Fertility preservation in women
The most fertile years in a woman’s life are the years from 26-35 when the ovaries still contain a large number of healthy ova. It has also been shown that a woman stops being fertile about 10 years before menopause. It is therefore wrong for a woman to think that because she has a regular monthly period she is also fertile. This is apparently more pronounced for women over the age of 38.
Age-related infertility is the most common infertility problem in all advanced Western societies. The most difficult of all is that the woman does not realize or does not want to admit that age is the most difficult “enemy” of her fertility.
Fortunately there is now a solution to that problem and the woman can preserve her fertility by having her eggs frozen at an early age by doing a short IVF protocol for approximately 10 days
Τα ποσοστά επιβίωσης των ωαρίων όταν αποψυχθούν είναι της τάξης του 95%, ενώ τα ποσοστά επίτευξης εγκυμοσύνης μετά από απόψυξη ωαρίων και γονιμοποίηση εξαρτώνται από την ηλικία της γυναίκας όταν τα κατέψυξε. Η καλύτερη ηλικία για κατάψυξη ωαρίων είναι από 28-35 έτη.
So if you want to have your own biological child in the future but currently the conditions are not met for that purpose (absence of partner, social conditions, professional ambitions) you can check your egg reserve and quality by having a simple blood test – Anti mullerian hormone (AMH). If the test shows that the reserve and the quality of the eggs are diminishing, then you can resort to a fertility conservation process by having your ova frozen.
Thaw survival rates for eggs are of the order of 95%, while rates of pregnancy after egg thawing and fertilization vary, depending on the woman’s age when the eggs were frozen. The best age for freezing ova is from 28-35 years.
Fertility preservation in women with cancer
Every young woman diagnosed with cancer has the inalienable right to gain direct access to the adequate services in order to maintain her fertility. It is both the oncologist’s obligation to inform her about the existence of such possibilities before starting treatment for cancer, and the reproductive physicians, to immediately enable her to freeze ova or ovarian tissue.
Treatment for cancer at a young age can lead to temporary or permanent infertility. If it is a gynecological cancer, it may require surgery to remove the tumor; however surgical removal of the ovaries, uterus or fallopian tubes may also be necessary.
If chemotherapy is needed, ova can also be damaged in addition to cancer cells. The risk of infertility resulting from chemotherapy is related to the age of the woman, the specific chemotherapeutic agents to be used, the dose administered and the duration of the treatment. The same applies to radiotherapy, especially if it is carried out in the pelvic region and can lead to premature menopause.
The options before starting treatment for cancer are:
- the freezing of mature ova,
- the freezing of embryos,
- freezing ovarian tissue,
- taking medications that could partially protect the ovaries during chemotherapy.
The specialized gynecologist in collaboration with the oncologist will take into account the type of cancer affecting the woman, the treatment plan, the woman’s age and will draw up the personalized action plan.
Freezing of embryos
If a woman with cancer is in a permanent relationship and her partner so wishes, the woman can freeze ova fertilized with her partner’s sperm. i.e. embryos. The process is the same as freezing eggs, except that the ova retrieved are fertilized and frozen one or two days later. Embryo freezing has better thaw survival and pregnancy rates compared to egg freezing.
Freezing of ovarian tissue
If the time until initiation of treatment for cancer is less than 10 days not allowing women to undergo a short ovary stimulation protocol, the only solution is to harvest a small specimen ovarian tissue from the ovary and to freeze it. Ovarian tissue collection is surgically performed by laparoscopy [link] and the woman may start treatment for cancer with only one day delay. Tissue may be stored for many years.
When it comes to childbirth, after full cancer cure, this piece of ovarian tissue is implanted – re-transplanted into the woman’s pelvis, again using laparoscopy. Nine months later, the transplanted ovarian tissue can begin to produce reproductive hormones and follicles. Pregnancy can be achieved either by ovarian stimulation and IVF or perhaps even naturally.
The second step described above, the stage of transplantation of the frozen ovarian tissue, is still at the experimental stage. Six healthy children only have been born worldwide using this method. It is quite possible that in the future we will be able to apply it to the daily clinical practice so that we can use all the ovarian tissue samples we now collect and freeze.