you’re using. For example, freezing your sperm takes a few days. But freezing your eggs can take up to three weeks. Your healthcare provider can give you a better idea of the general timeline for each preservation method.