When Parents magazine wrote about 13 female celebrities who delivered babies after age 40, it was more than a story about the lifestyles of the rich and famous. Fertility preservation is increasingly recognized as an option for individuals or couples who want to be parents in the future. For example, Facebook, Apple and Google announced coverage for young female employees who want to store eggs for the future.
I work in a reproductive clinic and as a genetic counselor, I talk with individuals and couples about their risk for disease and also their hopes for a future family. For some, the greatest concern is making sure their future children don’t inherit a genetic disease or condition. For others, the concern may be life events that threaten fertility, or worries whether postponing a family because of financial or other reasons will threaten their ability to have a child later. For example, the chance for having a baby significantly decreases with age or after certain medical treatments like chemotherapy.
What is “fertility preservation” and why would women consider it?
Fertility preservation is the storing of eggs, sperm, embryos or other reproductive tissue for use in the future. It is important to point out that this is not a guaranteed insurance policy. Storing reproductive tissue does increase the possibility that a woman can have a healthy biological child in the future, but there is a chance it may not work. Still, the process provides options for the future. There are several fertility choices for females:
- In vitro fertilization (IVF) is the most common option. In this case, eggs are retrieved and fertilized with sperm prior to being frozen. Frozen embryos have relatively high success rates with modern freezing procedures. A major advantage of IVF is that an embryo can be tested to see if it has the correct number or chromosomes, but does require that the biological father is chosen. In some cases, more than one IVF cycle may need to be performed to have sufficient embryos for future transfer.
- Oocyte cryopreservation is similar to IVF in that the eggs – or oocytes – are retrieved. Unlike IVF, the eggs are then frozen before fertilization. Recent studies have shown that pregnancy rates are nearly identical when frozen oocytes are later fertilized when compared to fresh eggs used during IVF. One major benefit of this choice is that if a partner is not present at the time of freezing, it preserves the opportunity to involve a future partner at a later date.
- Freezing ovarian tissue is where small portions of the ovary are removed, frozen, then later replaced. This option is still considered experimental, but the major benefits of ovarian tissue freezing are that upon replacing the tissue, it may be possible to achieve pregnancy without in vitro fertilization and it can restore hormonal functioning.
The benefits and limitation of each of these options are too extensive for the purposes of this post, but they are choices you may hear about if you’re considering fertility preservation. There is often a lot of confusion about what is available and why to choose one option over the other. The best approach to figure out which option is best for you is to speak with a team of experts. A reproductive endocrinologist would help you to better understand the medical aspects of fertility preservation while a genetic counselor could talk about role that genetics plays in making the best decision for you and your future family.
Who should consider fertility preservation?
There are many reasons people in different stages of life and situations may consider fertility preservation. All men and women who have a new diagnosis of cancer and are of reproductive age should be offered fertility preservation prior to proceeding with treatment. In most cases, it is best to visit with a reproductive endocrinologist to talk through the various options and tailor a plan that best suits your needs. This likely will not significantly delay your cancer treatment.
Many women or couples who are in their mid to upper 30s are now considering IVF with genetic testing to store embryos for the future. Genetic testing helps doctors identify the “normal” embryos to store so that couples can use them to conceive pregnancies often well into their 40s and maybe early 50s. This is a complicated option that I, as a genetic counselor, would help guide you through.
More recently, younger women who want to delay childbearing are considering fertility preservation in the hopes to have more options when they are older. While fertility preservation is not a guarantee, it does give some women peace of mind for the future when they are ready to start a family.
Young men and women with genetic conditions could also benefit from fertility preservation. For some genetic conditions, fertility will decline dramatically with age. If you were diagnosed with a genetic condition or a gene mutation, I encourage you to speak with a genetic counselor about the option of fertility preservation.
Are there drawbacks?
The cost of storing eggs and embryos can be more than $10,000. Therefore, this isn’t an option for everyone. But for many young people with cancer, there may be options for financial assistance. For example, Maryland recently became the third state to pass a bill that requires certain types of insurance to cover the costs of fertility preservation in young people with cancer.
In addition, it’s been reported that some individuals who did fertility preservation later regretted going through with it. Therefore, it is very important to discuss the long-term benefits and concerns before proceeding.
Next Steps
If you have questions about your future fertility, please consider speaking with your healthcare provider or genetic counselor. In many cases, they will refer you to a reproductive specialist who will help guide you through the process. If you would like to learn more or find a specialist yourself, please visit ReproductiveFacts.org.
In addition, you may also benefit from visiting with a genetic counselor who specializes in reproductive genetics. A genetic counselor can walk you through family history and age-related risks. You will also discuss testing options for both you, your partner and potentially an embryo. To find a reproductive genetic counselor, please visit FindaGeneticCounselor.com.
Jay Flanagan, MS, CGC, is a preconception and prenatal expert for the National Society of Genetic Counselors and is a genetic counselor at Sanford Health in Sioux Falls, South Dakota.
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