Fertility Preservation

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.