Infertility is becoming more common on a global scale, affecting people of all genders and ages. It describes the inability of the male or female reproductive system to conceive a child after engaging in regular, unprotected sexual activity for at least a year. Numerous studies have found that infertility is on the rise in India, which has gradually increased demand for fertility preservation and may have a significant impact on the lives of future parents.
Fertility preservation
Fertility preservation is the process of preserving a person’s fertility for future conception after a medical or surgical procedure, such as radio or chemotherapy, high grade and advancing endometriosis, ovarian surgery, and so on, threatens their fertility. Alternatively, it is for those who are not ready to become pregnant for social or personal reasons but are concerned about losing their fertility in the future. It usually entails techniques and procedures for sperm, egg, or embryo extraction, freezing, and preservation. This makes it easier for the couple to decide when it is the best time to start a family.
Even though the majority of people have difficulty getting pregnant, fertility preservation may be beneficial for some people who have specific diseases or disorders. This strategy can also be applied to accidents that may result in fertility issues. This treatment has been extremely beneficial for cancer patients who intend to become pregnant soon. These treatments may be beneficial to the following demographics:
- Endometriosis– It is a condition in which tissues that resemble the uterine lining develop in other parts of the body, causing pain and infertility.
- Uterine fibroids -These are tumours comprised of fibroblasts, smooth muscle cells, and other cells that grow inside or outside the uterine wall, causing pain and irregular bleeding.
- Exposure to chemicals– A person may benefit from this treatment if they were exposed to toxic chemicals that affect fertility while serving in the military or at work.
- Cancer Patients – Patients with cancer Specific cancer treatments may have an effect on a person’s fertility, either temporarily or permanently.
- Prolonged separation – In some cases, couples are forced to spend extended periods of time apart due to travel or military obligations.
- Autoimmune disease – If a person is about to start treatment for an autoimmune condition like lupus, they can opt for fertility preservation.
- Delayed conception – Couples who want to postpone pregnancy for a variety of reasons can use fertility preservation techniques to store their sperm or eggs for later use.
- Biological – In some cases, infertility is genetic, or it is caused by another genetic disorder that affects future fertility.
Latest Advancement & Various options available for fertility preservation
Numerous recent innovations in the field of fertility preservation have occurred in India. According to the ART (Regulation) Act 2021, sperm and eggs can be cryopreserved for self-use and stored indefinitely. Additionally, there are numerous ways to preserve both male and female fertility. These include:
-
- Embryo freezing: Embryos for this procedure are obtained through in-vitro fertilisation (IVF), a cutting-edge fertility procedure. Injections are used to stimulate the ovaries to produce mature eggs, which are then combined with sperm through an egg retrieval procedure. These fertilised eggs are frozen for later use.
- Gonadal shielding: For male cancer patients who have already received chemotherapy, this is an additional treatment option. A lead shield is used in this procedure to protect the testicles from radiation.
- Egg freezing– Similar to embryo freezing, eggs are frozen to be fertilised later.
- Sperm cryopreservation: This term refers to a male fertility preservation procedure that involves taking a sample of sperm, freezing it, and storing it for later use.
- Ovarian tissue freezing – This entails surgically removing the ovarian tissue so that it can be used later. This option is available to young cancer patients who will be treated.
Latest Innovations in Fertility Preservation
The following are some of the recent innovations in fertility preservation:
- Embryo cryopreservation: The procedure entails taking sperm, extracting eggs as in IVF, fertilising them in the lab to create embryos, and then storing the embryos by freezing at an extremely low temperature, which enables the cells to have an endless shelf life. Through cryopreservation, all biological processes are halted and time-dependent harm to the sperms, eggs, or embryo is avoided. In addition, the embryos are thawed and used for conception later on as needed.
- Ovarian Transposition: This is an excellent surgical technique for keeping the ovaries out of the radiation field while women of reproductive age undergo radiotherapy to preserve fertility. They can use it before undergoing gonadotoxic pelvic radiation. It is a simple, safe procedure that can be performed via laparotomy (open surgery) or laparoscopy (keyhole surgery). Ovaries are hitched up outside the pelvis to protect against radiation exposure. This method cannot be used to administer chemotherapy to the ovaries.
- In-vitro maturation: The eggs of women are collected immediately and matured outside the body in this procedure. This is done as part of the IVF procedure. IVM may be considered for women who have been diagnosed with a condition that requires immediate treatment (radiotherapy or chemotherapy) that is harmful to fertility and there is no time to complete an IVF cycle in order for the eggs to mature inside the body. Because women with PCOS are more likely to develop ovarian hyper stimulation syndrome, this technique can also be used with them (OHSS). OHSS is an exaggerated reaction to ovulation-inducing medications. In comparison to the more traditional method of slow freezing, oocyte vitrification offers higher success rates, but this method is also constrained by the quantity of oocytes that can be obtained. Technically difficult and requiring ovarian stimulation, oocyte cryopreservation could cause a delay in cancer treatment.
Ovarian tissue cryopreservation and transplantation is an effective method of preserving fertility, especially for patients who require immediate treatment or for prepubescent girls. This option can restore endocrine function more than 95 percent of the time and has a pregnancy rate of up to 40%. It has been demonstrated that the procedure can restore fertility and hormonal cycles. Natural conception and IVF following transplantation have both been reported to be successful.
Prospects For Fertility Preservation & Challenges
Some chemotherapy treatments directly impair patients’ reproductive capacity. The selection of cancer treatments is critical because they may harm or have a negative impact on vital reproductive organs.
The complete medical history of the patient, details of any underlying illnesses, the cancer treatment being considered or planned, and the effect of the treatment on fertility are all important pieces of information that help the treating fertility specialist better understand the risks to the ovary. The fertility specialist recommends the best course of action based on the patient’s medical records, diagnostics, and current and anticipated medical conditions. Because IVF is not an option for prepubescent or young girls, these factors are critical. Prepubescent girls haven’t started menstruating yet, so they don’t have the necessary growing eggs for IVF stimulation.
Cancer Management in the Reproductive System & Beyond
Male and female gonadotoxicity, which harms the ovaries and testes, is a common side effect of cancer treatment. Even when cancer treatment is successful, infertility and hypogonadism (low functioning ovaries or testes) can be extremely distressing. What radiotherapy and other traditional chemotherapy regimens can do to patients is well known.
Both men and women can benefit from fertility preservation because it allows them to have biological children in the future. There is strong evidence in the literature that cancer survivors have a higher quality of life if they can keep their fertility. The potential side effects of anti-cancer treatment on the testicles and ovaries must be fully disclosed to all patients. They should be fully informed about the effects of gonadal toxicity and how they will most likely impair their ability to reproduce. They should be reassured that they can overcome the challenges to a large extent with the help of modern, personalised fertility treatments. Fertility treatments, like any medical procedure, have risks. A fertility specialist with fertility preservation experience can thoroughly explain the suitability, safety, and best protocols or modalities for various situations.