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Fertility Preservation

Overview

THE BIOLOGICAL CLOCK

Women are born with roughly five hundred thousand eggs; by the time a woman turns 40, this reserve is depleted.

The “biological clock” is directly associated with the gradual depletion of the egg supply that each woman is born with. The ticking of their ovarian biological clock, i.e., with ageing, and not knowing their position on this clock represent two of the most prominent dilemmas that women face. To address these issues, cryopreservation technology, which is rapidly manifesting as ‘fertility insurance’, is attracting widespread attention.

What if it was possible to stop eggs from ageing? A 42-year-old woman could serve as her own egg donor: a gift from her 30-year-old self.

For career-oriented women or women about to undergo chemotherapy, halting the biological clock is a viable option. Thus, a woman can work or recover from a specific condition and choose to conceive later. This option has finally been made possible by science owing to vitrification.

Occurrence of malignancies for which gonadotoxic therapy (including chemotherapy, radiation, and/or surgical resection), immunotherapy, and/or bone marrow transplantation are required:

  • Haematological malignancies (leukaemia, lymphoma, and multiple myeloma)
  • Breast cancer
  • Sarcomas
  • Certain pelvic cancers
  • Central nervous system tumours
  • Ovarian-focussed cancer radiotherapy

Oncofertility is a branch of gynaecologic oncology that represents the combination of dedicated cancer and reproductive care to ensure that after cancer diagnosis, patients and/or survivors can preserve their fertility and achieve maximum reproductive potential. Oncofertility preservation involves a discussion of the effects of cancer treatment on the male/female reproductive systems and the associated risks and complications. Agents used for cytotoxic chemotherapy exert progressive, often irreversible, effects on the ovaries, causing the degeneration of the primordial follicles, loss of eggs, decrease in the levels of the anti-Müllerian hormone, and exhaustion of the ovarian follicle reserve. The type of chemotherapeutic drug used, its dosage, the duration of chemotherapy, and the age of the patient during treatment determine the extent of these effects. Radiation affects the primordial follicles, leading to early ovarian failure. Considering these adverse effects, counselling regarding the risk of infertility after cancer treatment and the appropriate methods for preserving fertility must be administered to the patients. Cryopreservation of oocytes, embryos, and/or ovarian tissues (or sperms, semen, and/or testicular tissues) represents a valuable modality for preserving reproductive potential. On the basis of specific factors, such as the age of the patient, time to initiate anticancer treatment, risk of the occurrence of early ovarian insufficiency, and the possibility of using hormones to stimulate eggs, an appropriate method for preserving fertility is suggested.

Presence of non-oncological diseases:

  • Systemic diseases for which chemotherapy, radiation therapy, and/or bone marrow transplantation are required (for example, clotting disorders)
  • Ovarian conditions: Presence of bilateral benign tumours in the ovaries, severe and recurrent ovarian endometriosis, and/or risk of developing ovarian torsion
  • Family history or increased risk of developing premature ovarian insufficiency
  • Genetic diseases that can affect future fertility (E.g.: Turner syndrome, galactosaemia, thalassemia, sickle cell disease)
  • Autoimmune conditions, such as systemic lupus erythematosus

Societal reasons:

  • Age
  • Desire to postpone childbirth to a later stage in life
  • Exposure to toxic chemicals
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