Personal circumstances or medical conditions, such as cancer, can become barriers to pregnancy for some individuals. Fertility preservation can help men and women fight the loss of reproductive potential.
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Egg (oocyte) Cryopreservation
A woman's fertility is largely dependent on the quality of her eggs. As a woman ages, her egg quality and chances of conception decrease. In addition, some medical conditions, such as premature menopause and cancer, can greatly limit a woman's ability to conceive.
Fertility preservation gives women the option of freezing eggs (oocyte cryopreservation) for future use. Although the woman may age, the eggs will maintain the same age as when they were frozen.
A number of steps are involved the egg freezing process:
- Testing ovarian reserve: Ovarian reserve testing consists of blood work and an ultrasound. Both are important for establishing the current level of ovarian function and are used to measure several things:
- Antral follicle count (AFC) via ultrasound. The antral follicles are the 2 to 10 millimeter fluid sacs within the ovary that represent the next wave of ovulation. In general, the more antral follicles seen, the better prognosis for the patient.
- Day three blood work measures the levels of follicle stimulation hormone (FSH), anti-mullerian hormone (AMH), estradiol, lutenizing hormone (LH), prolactin and thyroid stimulating hormone (TSH). Higher than normal levels of FSH and lower AMH indicate a potentially reduced fertility potential. Testing results are used by the physician to help determine the best medication protocol for optimizing the number of eggs produced during the stimulation phase of the egg freezing process.
- Ovarian stimulation: Medications are taken to stimulate the optimal growth of many eggs in one cycle, rather than the usual one egg per cycle.
- Egg retrieval: After appropriate monitoring by blood estrogen levels and ultrasound, an ultrasound-guided harvesting of eggs from both ovaries is performed.
- Egg preparation: In the ARTS IVF Lab, the eggs are identified under a microscope by an embryologist and withdrawn from their fluid in preparation for freezing.
- Cryopreservation: The embryologist places the eggs in special solutions to remove water from the eggs and then bathes them in protectant solutions during the freezing process known as vitrification. Vitrification is an advanced "quick-freezing" process designed to protect eggs from injury during the egg freezing and thawing processes.
- Storage: Cryopeserved eggs are placed in sealed, uniquely identified straws and stored in liquid nitrogen.
Using frozen eggs
When a couple is ready to use their cryopreserved eggs, some or all of the eggs are thawed and then injected with a single sperm from the male partner to bring about fertilization. Fertilized eggs are cultured in the ARTS IVF Lab and begin to divide and develop into embryos.
Generally, one or two of the best dividing embryos are transferred into the uterus using a thin transfer catheter at a designated time in the cycle. Other embryos that have grown well after fertilization but are not transferred can be cryopreserved as embryos.
Potential for Success
Egg freezing is still considered experimental by the American Society for Reproductive Medicine. However, Texas Health's ARTS and many other programs have seen a significant increase in survival rates of thawed eggs (more than 80 percent) due to new advances in cryopreservation. In addition, studies show that fertilization and embryonic development of eggs that are frozen and then thawed are comparable to freshly retrieved eggs.
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Frequently Asked Questions
At what age should I consider freezing my eggs?
Women in their early to mid-30s who are likely to experience a real decline in their fertility in the near future are the best candidates for egg freezing. Women already in an age group where fertility has likely been compromised, such as age 40 and over, are less likely to benefit from egg freezing once those eggs are thawed. Women 40 years and over may be considered if they have ovarian testing indicating good ovarian function and reserve, increasing the likelihood that egg banking for them may still be an option.
Will I reduce my available eggs in the future by freezing now?
No. At the beginning of each menstrual cycle, hundreds of eggs begin the process of maturing for ovulation. Each month only one egg is ovulated and the rest degenerate. The medications used in ovarian stimulation allows many of those eggs otherwise lost to reach maturity and retrieval for freezing.
How are the eggs obtained?
Once ready for retrieval, eggs are collected in the ARTS Laboratory. You will be lightly sedated and should feel no discomfort. The eggs are removed through the vagina using a small ultrasound guided needle that allows the fertility specialist to drain the fluid-filled follicles containing your eggs.
How long does the process take?
From the time of your initial consultation through the process of ovarian stimulation, egg retrieval and egg cryopreservation, the entire process can take five to six weeks. The process can be completed in two to three weeks in women needing cancer treatment.
How long can the eggs be stored?
Studies indicate that frozen eggs can remain viable for many years.
Are there risks?
The Informed Consent documents you will review and sign will give greater detail, but the most common risks involve complications from the stimulation of the ovaries and potential bleeding and/or infection from the egg retrieval.
