Maybe you've put off thinking about having a child until you've finished your education or established a stable job. Or, unfortunately, you've had to undergo treatment for a medical condition like cancer. At a time like this, it's normal to wonder, "Will I ever be able to have a child?" But thanks to the advances in medicine today, there is technology that can help you in this situation. That's what we're talking about today.
What is Fertility Preservation?
Simply put, this involves safely storing your own reproductive cells or tissues to help you have a child in the future. This means that your eggs, sperm, embryos , or reproductive tissue is frozen in a special way and kept safe for future use.
This method can be used for adults as well as sometimes for young children. It can be divided into two main parts:
1. Medical reasons: This is done to prevent any harm to your fertility due to a medical condition or treatment.
2. Elective Preservation: If you are postponing having children for personal reasons, for example, work, education, or until you find a suitable partner, you can resort to this method before your fertility declines with age.
Why do we need to think about this?
There are several factors that can affect your ability to have children in the future (fertility). Sometimes it can be due to the condition itself, or it can be due to surgery or medication. This is also a concern for those thinking about having children in their late 30s or 40s, because studies have shown that natural fertility decreases with age.
| Factors that can affect fertility | A simple explanation |
|---|---|
| Age | If you are delaying having children until you have achieved your education, career goals, or a more stable life, you may want to consider preserving your eggs or sperm before your fertility declines with age. |
| Cancer | Cancer treatments, such as chemotherapy, radiation therapy, and surgery, have a high chance of damaging a person's fertility. |
| Autoimmune Diseases | Diseases such as lupus and rheumatoid arthritis, and their treatments, can also cause fertility problems. |
| Reproductive health problems | Conditions like endometriosis and uterine fibroids can make it difficult to get pregnant. |
The most important thing is to talk to your doctor about this as soon as you know you have this risk. That way, you can be clear about your options.
What are the methods of preserving fertility?
The methods used for this vary depending on the gender. Let's look at the main methods for women and men.
Methods for women
- Egg Freezing: This involves giving hormone injections to stimulate the ovaries to produce more eggs than would be released in a normal monthly cycle. The doctor then removes the eggs from the body, freezes them in a special way, and stores them.
- Embryo Freezing: This method is similar to egg freezing. Here, eggs are also removed from the body. But then those eggs are fertilized with your partner's or a donor's sperm to create embryos. This process is called IVF (In Vitro Fertilization) . These created embryos can be implanted in the uterus right away, if necessary, or frozen for future use (Embryo Cryopreservation).
- Ovarian Tissue Freezing: Imagine you are in a hurry to start cancer treatment and don't have time to wait two to three weeks for hormones to develop your eggs. This is when you can use this method. Here, a small piece of tissue is surgically removed from your ovaries and frozen. When all your cancer treatments are over and it's time to think about having a child, your doctors will implant that piece of tissue back into your body. If that tissue becomes active again, you may have a chance to get pregnant naturally or through IVF.
- Ovarian Transposition (Oophoropexy): If radiation therapy is given to the pelvic area, the ovaries may be damaged. To prevent this, the surgeon temporarily moves the ovaries to the upper abdomen, away from the area where the radiation is being delivered.
- Radiation Shielding: During radiation treatment, the ovaries are covered with a special shield made of lead to minimize radiation exposure.
Methods for men
- Sperm Freezing: This is the simplest and most commonly used method for men. A semen sample is collected, frozen, and stored.
- Testicular Tissue Freezing: Some men may have no sperm in their semen. Also, boys who have not reached puberty do not produce sperm. In such cases, a small piece of tissue can be removed from the testicles, tested for sperm, separated and frozen.
- Radiation Shielding: As with women, special lead shields are used to protect the testicles during radiation treatment for men.
How does this process happen?
Each of these methods works differently. Let's look at them in a little more detail.
Egg and embryo freezing
This process begins with ovarian stimulation, which involves injecting yourself with a hormone every day for about 10 days.
The egg retrieval procedure is performed under anesthesia, meaning you are asleep and do not feel any pain.
- The doctor guides a very fine needle through the vagina to the ovary using ultrasound guidance .
- The developed eggs are slowly pulled out through that needle.
- The eggs are then frozen directly, or they are fertilized, embryos are created, and frozen.
You will not feel any pain during this procedure, but you may experience some discomfort, such as bloating, in the days before and for a few days after the procedure.
Ovarian tissue cryopreservation
This is done under general anesthesia. It is performed as a keyhole surgery (Laparoscopy) .
- The surgeon makes two to four very small incisions in the abdomen.
- A delicate instrument with a camera is inserted and the inside of the abdomen is observed.
- A piece of ovarian tissue is removed using small instruments.
- Then the instruments are removed and the incisions are closed.
You can usually go home about two hours after this surgery.
Sperm freezing
This is a very simple process. All you have to do is masturbate and provide a sample of semen into a special cup.
However, if it is difficult to provide such a sample due to a medical condition, mental stress, pain, or religious/cultural reasons, there are ways that doctors can help.
- Medications: There are medications that can help with ejaculation.
- Vibratory Stimulation: Vibration from a special device can stimulate ejaculation.
- Electroejaculation: This is done under anesthesia. Ejaculation is induced by a gentle electric current delivered by a device inserted through the anus near the prostate gland.
Are there any side effects or risks?
As with any medical procedure, there are some risks involved with these procedures. However, these are very rare. Your doctor will explain all of this to you.
- Very rarely , bleeding or infection may occur during egg or sperm retrieval.
- There is a higher chance of having twins or more babies during the IVF process. There may also be a slightly increased risk of premature birth, low birth weight, miscarriage, and ectopic pregnancy.
- There is a very small risk of infection, bleeding, and damage to surrounding organs during keyhole surgery.
- Hormones given to stimulate the ovaries increase estrogen levels in the body. This may slightly increase the risk of blood clots.
- Very rarely, ovarian stimulation can cause a condition called Ovarian Hyperstimulation Syndrome (OHSS) .
How successful are these methods?
This is a problem that many people have. The important thing is that not all fertility preservation methods guarantee 100% pregnancy .
Egg, sperm, and embryo freezing are the most commonly used and proven methods. Some other methods are not yet as common, so data on their success is still being collected.
Success varies from person to person. It depends on many factors, including your age, body mass index (BMI), other medical conditions, and whether you have had previous IVF treatment . Only your doctor can give you the best idea of your chances of success based on your situation.
What is the best time to talk to the doctor?
If you have to make a decision about this, it's best to do it as soon as possible . The best time is:
- Before starting treatment for a disease like cancer.
- If you are a woman who is delaying having children, before the age of 35 .
- As soon as you are diagnosed with a medical condition that could affect your fertility.
Even if you've already completed treatment that could affect fertility, don't give up hope. You may still have some options left. So be sure to talk to your doctor about this.
Take-Home Message
- Fertility preservation is a valuable way to increase your chances of having a biological child in the future.
- These methods are beneficial for those facing medical conditions such as cancer, as well as for those who are delaying having children for personal reasons.
- There are a number of different methods available for women and men, with egg, sperm, and embryo freezing being the most commonly used.
- These methods are not 100% guaranteed to be successful. Their success is affected by a number of factors, including age.
- The most important step is to talk to your doctor as soon as possible to find out what the best option is for your situation. Don't be afraid to ask your questions openly.
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