Nowadays, social and personal conditions greatly affect women’s decision to become mothers. For this reason, fertility preservation is considered to be one of the great scientific advances in reproductive medicine, as it allows women to delay childbearing and to choose the ideal moment when they wish to have a child.
To go deeper into this subject and learn all the details from a specialist, Dr. Victoria Verdú, head of the medical team at IVF-Life Madrid and a doctor specialized in reproductive medicine, explains the main aspects that make this technique one of the key treatments in the field of fertility.
What is fertility preservation?
It is necessary to bear in mind that when we talk about fertility preservation we are referring to safeguarding a part of an individual’s fertility at a given time. It should be noted that it is not possible to preserve all of a patient’s or a patient’s fertility in its entirety, but rather this practice consists of freezing a partial amount of that fertility, preparing a quantity of eggs or sperm for future use.
When we do a fertility preservation cycle, we can freeze around 10-20 eggs, which gives us a chance of achieving a pregnancy of around 70% in women under 35 years of age. In this way, we have to be clear that preserving eggs does not mean that we have “fertility insurance”, because in order to fertilize these oocytes can be decisive in the success of the treatment, the quality of the male factor or the physical conditions at the time of gestation.
What are the differences between male and female fertility preservation?
In men, the reproductive capacity remains fairly stable over the years until the age of 50-55 years and when it is decided to preserve a semen sample, either because the patient suffers from oncological problems, because of a vasectomy or because he wants to preserve fertility at a suitable time without suffering from any pathology, we can find millions of sperm cells in a single semen sample.
Once the optimal gametes have been selected for use, they are frozen and allow several treatments to be carried out if they have the right quality and quantity in the ejaculate sample.
In the case of women, the process of loss of reproductive capacity is different to that of men; women are born with a large number of eggs, around 2 million. This is what we know as ovarian reserve, and from that moment onwards there is a continuous loss of ovarian reserve which can sometimes be accelerated by environmental factors, for example, smoking, genetic factors or pathologies that affect the ovary, such as endometriosis. The genetic quality of these eggs generally remains stable from the age of 18 to 35. From the age of 35 onwards, genetic anomalies in the eggs increase considerably.
On the other hand, when a woman decides to carry out a fertility preservation cycle, either for medical reasons, oncological pathology or for social reasons of wanting to postpone motherhood, she will manage to recover a limited number of oocytes in an ovarian stimulation, around 15-20 oocytes if the ovarian reserve is good, which will give us the possibility of attempting gestation in the future with these frozen oocytes at a certain age.
The chances of a future gestation with these future oocytes will depend very much on the age at which the eggs are frozen and their ovarian reserve at the time of preservation.
At what age is it advisable to start preserving genetic samples?
The ideal way of obtaining quality oocytes is to carry out this type of treatment at a reasonable age. We consider especially appropriate those ages below 35 years of age, an age at which, in general, the genetic quality is still optimal for its use.
From the age of 38 onwards, there are many cases of patients with genetic abnormalities. In order to favor the success of egg implantation, it is advisable to have quality samples, something that affects the success rate of pregnancy considerably.
What is the success rate of this therapy?
There are cases where fertility preservation is vital, such as in patients who have undergone high-impact treatments, such as radiotherapy or chemotherapy, who are no longer able to become pregnant due to the state of their ovarian reserve.
Pregnancy rates with frozen oocytes and being under 35 years of age, depending also on the quality of the sperm, are around 55%. It depends very much on the age at which the sample is frozen. It also depends on the quality of the male sample or the general condition of the patient and his ability to carry out a pregnancy. Reproductive prognosis improves the earlier the eggs are frozen.
Ideally, eggs should be frozen between the ages of 20 and 30, but this is not the norm, as parenthood is not one of our main concerns at this age.
As a professional, what do you think about the information available on this type of treatment?
This type of fertility techniques began to be viable from 2006-2007, which is when vitrification techniques appeared. In this sense, this new methodology allowed us to freeze eggs at high speed. Until then, the process of thawing the samples was complicated as, on many occasions, the samples deteriorated rapidly or did not evolve correctly.
Since then, I believe that this type of treatment has not been given the necessary visibility and there is a lack of culture about how our bodies work. This kind of lack of information leads many people to have wrong expectations about fertility and reproduction. Ordinary people are often unaware of the characteristics of our bodies. There are many cases of people who, at the age of 40, have a 5-10% chance of pregnancy. This is why they are unable to conceive when the time comes.
Do you think decisions are being taken to reverse society's perception of fertility?
For many years, planning for reproductive life was not a priority. We thought about avoiding unwanted pregnancies and family planning was limited to the recommendation to use contraceptive methods, but there was no discussion of how to achieve pregnancy at advance ages.
In 2014, Apple or Facebook offered their employees the possibility to freeze eggs. As a result, many women have learned that egg preservation is a real possibility to get pregnant at a more favourable time in their lives. Also, in recent years there seems to have been an information boom, and much of the information that was not previously available is now beginning to make its way into society.
These business decisions and their repercussions in the media made many women aware that egg preservation was a real possibility for obtaining a pregnancy at a more favourable time in their lives. Likewise, in recent years there seems to be more information available, and in primary care and general gynaecology consultations, women are already being guided in their reproductive project, and much of the information that previously did not reach them is now beginning to permeate society’s awareness of this treatment.
In the month of December more than half of the patients I have seen were patients who wanted to undergo fertility preservation. The truth is that I find it very striking because many people under 35 are starting to come, so the message seems to be getting through, especially among women, who are aware of the importance of ovarian reserve and how it relates to fertility.
There is a surge of interest in this type of treatment and the social circumstances are also conducive to getting the message across to people who need to preserve their fertility.
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