Fertility Preservation

Candidates for Fertility Preservation (Males and Females):

General Criteria: Individuals at risk of losing ovarian function in females or reproductive potential in males should be considered for fertility preservation.
Causes of Loss of Ovarian Function:

Cancer-Related:
Patients requiring radiotherapy or chemotherapy.
Carriers of certain cancer-related mutations.
Non-Cancerous Causes:
Autoimmune diseases.
Endometriosis.
Surgeries on the reproductive tract, such as ovarian cystectomy.
Social or elective reasons.
Bone marrow or stem cell transplant patients.
Multiple sclerosis patients on new-generation treatments.
Genetic mutations lead to infertility or early menopause.
Fertility Preservation Program Requirements:

Access: Rapid access to fertility preservation services.
Interdisciplinary Team: Oncologists, reproductive endocrinologists, urologists, and reproductive surgeons skilled in fertility preservation techniques.
Laboratory Support: Experienced assisted reproductive technology programs capable of embryo, oocyte, and ovarian/testicular tissue cryopreservation.
Counselors:
Mental Health: To support decision-making.
Genetic: To discuss the risk of genetic transmission and available genetic testing.
Financial: To address the costs, especially where insurance coverage is lacking.
Medical Considerations:

Methods of Fertility Preservation: Discuss all available options.
Alternative Options: Consider donor gametes, donor embryos, and adoption.
Patient Suitability: Assess the patient’s condition and ability to undergo the procedure.
Pregnancy Safety: Evaluate the potential safety of future pregnancies, especially after cancer treatments like pelvic irradiation.
Infectious Disease Testing: Required for all patients opting to bank gametes or tissues.
Disposition Planning: Discuss and document the disposition of preserved tissues during the patient’s death.
Impact of Cancer Treatments:

Chemotherapy: Primarily affects the ovaries, with damage dependent on:
Type of chemotherapy agent.
Dosage.
Patient’s age.
Baseline ovarian reserve.
Note: Prepubertal ovaries are less vulnerable to failure than those in older women.
Radiotherapy: Affects both ovaries and the uterus.
The prepubertal uterus is particularly susceptible to irradiation.