In Spain, the average age of maternity is around 32, a figure that continues to increase year after year. As age progresses, fertility is reduced and associated risks increase. But not everything is bad news: there are several medical procedures that allow preserving the ability to conceive in the future, an option known as fertility preservation.
These techniques are also used in women and men who must undergo aggressive medical treatments that could affect their reproductive function. “The intention is that, once this disease has been overcome, in the future pregnancy can be achieved,” explains Dr. Dolors Manau, a gynecologist of the Clinic Barcelona Hospital.
To determine if a person can receive a fertility preservation technique, a Multidisciplinary evaluation. In this process, the stage of the disease, the prognosis and the possible risks of the procedure are valued.
In the case of women, age and ovarian reserve status are key factors, since the risk of ovarian dysfunction is decisive when deciding whether or not preservation is performed. “The effectiveness of these techniques is basically conditioned by the quality of the gametes,” explains Dr. Manau.
The effectiveness of these techniques is basically conditioned by the gametes’s own quality
The ovarian reserve refers to the quantity and quality of ovules that a woman has. Its decrease with age is due to follicular loss – the ovules are within the follicles, so, by losing the follicles, ovules are also lost – and the aging of the ovules, which affects their quality. “A younger woman will have more ovules and higher quality than an older woman,” says Dr. Manau. For this reason, the probability of pregnancy decreases significantly with age.
This follicular loss can be accelerated with certain oncological treatments, known as gonadotoxicsuch as chemotherapy or radiotherapy. These drugs, mainly used to treat cancer or autoimmunological diseases, can exhaust the follicles and cause early menopause. Due to the high risk of ovarian damage, it is essential to evaluate the patient before starting treatment to determine if a fertility preservation technique can be applied.
The most used fertility preservation technique in women is Freezing of ovulesalso known as cryopreservation of oocytes. It is more recommended whenever there is enough time before starting the gonadotoxic treatment and the woman has an adequate ovarian reserve. The procedure consists of the administration of hormones to stimulate the ovaries, followed by an extraction of the ovules in the operating room, which subsequently freezed and stored in the laboratory.
When there is no margin to perform this technique – the stimulation process requires about 10 or 12 days – and it is necessary to initiate the gonadotoxic treatment immediately, the cryopreservation of the ovarian cortex is used. “This is a technique currently considered experimental in Europe,” explains Dr. Aina Borrás, gynecologist at the Clinic Barcelona Hospital. It consists of the freezing of the ovary cortex, which, after overcoming the disease, defrosts and reimplanted to recover its function.
Another experimental technique is chemoprotection, which consists of drug administration to reduce the loss of ovarian follicles during chemotherapy. Finally, in cases of cervical cancer or ovary, surgical interventions can be considered to preserve the integrity of the ovaries or the uterus. This is especially relevant when an aggressive treatment in the pelvic area is required, such as conservative ovarian surgery or cervical removal.
These techniques do not have side effects as such, but we must keep in mind the peculiarities of each
Although the freezing of ovules is the most demanded technique, all preservation methods are safe for the patient. “These techniques have no side effects as such, but we must keep in mind the peculiarities of each one,” says Dr. Aina Borrás, gynecologist at the Clinic Barcelona Hospital.
In addition, in recent years, interest in clinical and experimental research in this field has been increasing, which could improve these techniques and even the incorporation of new procedures. Scientific advances focus on the optimization of ovarian tissue preservation, increased survival of oocytes, embryos and ovarian tissue, activation of tissue with various drugs and the improvement of cellular culture media.
In the case of men who must go through potentially sterilizing treatments, the most commonly used option is CrioPreservation of semen, a technique that has improved significantly thanks to progress in laboratory freezing methods. This procedure must be offered before starting oncological therapy, regardless of semen quality. It consists of freezing and storage of semen samples for subsequent use in assisted reproduction techniques.
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