Fertility Preservation

Because of advanced fertility preservation procedures offered today at Yale Fertility Center - from the freezing of embryos, eggs, sperm, and testicular tissue to testicular sperm extraction, and more - cancer patients hoping to conceive in the future now have options. In fact, our team of specialists offers a new oocyte cryopreservation protocol with a significantly higher rate of conception success than previous methods. And for patients, this can turn hopes into reality.

Ovaries are very sensitive to chemotherapy and radiotherapy treatment, especially to alkylating agents. In addition to the type of drug and dose, also age at diagnosis is an important factor when evaluating the risk of premature ovarian failure after chemotherapy. Women that are younger than 30 years old have a higher chance of recuperating their ovarian function after chemo/radiotherapy as opposed to older women. However since it is impossible to predict the true risk of premature menopause, it is always recommended to consider fertility preservation prior to beginning chemotherapy or radiotherapy.

What are the options for fertility preservation?

An established method of fertility preservation is embryo cryopreservation, but this option requires the patient to be post-puberty and have a partner (or use donor sperm). In addition, with the help of the oncologist it must be determined the ovarian stimulation to required to produce oocytes will not negatively affect the cancer diagnosis. In addition, your oncologist will help confirm that the ovarian stimulation required to produce oocytes will not affect your cancer treatment.

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For women wishing to preserve fertility but without a male partner (or not interested in donor sperm), oocyte cryopreservation is a viable option. Pregnancy rates from cryopreserved oocytes are approaching rates seen from cryopreserved embryos in some centers and it is expected that this option will no longer be considered experimental. 

In several other conditions such as autoimmune diseases, severe endometriosis, as well as genetic conditions predisposing to premature ovarian failure, oocyte cryopreservation should also be considered.

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Cryopreservation of ovarian tissue should be seriously considered for any patient undergoing treatment likely to impair future fertility such as pelvic, extrapelvic and/or systemic malignant diseases. The only option for patients who need immediate chemotherapy is cryopreservation of ovarian tissue. The main aim of this strategy is to remove (with a laparoscopy) the ovarian cortex from one of the ovaries prior to the commencement of chemotherapy or radiotherapy and then freeze it for future use. Human ovarian tissue can be successfully cryopreserved, showing good survival and function after thawing. Thus in the event that the side effects of the cancer treatment result in cessation of the menstrual cycles and infertility, the ovarian cortical tissue is thawed and then re-implanted into the pelvic cavity. The re-implants can be either on the scaffold of the remaining non-functional ovary or in the pelvic sidewall.collapse
Fertility preservation options should be discussed and explored as soon as possible (at diagnosis, prior to cancer treatment initiation), and care must be taken not to add further stress to the patient/family this difficult time. At Yale, we have a designated team to counsel patients and families about fertility preservation options. It is important to note that some patients may not be candidates for fertility preservation before treatment due to the immediate need of starting chemo or because they are too ill to undergo the necessary procedures. It is important to note that some patients may not be candidates for fertility preservation before treatment.collapse
Reported cases of autotransplantation of cryopreserved ovarian tissue are summarized on the ISFP (International Society for Fertility Preservation) website, detailing in each case the age of the patient before freezing, whether she received chemotherapy before freezing, the indications for cryopreservation, the graft site and size, the interval before recovery of ovarian function after grafting and the outcome of transplantation. It is common to observe restoration of ovarian function after about 5 months from the autotransplant.collapse

Fertility Postponement

Throughout women’s reproductive life, the number of the oocytes is progressively depleted and at the same time their quality begins to deteriorate. Oocyte cryopreservation is one of the most innovative methods to safeguard against the age-related degenerative changes and to extend fertility opportunities by ‘suspending’ the biological clock.

  • Patients at risk of premature ovarian failure. This condition may result from: ovarian diseases such as cysts, benign tumors and recurrent or large endometriomas requiring ovary removal; and chemotherapy or radiotherapy to treat cancer or other systemic diseases; or from genetic conditions (fragile X, mosaic Turner syndrome, balanced translocations) that may predispose to premature ovarian failure. 
  • Women that are in a career or women that are not yet ready to reproduce or are not yet in a stable relationship. 
  • Oocytes banking for donation programs
  • Cases with no sperm available at the time of oocyte harvesting 
  • Patients who prefer to cryopreserve gametes instead of embryos for religious reasons
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At the Yale Fertility Center we utilize a cryopreservation technique known as “vitrification”. Vitrification involves ultra rapid freezing of the oocyte/embryo from 37 ºC to -196 ºC at a rate of -20,000 to -30,000 ºC per minute. High concentrations of cryoprotectants and high cooling rates are necessary to avoid cryoinjury and preserve the oocytes or the embryo.collapse