Fertility Preservation: Motives and Techniques

What are the reasons for fertility preservation?

The reason for fertility preservation, primarily in women, is because the maternal age for having a first baby is greatly postponed. Just as 50 years ago women used to go to planning centers to be prescribed the contraceptive pill because they did not want to have more children than they already had, today this has completely changed.

If women have a maternal desire, they should fulfill it before the age of 35 or, failing that, if they are not sure or if they are starting a professional life and want to postpone it, they should preserve themselves, save their eggs, to use them later, since at the age they want to be mothers, physiologically, they can no longer do so.

Males have a factory in their testicles so that every 3 months they have renewed the entire sperm population. On the contrary, women have a warehouse and this warehouse is depleting. All women are born with an endowment, a quantity of oocytes, and we will use them up as soon as we have our first menstruation. Logically, as we get older, that is to say, from the age of 35 onwards, this begins to diminish in quality, from the age of 37 onwards it is much more accentuated and from the age of 40 onwards much more, which makes it very difficult to become pregnant in a natural way.

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But at the same time this does not mean that a 30 year old girl does not have any problem, since the ovarian reserve of each one is totally individual. A 30-year-old girl who does not have an ovarian reserve problem is probably taking very few risks by postponing motherhood, however, a 30-year-old girl who has a low ovarian reserve should already consider and plan what she is going to do to fulfill her desire a few years later.

Is fertility preservation suitable for both sexes, and what techniques are used in each case?

Logically, fertility preservation can be performed by both men and women. The difference is that a male only has to abstain from sex for a few days, the semen sample is collected and processed in the laboratory so that the sperm are separated and joined with cryoprotectants. The cryoprotectants help the sperm not to be injured when frozen at 196 degrees below zero, and it is preserved in straws that can be kept for years and years and years without altering its quality.

For women it is a little more complicated, but it is still something that we do routinely and for us it is simple. There is an ovarian stimulation, because logically we want to take advantage of the entire litter of eggs of that month, which gives the same hormones that are naturally present in ovulation but in slightly higher doses, so that all of them grow and not just one of the candidate eggs. Once we have them, we have to aspirate them from the ovary vaginally under ultrasound control in the operating room, because it is performed under sedation. Once we have these oocytes in the laboratory, the ones that are really useful are separated, which are the mature ones, and a process is also followed with cryoprotectants in order to avoid the formation of crystals inside the oocyte that could damage it during the freezing process at 196 degrees below zero. This process is called vitrification. It is also preserved for years and years maintaining its characteristics perfectly.

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Up to what age is it possible to have children after having preserved fertility?

According to the recommendations of the Spanish Fertility Society, assisted reproduction treatments are allowed or recommended up to the age of 50, since after that age there are risks associated with age, both for the pregnant woman, that is, for the mother, and for the fetuses during pregnancy.

Fertility preservation in cancer patients

This is a very important issue that we should all be aware of, both primary care physicians and oncologists, since patients diagnosed with cancer have time to preserve their fertility. Their sperm and eggs can be kept frozen until the cancer is cured. But we need patients, at the moment when it is suspected or diagnosed, to go immediately to a reproduction center to be able to do it.

It is fundamental because in many cases when the patient comes, he/she comes already without time to be able to prepare a cycle. This is because for fertility preservation in a woman we need ovarian stimulation, we need about 15 days, in a man it is immediate but not in a woman, so we need time and precisely time is what these patients do not have.

For more information about assisted reproduction contact a specialist.