Preservation of female fertility

For many reasons, the number of births in Western societies is increasingly falling. Fertility preservation, which aims to reverse this trend, has two main indications.

Delaying the age of childbearing

In Spain, the incorporation of women into the world of work, among other factors, has led to a postponement of the age at which they consider becoming mothers. For this reason, it is becoming increasingly common for many women to visit a specialist in Assisted Reproduction to vitrify their eggs in order to have a high probability of pregnancy when, at a later date, they consider motherhood.

In the last few months a social debate has arisen due to the fact that the companies Apple and Facebook offer egg freezing to their employees. In the U.S., this procedure costs about $20,000 and these companies subsidize it because, they say, it allows them to freeze eggs during their fertile years, which also coincide with their most productive professional period.

A 45-year-old woman can become a mother with an egg that could have been extracted when she was 30 years old. This makes it possible to delay the age of childbearing while maintaining the chances of becoming pregnant at the age at which the oocyte freezing takes place.

In Europe this indication is not as widespread as in the USA, but it is a subject that is beginning to be discussed and it is an indication, that of vitrifying the eggs, which is progressively spreading in our society as well.

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It is a technique which, in reality, would be more indicated in our environment, since in Europe the social custom means that the age at which one wants to become a mother is increasingly delayed. This causes the ovarian reserve to drop to such an extent that when a woman considers motherhood, she sometimes has great difficulty in conceiving due to the aforementioned reason.

Therefore, women who clearly wish to delay childbearing until they are close to 40 years of age, or even later, should consider freezing eggs through the vitrification method. The most ideal time would be between 30 and 35 years of age.

Oncology patient

Cancer can occur at any stage of life. Thus, for example, there are different types of pediatric cancer, such as neuroblastoma, leukemia, tumors in the central nervous system, lymphomas, germ cell tumors and bone tumors, which are the most frequent in childhood.

Between the ages of 40 and 44, women are twice as likely as men to suffer from cancer.

The high survival rate of most oncologic processes in women under 40 years of age makes it necessary that, during the risk-benefit assessment of treatments, information on long-term adverse or secondary effects, especially those related to reproduction, should be clearly stated.

Since most of these pathologies are cured, it is becoming increasingly necessary to develop strategies to preserve fertility in these girls or young adults.

What methods of fertility preservation are available?

  • Ovarian cortex freezing. This is a relatively simple surgical technique, which allows the cortex of the ovaries (where the follicles are located) to be removed and cryopreserved. This method is usually performed in cases of prepubertal patients. There is some experience with this technique, but few centers have the permission of the health authorities.
  • Administration of GnRH analogs. These drugs are intended to protect the ovary from damage caused by chemotherapy drugs. Although the results are optimistic, there is still much controversy about their usefulness and benefits. They are used when no other method of preservation has been possible, given the urgency that cancer treatment often requires.
  • Oocyte vitrification. This technique consists of ultra-rapid freezing of the gametes and allows a high survival of the eggs after thawing. It is currently the most widely used method. It requires ovarian stimulation in order to achieve the maturation of ovarian follicles that allow the capture of oocytes and their subsequent freezing. For this reason, it is necessary that the establishment of cancer treatment is not imminent. In addition, oocyte vitrification is the method of choice to delay childbearing for social reasons.
  • Embryo vitrification: In this case, what is vitrified are not the eggs but the embryos. For this, the woman must have a stable partner. This method has the same or greater guarantees of success than oocyte vitrification.