Posted on October 28th, 2020by Dr. Jovana Lekovichin Fertility Preservation

Reasons to Consider Fertility Preservation

Fertility preservation is used to describe treatment options that give individuals an opportunity to delay their childbearing years. Each patient and circumstance is unique. Depending on sex, age and medical condition, as well as timing to start treatments, it is useful when patients are faced with the risk of losing their fertility.

Over the past several decades, advances in cryobiology have enabled tens of thousands of women to preserve their fertility. While initially used to preserve eggs in patients diagnosed with cancer, egg freezing is now performed for a multitude of indications. Most commonly, egg freezing is now used as a form of preventative medicine to protect eggs against the normal reproductive aging process.

Fertility preservation involves the use of cryopreservation, a technique which cools tissue and cells to sub-zero temperatures in order to stop all metabolic activity and preserve them for future use. In 1984 the first human live birth from a previously frozen embryo was reported and 2 years later in 1986, the first human live birth from a frozen oocyte occurred. While progress was slow until innovations in freezing, thawing, and, most importantly, fertilizing occurred, in 2006, RMA of New York reported healthy pregnancies from frozen eggs. Since that time, countless individuals for various reasons have used fertility preservation to build their families.

Gonadotoxic Conditions
There are many conditions that impose a risk for future fertility. Some of these conditions have this effect directly, such as benign and malignant tumors of reproductive organs, endometriosis, and fibroids. For most of these conditions, however, it is not the condition itself, but rather its treatment that leads to loss of fertility. We now know that certain types of chemotherapy and radiation used to treat most malignant conditions, as well as some benign ones, have one of the highest gonadotoxic potentials and can lead to damage of reproductive organs of variable degree from diminished fertility to complete loss of ability to conceive or bear a child. By using cryopreservation to preserve eggs or sperm prior to treatment of these malignant conditions, an individual preserves their ability to have a biological child in the future.

Trans-gender Medical Care
Fertility preservation has become an integral part of trans-gender medical care. Some of the aspects of the gender-affirming transition process (namely, removal of testicles for trans-female individuals and removal of ovaries for trans-male individuals) lead to irreversible loss of future fertility. It has been highly recommended to trans-individuals to preserve their fertility (vis-à-vis sperm cryopreservation and oocyte cryopreservation for trans-female and trans-male individuals, respectively) prior to the initiation of gender-affirming transition.

Aging
Finally, aging is an entirely physiologic condition that inevitably leads to loss of fertility, especially when it comes to female fertility. Interestingly, over the past several decades two factors have become instrumental drivers of delay of childbearing and increasing maternal age overall. The advancement of science, medicine, and technology has allowed for significant prolongation of the human lifespan in general. Median life expectancy for women in the US and developed world is 86-87 years. Additionally, we have seen a significant equalization of women’s societal roles in terms of pursuing education and professional careers, which often comes with postponing family building goals.

Increased survivorship in childhood and adolescent cancers, reduced morbidity of chronic diseases as a result of improved medical management, as well as advances in fertility preservation techniques in the past 30 years allow us to offer fertility preservation to patients who would have historically been too unhealthy or unable to pursue childbearing.

At RMA of New York, we are highly skilled at providing all aspects of fertility preservation for a full array of medical conditions that warrant it as well as preventative fertility preservation in order to counteract age-related fertility decline in the future. New York became a mandated state this year and coverage for fertility preservation for medical indications is now covered by many insurance carriers. I sincerely hope that the tremendous potential for preventative fertility preservation will be recognized as well and covered by insurance in the near future, increasing access to care and family building opportunities.

If you have questions about fertility preservation or are interested in making an appointment at RMA of New York, please call 212-756-5777 for more information.

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