Fertility preservation

Fertility preservation treatments are those in which the purpose, as in the other reproductive therapies, is to achieve a pregnancy, but in the long term rather than immediately. This decision can be taken due to several circumstances, for example, in the diagnosis of cancer. Chemotherapy or radiotherapy treatment can cause the loss of oocytes and ovarian atrophy, which, in most cases, will be irreversible given that the ovaries have a set number of germinal cells which will not regenerate.

There are also non-malignant diseases which will treatments such as some types of autoimmune diseases, for example, and the woman may simply decide for various reasons, such as not wishing to get pregnant at that comment, to use these techniques.

What types of fertility preservation treatment are there?

• Oocyte freezing: consists of the completion of an ovary stimulation cycle to recover oocytes which will later be frozen by a specific process called vitrification.
• Embryo freezing. The oocytes are fertilised in vitro and the resulting embryos are frozen.
• Freezing of ovarian tissue (in girls or adult women). Although it is not a consolidated therapeutic option and must still be considered an experimental technique.
• Sperm freezing in men, prior to cancer treatment.

Vitrification is the technique for freezing the eggs that have shown the best results. Unlike classic freezing, with this method, we avoid the formation of harmful crystals at cellular level.

Why should you preserve your fertility?

The ovary s as a storage facility for eggs; it contains its greatest number (6-7 million) is during foetal life (within the uterus of the mother). From that time, the number reduces: when you are born, it reduces to 1-2 million oocytes and at around 50 years the ovary reserve runs out and the menopause s.

 

5 stages can be distinguished in the ovary reserve:

1. Start of ovulation: Around 13 years.
   At the start of puberty, there are 300,000 to 500,000 eggs left.
2. Fertility peak: Around 20 years.
   The ovary is at full ; these are the best quality eggs and it would be to optimum time to get pregnant, vitrify the eggs or donate them.
3. The decline commences: Around 35 years. From 26-30 years, the decline commences and at 35 years we speak of the point of the maximum turning point. At this age, if, after 6 months of actively trying to get pregnant you do not achieve it, we recommend that you see a specialist.
4. Difficulty achieving an evolutionary pregnancy: Around 42 years. As you get older, the eggs' number of chromosomes changes such that, upon fertilising these "older eggs", the embryo may have a higher or smaller number of chromosomes (out of these possible chromosome alterations, the best known is Down syndrome). From 40 years, the possibility of achieving a natural pregnancy is 5% per cycle. At 40-42 years, the possibility of having a live newborn after in vitro fertilisation with your own eggs is 13% and 9% at 43-44 years. At 45 years, most women are incapable of getting pregnant; this is the case for both natural conception and in vitro fertilisation, with the use of donated eggs being the reasonable alternative.
5. Menopause: cessation of menstruation from approximately 51 years. This is the average age of menopause, the moment when the ovary no longer has eggs and the woman stops having periods.

 

Is there a study to assess the ovary reserve status?

To determine the ovary reserve of a woman, both hormonal analysis and transvaginal ultrasound are used to the antral follicles. The anti-Müllerian hormone is a substance produced in the ovary and is one of the markers best reflecting not only the ovary reserve but also the response to ovary stimulation treatments and the probability of pregnancy.

It can be measured at any point of the cycle: levels between 2-7 ng/ml indicate a very good reserve, between 1-2 ng/ml is a normal reserve and levels below 0.6 ng/ml are considered low reserves.

What is the best age to vitrify eggs?

The optimum time to vitrify eggs in order to delay the age at which to have a baby would be between 30 and 37 years. Above that age, the quality of the conserved eggs reduces and the possibilities to achieve an evolutionary pregnancy are less favourable than with younger eggs.

Does the egg vitrification technique have risks?

The risks are minimal and it is a treatment which is very well tolerated by most women.
The main ones are the risks derived from the ovary stimulation treatment, generally minor abdominal discomfort; risks derived from the anaesthesia or the follicle puncture such as pain and bleeding, although they are usually minor.

Does it affect subsequent fertility?

It does not affect subsequent fertility.

How long is needed to vitrify eggs?

Approximately 15 days are needed to mature the eggs and to make them optimal to be vitrified; controls are performed every 3-4 days with the gynaecologist during this period.

The medication is administered daily at home and, in each control, the gynaecologist will indicate the necessary dosage.

The eggs are ed in the operating theatre under sedation and the period will occur some days later as normal.

Is the process painful?

The medication is administered subcutaneously; it is injected but it is designed so that the woman can do it herself at home easily and comfortably.

To make the egg ion process painless, sedation is used; it is performed in the morning and in the afternoon you can continue with your normal life.

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