Various reasons often prompt us to postpone parenthood. When we do not exclude in the future and currently planned treatment (chemotherapy, radiation therapy, surgery) or a natural ageing process may rule out a chance of having children, it is well worth considering fertility preservation.
Cancer therapies (chemotherapy and radiation therapy) frequently compromise ovarian function. This happens because ovaries are particularly sensitive to cytotoxic treatments. As a result, patients lose their chance of having biological children despite recovery following cancer treatment. A medical solution for these patients is to arrange for fertility preservation prior to the treatment beginning.
Sometimes we postpone parenthood for personal reasons. Please remember that the biological clock never stops ticking and the only option of future parenthood may be egg freezing.
At Centrum Medyczne Macierzyństwo, we offer three medical procedures to allow fertility restoration in patients with a history of cancer. Selection of the proper method depends on a patient’s age, her current personal situation and time limits related to the cancer therapy.
This method is intended for a patient being in a stable relationship with her partner. A couple that try for a baby must undergo the in vitro preparation before initiating cancer treatment. The freezing procedure applies to embryos (resulting from the fusion of a woman’s egg and her partner’s sperm) that can be transferred to the woman’s womb after treatment completion. The method is not recommended when time matters (that is, the patient should start the cancer therapy as soon as possible, not wasting time for hormonal stimulation) or the type of cancer precludes hormonal stimulation.
This method is intended for women of childbearing potential who are not in a stable relationship. The freezing procedure only applies to eggs which, in the future, can be in vitro fertilised after the cancer treatment. The time is also a limitation here. If the patient should start her cancer therapy promptly, there is no time for hormonal stimulation to collect at least a few mature eggs. Moreover, the method is not used when the type of cancer precludes hormonal stimulation.
Egg freezing is also a procedure of choice for patients who want to preserve fertility for reasons other than cancer.
An advantage of this method is primarily a lack of time restrictions. It can be practised even in prepubescent girls without significant ovarian activity. Thanks to the procedure, healthy ovarian tissue can be re-implanted when the patient has recovered from cancer and reached sexual maturity. Thus, it allows fertility restoration in a woman whose ovarian function is permanently compromised because of cancer treatment. The method of ovarian tissue freezing also applies to adult women who must promptly initiate cancer therapy (they have no time for hormonal stimulation) and those with the type of cancer that precludes hormonal stimulation. This technology is regarded as an experimental procedure. The first child of a woman with fertility restored after having her ovarian tissue frozen was born in 2004.
A patient who must be quickly managed in order to preserve fertility (most often patients with cancer) has the whole ovary or its part removed. This is a laparoscopic procedure; the ovary is then shipped to a laboratory where its cortex (rich in follicles with eggs) is isolated and processed. The processed portions of ovarian cortex are frozen. Following the cancer treatment, when the patient decides to become a mother, the portions collected are thawed and re-implanted into the ovary or the retroperitoneal area. They initiate endocrine activity within 3 to 4 months, which results in egg maturation and the ability to conceive, followed by pregnancy.
A group of the patients undergoing the procedure get pregnant naturally while the others need in vitro fertilisation.
It is worth noting that ovarian implants only function for a certain time. Therefore, they are thawed only after the patient has decided to have a child.
Cancer treatment frequently leads to temporary or permanent fertility impairment. This happens because the reproductive glands (testicles) are extremely sensitive to cytotoxic treatments. In order to preserve fertility following the cancer therapy, it is recommended that sperm should be delivered to the cryobank prior to chemotherapy where it will be stored until the treatment has ended and up to the moment the patient decides to father a child. Sperm freezing is also recommended for patients being prepared for urological operations that may result in fertility loss.
It is also worthwhile to consider sperm banking while planning insemination or in vitro fertilisation and: there is a problem of delayed ejaculation, sperm parameters are extremely poor or a patient cannot come to the Centre on the day of insemination/in vitro fertilisation procedure.
In order to store sperm in the bank of Centrum Medyczne Macierzyństwo, a patient should come to the Centre before treatment initiation and have a semen analysis as well as tests for viruses and bacteria. Having received the results, the patient provides a semen sample for freezing. In the andrology laboratory, proper cryoprotectant is added. The semen portions are then placed in 0.5 ml straws, frozen and stored in the sperm bank. The semen, frozen and stored in the sperm bank, can be used for insemination or in vitro fertilisation (IVF/ICSI).