It is common knowledge that gonadotoxic cancer treatments like chemotherapy and radiation expose patients to a risk of subsequently becoming infertile. A few other conditions, such as endometriosis, autoimmune diseases, such as SLE and rheumatoid arthritis, and haematological disorders, such as thalassemia and aplastic anemia, frequently require therapy that could harm future fertility.
The gonadotoxicity of these treatments depends on a number of variables, including the patient’s age, ovarian reserve, the type of therapy (chemotherapy, radiation, immunotherapy, or surgery), as well as the doses and duration of that therapy. Thus, for all of these women or couples, fertility preservation is crucial.
All patients who have a condition that may affect their ability to conceive in the future or who require treatment that could be gonadotoxic are offered counselling.
When a couple want to postpone getting married or having children but does not have a specific medical condition, they can choose to freeze their eggs, sperm, or reproductive organs. There could be many potential causes for the postponement, including career, financial security, or any other social factor.
This is more crucial for women because over time, the quantity and quality of eggs decrease, which may cause issues when trying to conceive later on. Early egg or embryo freezing ensures better quality, which is beneficial for the couple.
- Cancers and its treatment like chemotherapy or radiotherapy
- Heat and Exposure to toxins [work place]
- Autoimmune disorder which requires immunotherapy or chemotherapy
- Conditions which require gonadectomy
- Occupation [Jobs with Military or staying away from the family]
- Cancers [Breast cancers, Cervical cancers or Endometrial cancers] .
- Chemotherapy / radiotherapy or Prophylactic oophorectomy [BRCA-1/ BRCA-2 mutation] for those cancers.
- Genetic / chromosomal disorders which may affect future fertility.
- Autoimmune disorder requiring chemotherapy or immunotherapy [SLE, MS, Rheumatoid Arthritis, etc.].
- Disease which affects ovarian reserve and requires repeated surgery on ovaries like Endometriosis.
- Social reasons [wants to delay child bearing, financial barriers, career aspirations, problem in family, etc.].
- Childhood cancers [Leukemia, lymphoma, CNS tumors, etc.].
- Benign ovarian tumors and other cancers like Breast cancer, etc.
- Family history of premature ovarian insufficiency.
- Disease requiring repeated surgery on ovaries [Endometriosis].
- Genetic / chromosomal disorder [Turner syndrome].
- Autoimmune disorder requiring chemotherapy or immunotherapy [SLE, MS, Rheumatoid Arthritis, etc.].
- Social reasons [late marriage, career aspiration, not finding the right partner].
1. Sperm Cryopreservation
Masturbation is used to gather sperm samples. One sample of semen can only be utilized for one attempt at pregnancy, hence it is best to collect and store several samples.
Invasive surgical methods, such as TESA/micro-TESE, etc., can be utilized to collect spermatozoa in patients with low sperm counts. Sperm is typically stored for a duration of ten years. Sperm cells are used to fertilize the ovum using assisted reproduction (intracytoplasmic sperm injection), which results in the development of an embryo.
2. Testicular Biopsy
Sperms retrieved by testicular biopsy in this manner are maintained. When spermatozoa are obtained and cryopreserved prior to chemotherapy, it is helpful for cancer patients.
These may be applied to fertilize oocytes and produce embryos following cancer treatment or whenever the couple is prepared.
3. Testicular Tissue/ SSCs Cryopreservation (Experimental)
Seminiferous tubules are implanted with SSCs made from frozen testicular tissue. It goes through self-renewal and establishes spermatogenesis, which should enable natural conception without the need for additional reproductive treatments.
1. Mature Oocyte Cryopreservation
Women who are unmarried, post pubertal girls (adolescent girls whose periods have begun), or those without a long-term spouse should use this approach.
The European Society of Human Reproduction and Embryology recommends it as the best strategy for preserving fertility because it has a long history of success.
Oocyte retrieval and controlled ovarian stimulation are used to accomplish this. Cryopreserved mature eggs (metaphase stage, Mll oocytes) are collected. Using ART/IVF, frozen eggs are thawed later and fertilized.
This method is also effective for married women whose partners are away from home for an extended amount of time.
2. Embryo Cryopreservation
It is one of the best & established method for fertility preservation in a married couple.
Partner availability is a must for embryo freezing method. It requires ovarian stimulation, followed by egg retrieval, fertilization, & cryopreservation of the embryos.
Frozen embryos can be stored for up to 5 years. A frozen embryo transfer can be done at any time when the couple is ready.
3. Immature Oocyte Cryopreservation & In Vitro Maturation (Experimental)
Immature eggs are obtained trans-vaginally, where they are then matured in a specific medium. Mature eggs can then be cryopreserved, or if a partner is available, an embryo can be created through ART and frozen.
The benefit of this approach is that chemotherapy and radiation therapy can be started right away.
4. Ovarian Tissue Cryopreservation (Experimental)
Throughout the menstrual cycle, it is possible at any time. Because it involves surgery, general anesthesia is necessary.
With this technique, either the entire ovary or the ovarian cortex containing the primordial follicles can be cryopreserved. After the patient’s therapy is finished, the cryopreserved tissue is thawed and put back into the body.
Due to the age-related decline in ovarian reserve, it should ideally be performed on young women. Following transplantation, ovarian endocrine function typically lasts for about 5 years.
Depending on the type of cancer, there is a small risk that ovarian tissue transplantation will reintroduce malignant cells.