FERTILITY PRESERVATION PART 1
The process of preserving eggs, sperm, or reproductive tissue in order to have biological children in the future is known as Fertility Preservation. Fertility preservation gives couples or individuals the ability to have children in the future where they would otherwise be unable to do so due to a medical condition or treatment.
Fertility preservation is a new field that includes a range of fertility therapies for patients who are about to undergo medical treatment that may have an impact on their future reproductive outcomes. Although fertility preservation is most commonly associated with cancer treatment, it has also been used for medical conditions such as lupus, inflammation of the kidney, and impaired blood cells in the bone marrow, as well as in adolescent females with conditions linked to premature ovarian failure.
When Is Fertility Preservation Recommended?
Fertility preservation is recommended for individuals who are:
- Undergoing major surgeries, radiation or chemotherapy – These therapies rapidly attack dividing healthy cells in the body, such as the sperm cell and ovarian follicle cells (egg). These patients may exhibit symptoms similar to menopause in females or andropause in males, which may indicate reproductive damage. Prior to these treatments, it is important to test for anti-Müllerian hormone (AMH) levels in females so as to predict long term post-chemotherapy loss of ovarian function, and thus the need for planning fertility preservation for future use.
- Ageing – In females, increasing age is directly related to decreased reproductive potential. This can be due to a variety of factors, including the number of eggs available and their overall reproductive quality. Males experience declining fertility as they age as well. Ageing in male declines the quality of sperm but does not affect the overall sperm count. These changes may be attributed to the decrease in testosterone that men experience as they age.
- Endometriosis – This is a condition in which tissue similar to the uterine lining grows outside the uterus leading to pelvic pain and an irregular menstrual cycle. Although endometriosis reduces fertility, it does not always prevent conception. Women who have a family history of early menopause or other medical conditions such as endometriosis are encouraged to pursue fertility preservation options to help ensure their ability to have a child when they are ready.
- Polycystic Ovarian Syndrome (PCOS) – this is the most common endocrine disorder that women experience during their reproductive years. Anovulation is common in females with PCOS, that is, patients with PCOS may not release an egg regularly. Since the link between infertility and PCOS has been well established, fertility treatment such as ovulation induction has been used in females with PCOS to produce eggs which may be preserved for future use.
- Primary Ovarian Insufficiency (POI) – POI or Premature ovarian failure or premature menopause occurs when ovarian function is interrupted prematurely before the age of 40. Ovarian deficiency results in a decrease in serum estrogen levels, which can lead to infertility.
- Exposure to toxic chemicals – The body requires proper hormone functioning to maintain normal menstrual cycles and to conceive. These toxic chemicals such as pesticides, fire retardants, dioxin, chloroform, heavy metals and chemicals used in the production of plastics mimics the estrogen hormone in the body leading to irregular menstrual cycles, problems with the ovarian eggs, implantation failure during IVF, PCOS, endometriosis and higher rates of infertility. Exposure to toxic chemicals can reduce ability to conceive and have children.
- Uterine fibroids – Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. A further complication includes infertility. When fibroids are left untreated, they can take up a lot of space in the womb that a growing fetus needs, making it difficult or even impossible for a woman to conceive or maintain a pregnancy.
- Autoimmune disease – Autoimmune diseases such as thyroid disease, type 1 diabetes, inflammatory bowel disease, chronic skin disease and celiac disease affects female fertility by prematurely depleting ovarian reserve, interfering with fertilization and implantation, and increasing the risk of miscarriage and other pregnancy complications.
FERTILITY PRESERVATION IN MALES
Fertility preserving options in males includes:
- Sperm cryopreservation – Men who want to preserve their fertility before undergoing treatment for cancer or another fertility-threatening disease can have their sperm frozen and stored at a fertility clinic or sperm bank. Sperm is obtained through masturbation in post-pubescent boys and men for future use in a process known as cryopreservation. This is the most well-known method of male fertility preservation. Sperm can also be obtained through testicular aspiration and stored for future use in prepubescent boys. Researchers are also investigating methods for cryopreserving testicular tissue samples in order to re-implant them into the body after treatment.
Gonadal shielding in males – This procedure involves placing small lead shields over the testicles to reduce the amount of radiation exposure and protect the testicles. Radiation therapy for cancer and other conditions can have a negative impact on fertility, especially if it is used in the pelvic area. Some radiation treatments