Nowadays,infertility is a major health concern. According to the World Health Organization one in every six couples are struggling to become parents . Infertility is defined as the inability to conceive after normal unprotected sexual intercourse.
Infertility may result from a problem with either the male or the female partner, or a combination of factors that interfere with pregnancy. But fortunately, due to the advancement of science and technology, there are many safe and effective treatments that can significantly improve your chances of getting pregnant.
Q.Who should be offered fertility preservation in case of both males and females?
Ideally anyone at risk of loss of ovarian function in females and or loss of reproductive potential in case of males.
Causes of loss of ovarian function:–
Oncogenic causes—
• All forms of cancer patients requiring radiotherapy /chemotherapy.
• Mutation carrier for certain types of cancer.
Non oncogenic causes:-
• Autoimmune diseases
• Endometriosis
• Any surgery on the reproductive tract —ovarian cystectomy etc.
• Social /iatrogenic —wanting to postpone childbirth.
• Patients undergoing bone marrow or stem cell transplantation.
• MS patients receiving new generation treatments.
• Patients with genetic mutations leading to loss of fertility and early menopause.
Fertility preservation program requirements:-
• Rapid access
• Interdisciplinary medical team –oncologists,reproductive endocrinologists,urologists,reproductive surgeons trained in FP techniques.
• Lab requirements—Experienced ART programs—embryo cryopreservation/oocyte cryopreservation/cryopreservation of ovarian and testicular tissues
• Counsellors –
Mental—to navigate them for a difficult decision making process.
Genetic —risk of transmission to offspring /genetic testing like PGT .
Financial—cost due to lack of insurance coverage.
Medical considerations to be discussed:-
• All methods of FP.
• Give alternative options of donor gametes,donor embryos and adoption.
• Given state of the patient capable of undergoing the procedure.
• Potential safety of future pregnancy after cancer should be addressed especially after pelvic irradiation.
• Infectious disease testing for all patients banking.
• All those who elect to cryopreserve —disposition in the event of death should be discussed and documented.
Chemotherapy –the impact is mostly on ovaries .Degree of damage is dependant on:
• Type of agent .
• Dose given.
• Age of patient
• Baseline ovarian reserve .
The pre pubertal ovary is less susceptible to ovarian failure as contrast to older women.
Radiotherapy-affects ovaries and uterus.
Human oocyte is sensitive to radiation with estimated lethal dose of <2Gy.Pre pubertal uterus is more susceptible to irradiation.
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In-Vitro Fertilization (IVF) is a technology in which the eggs from the female partner and sperms from the male partner are fertilized in a specialized culture medium. It is commonly known as test tube baby because the process of fertilization occurs outside the body.

ICSI is a micromanipulation technique developed to achieve fertilization. In this procedure a single sperm is injected directly into the cytoplasm of an egg.

IMSI helps magnify the image of the sperm 7,200 times, thereby allowing doctors to pick the best looking healthier sperms. The machine is an advanced version of the earlier technique of Intracytoplasmic Sperm Injection (ICSI)