One of the greatest known risks of egg cryopreservation is that women may delay pregnancy, which they perhaps would have pursued if egg cryopreservation was not an option. By delaying pregnancy, they may limit their potential for achieving conception, with or without a frozen egg.
Why should I choose Texas Health ARTS?
- The ARTS program offers a wide variety of infertility treatments, from basic care to some of the most advanced in vitro fertilization (IVF) procedures available.
- ARTS has been named one of the "10 Best Fertility Centers" in the United States by Child magazine.
- ARTS features an on-site Andrology Laboratory for male infertility testing that accepts most insurance plans. Plus, men can be referred directly to the lab for testing by an obstetrician/gynecologist, family medicine or internal medicine physician.
- ARTS is a hospital-based program, providing access to chaplains, psychologists and complementary (non-medical) treatments to care for the "whole" patient - physically, emotionally and spiritually.
- ARTS offers a convenient array of services and there are many physician on the medical staff including obstetricians, neontatologists, oncologists and urologists.
- ARTS is a member of the Society for Assisted Reproductive Technologies (SART).
- ARTS has on-site reproductive laboratories certified by the College of American Pathologists (CAP).
- Physicians on the medical staff, scientists, technicians, nurses and administrators in the ARTS program are dedicated to caring for both your physical and emotional needs.
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Similar to freezing eggs, embryo cryopreservation can be performed when there are more embryos than needed for a single in vitro fertilization (IVF) cycle. The extra embryos can be frozen for future IVF cycles.
These embryos can give couples multiple chances to conceive from one IVF retrieval, since frozen embryo cycles do not require the time or expense of additional fertility medications, egg harvestings and lab procedures.
Freezing and storage
The embryologist places the embryos in special solutions to remove water from the embryos and then bathes them in protectant solutions during the freezing process known as vitrification. Vitrification is an advanced "quick-freezing" process designed to protect embryos from injury during the freezing and thawing processes. Cryopreserved embryos are placed in sealed, uniquely identified straws and stored in liquid nitrogen.
Using frozen embryos
When a couple is ready to use their cryopreserved embryos, some or all of the embryos are thawed so that the age of the embryos corresponds to the age of the uterine lining. The embryos are placed in the uterus around the time of ovulation and when the thickness of the endometrium (lining of the uterus) is optimal.
Not all embryos survive the cryopreservation process. Before the frozen embryo transfer, an embryologist will evaluate the embryos to make sure they are ready for transfer. During the embryo transfer, a catheter is inserted through the cervix, and the embryos are injected into the uterus.
According to the Centers for Disease Control and Prevention's 2007 Assisted Reproductive Technology Report, 29 percent of all frozen embryo transfers result in live births. Success depends on a number of factors, including the number and quality of embryos, the patient's age and the cause of the infertility.
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Sperm preservation is available at the ARTS Andrology Lab for men who wish to preserve their fertility prior to cancer treatments or vasectomy, and to preserve sperm for intrauterine insemination (IUI) if the male partner will be out of town for the IUI.
Success of the freezing process depends on a number of factors, including semen volume, sperm count and percent motility. Collected sperm are diluted with a special protectant during the freezing process. Frozen sperm are placed in sealed, uniquely identified cryo-vials and stored in liquid nitrogen.
Using frozen sperm
Cryopreserved sperm can be used at a later date to achieve pregnancy through either intrauterine insemination (IUI) or in vitro fertilization (IVF). When the sperm are thawed in the Andrology Lab, an embryologist analyzes the sperm count and motility (ability to move). A "test thaw" may be requested by the patient's physician prior to insemination to confirm quality of the specimen. If poor sperm characteristics are identified or if very few frozen sperm samples are available, IVF may be the recommended option.
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Cancer and Fertility
A cancer diagnosis can be overwhelming and involves numerous important decisions, including decisions regarding fertility preservation. Although cancer treatments can have a significant impact on fertility, they do not have to end a patient's dreams of having a child. A growing range of options are available for most cancer patients who would like to be proactive and preserve their fertility.
ARTS understands that coping with treatments for a potentially life-threatening disease while also considering treatments that could preserve future fertility can be extremely stressful. Our team is dedicated to being sensitive to cancer patients' concerns and needs.
The decision to undergo preservation treatment is made collaboratively by the patient, oncologist and a fertility specialist. Options available for cancer patients to preserve their fertility potential include:
- Egg cryopreservation (freezing)
- Embryo cryopreservation (freezing)
- Sperm cryopreservation
ARTS is a participating program with LIVESTRONG, a non-profit group that works with select fertility centers to provide financial assistance for fertility preservation for cancer patients. For more information, visit www.livestrong.org.
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