Fertility Preservation
Srinivasan Krishnamurthy
FRCS(Ed) FRCOG
Associate Professor & Chief of
Gynecology
Director of Gynecological
Ultrasound
McGill University & McGill University
Health Centre, Montreal, Quebec,
Canada
Fertility preservation by oocyte
cryopreservation
• women at risk of early menopause – preC/T or R/T for cancer, SLE, auto-immune
disorders, multiple sclerosis
- Turner syndrome
• preservation of fertility in women who
are not ready to have children
Preservation of fertility in young
women undergoing C/T or R/T
• >600,000 invasive female cancers/yr in
N.A. (8% < 40 years)
• improved survival for many children and
young adults with cancer
• need to consider future fertility prior to
treatment
• women face cancer treatment better if
they believe they can still have children
Six distinct issues should be considered
Fertility preservation in cancer patient
• The risk of sterility with the proposed treatment
program
• The overall prognosis for the patient
• The potential risks of delaying chemotherapy
• The impact of any future pregnancy upon the
risk of tumor recurrence
• The impact of any required hormonal
manipulation on tumor itself
• The possibility of tumor contamination of the
harvested tissue
Social oocyte storage for fertility
preservation!
• Women are born with a fixed number of
oocytes
• Reproductive aging from 20-24 to 40-45 years
results in poorer health outcomes
• infertility 7% - 14.3%
• Down syndrome 1/1440 – 1/68
• miscarriage 10% - > 50%
Social oocyte storage for fertility
preservation!
• There is no controversy about men freezing
sperm if they have cancer
• As women invariably lose their fertility as
they age
• Greater likelihood if they have familial,
genetic, endocrine, endometriosis, or any
other major medical condition
• Social oocyte storage would be
preventative medicine.
Social oocyte storage for fertility
preservation!
• Advent of OC, women’s liberation
and changing social norms have led
to delay in childbearing resulting in
relative aging of population and
dire societal consequences; perhaps
over time, even actual decline of
certain populations!
Social oocyte storage for fertility
preservation!
• Less educated women have children
younger
• Involuntary childlessness at 34 has
increased in all age groups over the
past 30 years
Social oocyte storage for fertility
preservation!
• Women who take time off work to
have children face significant loss of
income and career impediments
when they return to work
• A major problem is lack of
awareness of decline of fertility
even in the educated public
Social oocyte storage for fertility
preservation!
• A study at UBC showed that 20%
of students believed fertility stays
the same from menarche to
menopause while 3% actually
believed women remain fertile for a
few years after menopause!
Social oocyte storage for fertility
preservation!
• Another study reported that 63% of Stanford
and UC students were unaware fertility
declines between 30-34
• 61% believe IVF always works
• 78% believe exercise and diet preserve
ovarian function
• 51% were in a relationship, only 29% would
stop education or careers to have babies.
Social oocyte storage for fertility
preservation!
• Clearly, it would be ideal if all women
can have children at a young age and
society should be re-organized to help
them achieve this, since childbearing is
not just for individual benefit but for
societal good as well
• Unfortunately, this is not always
possible and social fertility
preservation becomes useful
Social oocyte storage for fertility
preservation!
• Oocyte vitrification (OV) was initially
developed help women at risk of early
menopause – pre-C/T or R/T for cancer,
SLE, auto-immune disorders, multiple
sclerosis, Turner syndrome, IBD, severe
endometriosis, F/H early menopause
and most major illnesses
Social oocyte storage for fertility
preservation!
• While intact ovarian transplantation,
ovarian tissue freezing and freezing IVF
or IVM embryos all allow fertility
preservation, the easiest way nowadays
for social fertility preservation is IVF
and OV
Social oocyte storage for fertility
preservation!
• A number of studies, largely using egg
donation as the model, have suggested that
vitrified thawed donor eggs, produce
almost comparable pregnancy rates as
fresh oocytes
• In a study of IVF OV in 38 infertile
women, we achieved 81% oocyte survival
rate, 45% clinical pregnancy rate/cycle
and 40% live birth rate/cycle started
Social oocyte storage for fertility
preservation!
• There is also a need to remove the double
standard that exists between men and women
reproducing in their forties or early fifties and a
good model is that of Israel, where free OV for
20 eggs is allowed and can be used until 54
years of age.
• There has to be a new paradigm of thinking
and SOV should be encouraged and one day,
young women will routinely create their own
personal egg bank, which they may even will to
their own daughters.