Fertility Preservation – Options for Women and Men

Fertility Preservation Options for Men

Males produce sperm throughout their lifetime. There are some scenarios where they should consider preserving their sperm through cryopreservation. This can include: the need for chemotherapy, or other medical therapies that can negatively affect sperm numbers and quality. They should freeze sperm if they are considering using testosterone. Sperm freezing should be considered in patients who desire to undergo gender transition using estrogen therapy.

Men undergoing vasectomy may choose to freeze sperm prior in case they change their mind about trying to conceive in the future. Some men may consider freezing if they know they desire children and are getting older, as sperm quality can decrease with age. Generally a sperm freeze involves collecting a sample at a fertility clinic or sperm bank. It is then frozen or cryopreserved and stored until future use.

Female Fertility Preservation

Women may choose to preserve their fertility as we do know egg quality and quantity decreases with age. It can be electively done in the setting of delayed childbearing (or if a larger family size is desired and wanting to keep options open for the future). It can also be done prior to treatments that impact egg numbers/ovarian reserve, including chemotherapy, pelvic radiation, or significant surgery on the ovary (or ovary removal).

Some patients undergo gender transition may choose to undergo fertility preservation as well. Women can undergo oocyte cryopreservation. This is a process through which the ovaries are stimulated with medications to get multiple follicles to grow over the course of a couple of weeks. A surgical procedure called a transvaginal oocyte retrieval is then performed to remove the eggs from the ovaries.

Then they can be frozen or cryopreserved for later use. Some may also choose to undergo embryo cryopreservation. If they choose to do this, then the eggs would be fertilized at the on the day of egg retrieval, then the embryos would be cultured and cryopreserved or frozen for future use. Many women choose to freeze eggs to maintain their reproductive autonomy and flexibility for future use.

A less commonly performed procedure is ovarian tissue cryopreservation. This is where an ovary is surgically removed or some tissue from an ovary is surgically removed, and the tissue is frozen or cryopreserved. It can then be later reimplanted into a woman. This is an option for patients that cannot undergo regular oocyte cryopreservation (i.e. before puberty, or timing of treatment like chemotherapy is so urgent that there is not sufficient time for the ovarian stimulation process).