Fertility preservation is a rapidly developing branch of reproductive medicine, including gamete preservation (oocytes or spermatozoa) and reproductive tissue preservation (ovaries or testicles). Fertility preservation gives patients at risk of losing their reproductive capacity the ability to further conceive and have their own genetic child. The main beneficiaries of fertility preservation strategy are the cancer patients who undergo surgery, start chemotherapy or radiation therapy, or proceed with the other clinical treatments leading to premature menopause, and healthy women who just want to postpone childbearing. Main options for safeguarding women of their reproductive health include cryopreservation of oocytes or ovarian tissue.
Preservation of the biological materials at cryogenic temperatures (i.e. cryopreservation) allows to completely stopping biological reactions in order to maintain the viability of cells while keeping the unchanged physiology of tissues after organ transplantation, or in case of human gametes, in order to preserve their unchanged ability to cultivate embryos capable to achieve successful pregnancies and deliver healthy babies. Effective cryopreservation of oocytes has greatly helped women as a tool for fertility preservation, especially during the past 10 years. More specifically, the introduction of vitrification as a cryopreservation technique into ART has established an effective female gamete cryopreservation tool that provides comparable results to those achieved with fresh oocytes and opens up a wide range of strategies, including fertility preservation.
Fertility Preservation for Social Reasons
In modern society, too many women take long strides in their careers and postpone motherhood further away from the younger years of childbearing. This trend affects developed countries mainly, most of which experience significantly lower fertility rates. Women are often forced to choose careers, financial security and certain social pressure ahead of their “biological clock”, a known decline in fertility over 30 years. With the increase in the number of women who decided to postpone motherhood, there is growing interest in the availability of current fertility preservation through cryopreservation techniques to protecting their future fertility options.
Although this argument is correct, it is essential to inform patients adequately starting with the youngest women, and to educate them that the probability of using their cryopreserved eggs in the upcoming years is reduced; however, their chance of natural conception can remain high. On the other hand, older women who are more likely to use their cryo-savings should be informed accurately about their reproductive chances. In any case, a child can be achieved when the oocytes have been vitrified over the age of 40 that makes it very difficult to set upper limits for applying this strategy.
The effectiveness of fertility preservation by means of oocytes vitrification to secure fertility is now a consolidated option that can be offered to women who want to be able to achieve the future motherhood. However, it is necessary to explain to women who are looking for optional fertility preservation that oocyte cryopreservation is not an “insurance policy” to secure the future motherhood, but means of increasing the chances of having a biological child, and that these chances depend on the age and on the number of oocytes preserved.
It is essential that women be informed about the fall in the probability of success over the age of 35. The quantity of vitrified oocytes should be adjusted depending to the woman’s age in order to increase the probability of having a child regardless of oocytes coming from one ovarian stimulation cycle or another. In cases of fertility preservation, due to greater biological efficiency, women should be fostered this option when younger than the age of 35, although the strategy may be less cost-effective at this age.