Fertility Preservation Introduction

Cancer therapies such as chemotherapy, radiation, and surgery can significantly impair reproductive function. These effects are dose-dependent and vary with age, treatment type, and underlying gonadal reserve. Fertility preservation allows patients to safeguard their reproductive potential before gonadotoxic treatment begins.

Key insights:

• Chemotherapy: Alkylating agents (e.g., cyclophosphamide) cause direct DNA damage to oocytes and spermatogonia.

• Radiation: Pelvic or total-body radiation can damage germ cells and disrupt hormonal axes.

• Surgery: Procedures involving reproductive organs may remove or compromise gamete production.

2. Who Should Be Offered Fertility Preservation

Any patient of reproductive age (including adolescents) who is scheduled for potentially gonadotoxic therapy should be offered fertility preservation counseling. Coordination between oncology and reproductive medicine is crucial, ideally within 24–72 hours of diagnosis.

Candidates include:

• Women undergoing chemotherapy, pelvic radiation, or bone marrow transplantation

• Men receiving systemic chemotherapy or testicular/pelvic radiation

• Prepubertal patients—where tissue cryopreservation is experimental but ethically supported

3. Overview of Established Methods

For Female Patients

• Oocyte Cryopreservation (Vitrification): Standard of care for women; rapid protocols allow completion within 10–14 days.

• Embryo Cryopreservation: Ideal for patients with a partner or donor sperm available.

• Ovarian Tissue Cryopreservation: Suitable when hormonal stimulation is contraindicated or time is limited.

For Male Patients

• Sperm Cryopreservation: Highly effective; even single ejaculate samples can suffice.

• Testicular Sperm Extraction (TESE): Option when ejaculation is not possible.

• Experimental: Testicular tissue cryopreservation for prepubertal boys.

Minimum Standards

1. Clinical Coordination

Every fertility center managing oncology referrals must establish a rapid-response workflow, including:

• Priority scheduling for urgent stimulations

• Designated liaison between oncology and reproductive teams

• Predefined consent and information materials specific to cancer patients

2. Laboratory & Technical Competence

• Only vitrification should be used for oocyte and embryo freezing to ensure optimal survival rates.

• Cryostorage facilities must have redundant monitoring, 24/7 temperature tracking, and emergency backup systems.

• Strict infectious disease testing and traceability documentation are mandatory.

3. Counseling & Documentation

• Detailed informed consent outlining success probabilities, risks, and experimental status (if applicable).

• Discussion of future use options: IVF, surrogacy, or donation.

• Legal clarity regarding ownership, disposition, and posthumous use.

Additional Standards

1. Optimizing Ovarian Stimulation

• Random-start protocols enable initiation at any menstrual phase, minimizing delay.

• Letrozole-based stimulation is recommended for estrogen-sensitive malignancies (e.g., breast cancer).

• Aim to retrieve mature (MII) oocytes rapidly while maintaining low estradiol exposure.

2. Advanced Preservation Options

• Dual stimulation (DuoStim) can double oocyte yield in limited time.

• In vitro maturation (IVM) may be used when stimulation is unsafe or impossible.

• Ovarian tissue autotransplantation has resulted in over 200 live births worldwide and is increasingly mainstream.

3. Multidisciplinary Follow-Up

• Reassessment of reproductive function post-therapy (AMH, AFC, semen analysis).

• Genetic and reproductive counseling before conception attempts.

• Collaboration with surrogacy agencies (like Surrogacy4All) when uterine factors preclude pregnancy.

Pro Tips from Fertility Experts

1. Speed is everything. Establish a “fast-track oncology fertility protocol” to initiate ovarian stimulation within 24–48 hours.

2. Communication defines outcomes. Maintain direct oncologist-to-embryologist communication lines to avoid treatment delays.

3. Standardize your consent templates. Include future use, storage limits, and legal ownership clauses.

4. Audit your success rates annually. Track fertilization, survival, and thaw outcomes by cancer diagnosis to refine counseling.

5. Educate oncology teams. Regular joint rounds ensure every cancer patient of reproductive age receives a fertility preservation referral.