Fertility Preservation Options for Females

• Embryo Freezing
  • Provides excellent pregnancy rates
  • A downside is the need for multiple days of ovarian stimulation, which obviously raises estrogen levels which can be harmful with estrogen dependent cancers as well as delaying treatment.
    • Recent research shows that some breast cancer patients may be safely stimulated by tamoxifen or letrozole.
    • In Vitro Maturation is another area being studied in an attempt to find methods of limited estrogen exposure.
  • A second downside for the single patient is the simple fact that embryos are the result of the fertilization of an egg (oocyte) with sperm. A source for sperm must be found, often an anonymous donor, which means that when a patient does find “Mr. Right”, he won’t be biologically linked to the child.
• Oocyte (egg) freezing
  • If possible to arrange, this provides the patient with the combination of the least invasive procedure and the most options in the future.
  • Once again the downside is the need for multiple days of ovarian stimulation, which obviously raises estrogen levels.
  • Oocyte freezing is really just now becoming a real viable option. Very few centers in the US have significant experience with this technology. Worldwide, only about 1000 births have been established, thus this procedure should only be conducted under the guidance of an Institutional Review Board.
• Ovarian tissue storage
  This procedure involves:
  • Laproscopic surgical removal of one ovary.
  • Slicing of thin strips of the exterior of the ovary
  • Cryopreservation of those strips
  • Storage for future transplant back into the patient or invitro maturation of the ovarian tissue and oocytes
• Advantages
  • Can be completed quickly
  • Does not require ovarian stimulation
  • Allows for use of a future partner’s sperm
  • Can be performed on pre-pubescent girls
  • May allow natural conception
  • Normal hormone production
  • May allow In Vitro Maturation of follicles
• Disadvantages
  • Invasive procedure
  • Experimental
  • Limited success to date
  • Slight but possible risk of transferring cancerous cells back to the patient if the tissue is transplanted to the patient