What are the latest advancements in fertility preservation?

There have been several latest advancements recently in the field of fertility preservation in India. According to the ART (Regulation) Act 2021, as long as the eggs and sperms are cryopreserved for self-use, the eggs and sperms can be stored for an indefinite period of time.

Some of the latest innovations in the field of fertility preservation include:

Ovarian Transposition: For fertility preservation in women of reproductive age in India, undergoing radiotherapy, this is a great surgical technique to keep the ovaries out of radiation field. This can be used before they undergo gonadotoxic pelvic radiation. It is a simple and safe technique that can be performed either using a laparotomy (open surgery) or laparoscopy (keyhole surgery). Ovaries are hitched up and fixed out of the pelvis to avoid exposure to radiation. This technique does not protect ovaries from chemotherapy.

Embryo cryopreservation: The method involves taking sperm, extracting eggs as in IVF, fertilise them in the lab to make embryos, and store the embryos by freezing at a very low temperature which allows the cells to have indefinite longevity. Cryopreservation suspends all biological activity and prevents time-dependent damage to the sperms, eggs or embryo. Furthermore, when the embryos are needed, they are thawed and used for conception in the future.

In-vitro maturation: This procedure involves womens’ eggs being collected without delay and matured outside the body. This is done as a part of IVF treatment. IVM may be considered for women who are diagnosed with a condition that needs immediate treatment (radio or chemotherapy) which is harmful to fertility and there is no time to under IVF cycle to achieve full maturity of eggs inside the body. This technique can also be used with poly polycystic ovarian syndrome (PCOS) because women who have PCOS are at a greater risk of ovarian hyper stimulation syndrome (OHSS). OHSS is an exaggerated response to medicines used to induce ovulation. Oocyte vitrification offers increased success rates in comparison with older technique of slow freezing; however, this approach is also limited by the number of oocytes that can be obtained. Oocyte cryopreservation is technically challenging and requires ovarian stimulation, thus potentially resulting in a delay in cancer treatment.

Ovarian tissue cryopreservation and transplantation, is an effective fertility preservation strategy, especially for those patients who have to undergo immediate therapy or for pre-pubertal girls. This option can restore endocrine function in more than 95% of cases and pregnancy rate of up to 40%. The procedure has shown to restore hormonal cycles and fertility. Success hrough IVF after ytransplantation as well as through natural conception has been reported.

What are the challenges and opportunities for fertility preservation?

Some forms of chemotherapy have a direct adverse effect on the reproductive capacity of patients. Choice of cancer treatments is important as it can affect the reproductive organs or can have a harmful impact on the organs that are vital for fertility.

The complete history of the patient, details of underlying diseases, cancer treatment being planned/discussed, and impact of the treatment on fertility are essential knowledge as they help the treating fertility expert to understand the ovarian risks better. Based on the medical records, diagnostics and the current and future medical condition, the fertility expert suggests the most appropriate option to the patient. These considerations are especially critical for pre-pubertal or young girls where an IVF cycle is not possible. Pre-pubertal girls have not started menstrual cycles and therefore have no suitable growing eggs to stimulate under IVF.

What is the impact of cancer management on reproductive organs and way forward?

Male and female gonadotoxicity (harmful effects on ovaries and testes) are common complications of anti-cancer treatments. Infertility and hypogonadism (low functioning ovaries or testes) can be a source of considerable distress even with effective cancer therapy. The effects of radiotherapy and other older chemotherapy regimens are well known.

Fertility preservation works well for both men and women as it provides a platform for both the genders to have biological children in future. There is good evidence in literature suggesting a better quality of life for cancer survivors if they have had the option to preserve fertility. It is important that all patients requiring anti-cancer treatment should be fully informed about the potential negative impact of the treatment on the ovaries and testes. The gonadal toxic consequence and likely adverse effect on reproductive capacity should be explained in details to the patients. They should be reassured that modern, personalized fertility treatments can help them overcome the challenges to a large extent. But like all treatments fertility treatments too have their limitations. A fertility specialist with experience in fertility preservation can explain in detail, the suitability, safety and best protocols or modalities suitable in different situations.