Fertility Preservation

Fertility Preservation Introduction

Cancer treatment often has a major impact on fertility, for both men and women. In some cases, once treatment begins, conceiving a child through normal means becomes difficult or impossible. Fertility preservation makes it possible to still have children even with cancer treatment.  This guide covers the important basics about fertility preservation options, for both men and women, so you can understand the alternatives and choose what is right for both of you.

Fertility Preservation for Women

• Embryo Cryopreservation - Embryo cryopreservation is the most popular method of fertility preservation for women. In this outpatient procedure, eggs are harvested from your ovaries and fertilized through in vitro fertilization, then frozen and stored. At the beginning of your menstrual cycle, you will receive daily injections of synthetic hormones to help stimulate your ovaries and increase the likelihood that multiple eggs can be collected during a single cycle.
  
  The eggs are removed just before you ovulate through a needle inserted into your ovary through your vagina. Then the eggs are combined with sperm and frozen. This method has the highest chance of success for women. About 95 percent of the time the embryos survive the freezing and thawing process. An important consideration is that the need to time egg retrieval can delay the start of cancer treatment by two to six weeks.

• Oocyte Cryopreservation - Egg freezing, also called oocyte cryopreservation, is another common method of fertility preservation for women. In this procedure, you will receive injections of a medication that stimulates your ovaries. Next your eggs are harvested during an outpatient surgical procedure. Then the unfertilized eggs are frozen. About 75 to 80 percent of these eggs survive the freezing and thawing process, and will be able to be successfully fertilized.  It is important to bear in mind, however, that pregnancy rates can be lower if using frozen eggs compared with frozen or fresh embryos.
• Oophoropexy - Ovarian transposition, also known as oophoropexy, is suggested if you are having pelvic radiation treatment for cancer but no chemotherapy.  During this outpatient surgical procedure, your surgeon surgically repositions your ovaries just before your radiation therapy to keep them as far away as possible from the radiation field. After the treatment, you may need for your ovaries to be repositioned again or use in vitro fertilization (IVF) to conceive.

Fertility Preservation for Men

• Sperm Cryopreservation (Freezing) - Sperm cryopreservation is the freezing of sperm to preserve them for future use. Before you begin cancer treatment, you will provide semen samples to be saved, either through masturbation or another method such as testicular aspiration; the use of a needle to extract sperm directly from your testicle. The samples are frozen and can be stored safely for years. Three collections are typically taken, with an interval of 48 hours between each collection.
• Testicular Tissue Cryopreservation - This method of fertility preservation for men is still being researched for effectiveness. In testicular tissue cryopreservation, a small section of testicular tissue (2-3mm) is extracted. The specimen is divided into several smaller sections and each one is tested for the presence of viable sperm. Then the other sections are frozen and stored in liquid nitrogen for future use, such as in-vitro fertilization. This surgery can be performed a few months prior to a reproductive procedure, at the convenience of the male partner.
• Gonadal Shielding - This method of male fertility preservation is used before cancer therapy begins. With gonadal shielding, carefully placed shields reduce your testicles' exposure to radiation during chemotherapy. Gonadal shielding can prevent 99 percent of the “leaked” and beam scatter radiation to the testicles. This method should be used for all men receiving radiation below the chest for cancer.
• Electroejaculation - For men who are unable to provide an ejaculate before they undergo cancer treatment, because of underlying neurologic issues or they are too ill at that time, electroejaculation is a viable option. This technique obtains the ejaculate through electrical stimulation of the spinal reflex that controls male ejaculation. This method is quick but it does require mild general anesthesia for it to be performed successfully.  The collected sperm is then washed and banked in routine fashion. The banked sperm can be used in the future with intrauterine insemination (IUI) or IVF, depending on the semen quality and recovery after it is thawed.