Dr. Amselem is a prestigious gynecologist in Barcelona specialized in Human Papilloma Virus, In Vitro Fertilization, Breast Cancer and Ovarian Cyst. In this article he discusses fertility preservation, both for men and women, and in which cases it is performed.
What is fertility preservation?
Fertility preservation is the set of medical actions whose purpose is to postpone the fertility capacity of a person. We know that a woman is born with about 400,000 oocytes, which are the cells capable of giving rise to new life. There are many, but throughout her life a woman ovulates about 400 times, she does not ovulate any more, that is, a woman begins to ovulate around the age of 15 and at 45, more or less, she stops ovulating, so it is 30 years and 12 ovulations a year, and the rest of the oocytes is an excess that nature has given to the woman so that she is capable of fertilizing. The problem is that those cells, those 400,000 oocytes, are at birth and they are cells that are aging over the years, they are stopped, they are on standby, and every year is a year that passes. When they have to wake up to get going, every year they are a little bit older, every year they can cause more failures when they wake up. Today we know that this degree of acceptable fertility reaches a maximum of 35 years of age, from then on they begin to fail more and more, so that by the age of 40 they fail a lot and from the age of 40 onwards the deterioration is very rapid, that is to say that a woman should seek pregnancy before the age of 35, the earlier the better. So the problem is that this is not always possible because of parallel things that make her postpone her maternity. From this fact, from knowing that a woman’s childbearing potential is limited, that from the age of 35 onwards it deteriorates or is lost, this medical activity arises, which is fertility preservation. In 1 cycle a woman produces 1 ovum, each month she produces her ovum, and 1 ovum is not useful for this management. The preservation of fertility consists of medicating it, making it so that instead of 1 egg it produces many, an ideal number is around 10, in 1 single cycle, these oocytes are removed, they are extracted by means of a surgical technique that consists of a puncture under sedation, it is not painful, it is not annoying and the following day the woman can return to her usual work, extract the oocytes, clean them, isolate them, mount them and vitrify them, before they were frozen, now the process has been improved and it has been made more efficient. These vitrified oocytes are preserved and have no limit, that is to say, they can be kept as long as you want, there is no technical limit. When the woman decides that she wants to become pregnant she can use those vitrified oocytes which are those of the age at which they were vitrified, if they were vitrified at the age of 30 she is using very young oocytes, 30 years old even if she is 40, the level of success will be good. If she delayed it a lot and sought vitrification at 37 years of age, the technique is the same but the success will not be the same because the egg is 37 years old. The vitrification technique saves what is there, so the ideal is that the woman who decides to vitrify oocytes, to preserve her fertility, the sooner she does it the better. If she has done it too early, at the age of 30, and it turns out that she wants to get pregnant at the age of 35 and she has a partner, she will not need to use those oocytes, she can have a normal relationship and she can have a pregnancy, but if she does not, she can use oocytes from 5 years ago, for example, the level of success will be much higher. That is what makes that if fertility preservation is well directed, well programmed, the success rate is very high.
Is it only possible in the case of women?
No, fertility preservation is also possible for men. In fact, the use of fertility preservation in men is much more common than in women and with a higher degree of efficacy and results.
In which cases is it recommended?
Fertility preservation in males has basically 2 indications. One is that of the male who has had a vasectomy and wants to preserve the theoretical possibility of keeping his sperm for later use, and the second is in the case of an illness that may affect the gonads, radiotherapies, chemotherapies, etc… In women, fertility preservation was created for oncological problems, women who were going to undergo an oncological process, breast, colon, whatever, and the aim was to preserve that fertility capacity for later use. Today this indication still exists, but the one that is emerging and beginning to be a priority is the social cause, the woman who voluntarily wants to postpone her maternity for work reasons, social reasons, not because of illness but simply because it is not the right time to become pregnant. This is the fundamental cause today of fertility preservation in women.
Fertility preservation in cancer patients
Fertility preservation in women with cancer, oncology, was the primary indication for this technique because, unfortunately, we are seeing more and more young women affected by cancer. Fortunately, these are women who, with appropriate treatment, can be free of the disease at an age when they could still be mothers. For a treatment of this type it is necessary to know that the disease is going to be cured or has the possibility of being cured, that the oncologists give us permission to use hormonal treatments that will not alter the oncology process and that the woman accepts the pros and cons of this technique.