Fertility Preservation Options for Individuals
The most effective fertility preservation methods are sperm cryopreservation for males and embryo or oocyte cryopreservation for females, which should be discussed and initiated as early as possible before any potentially fertility-compromising treatments begin. 1
Fertility Preservation for Males
Established Methods
- Sperm cryopreservation is the only established and effective method for fertility preservation in post-pubertal males and should be offered before initiation of any potentially gonadotoxic treatment 1
- Collection should occur before treatment starts, as even a single treatment session can compromise sperm quality and DNA integrity 1
- Even with limited sperm samples, future fertility may still be preserved through intracytoplasmic sperm injection (ICSI) 1
- Banking multiple samples is recommended when possible to maximize future fertility options 1
Experimental Methods
- For pre-pubertal boys, testicular tissue cryopreservation is recommended but should be performed only as part of clinical trials or approved experimental protocols 1
- Testicular tissue transplantation techniques are still being developed and have not yet been tested for safe clinical use in humans 1
Important Considerations
- Hormonal therapy for gonadoprotection in men is not effective and should not be recommended 1
- Patients should be referred to reproductive specialists as early as possible to maximize preservation options 1
- Psychological counseling should be offered, particularly when moderate to severe distress about potential infertility is present 1
Fertility Preservation for Females
Established Methods
- Embryo cryopreservation is a well-established method with good success rates but requires a male partner or donor sperm 1
- Oocyte cryopreservation (vitrification) is now considered a first-line method and is particularly suitable for women without a partner or those with religious/ethical objections to embryo freezing 1
- Modern ovarian stimulation protocols allow for cycle-independent timing, reducing delays in cancer treatment 1
- For women requiring pelvic radiation, ovarian transposition (oophoropexy) can be offered, though patients should be aware this technique is not always successful due to radiation scatter 1
Emerging Methods
- Ovarian tissue cryopreservation and subsequent transplantation is showing promising results with restoration of ovarian function and spontaneous pregnancies 1
- This approach is particularly valuable for young women with good ovarian reserve who have less than one week until chemotherapy begins 2
Special Considerations
- For women with estrogen-sensitive cancers, aromatase inhibitor-based stimulation protocols can be used to minimize potential risks 1
- Conservative gynecologic surgery approaches may preserve fertility in early-stage gynecologic cancers 1
- GnRH agonists may reduce the risk of premature ovarian failure by up to 50%, though evidence suggests this effect may not be long-lasting 2
Timing and Referral
- Fertility preservation discussions should occur as early as possible before treatment starts 1
- Early referral to reproductive specialists is crucial, especially for females, as some preservation methods are time-sensitive 1
- Follow-up discussions about fertility should occur after treatment completion 1
- All discussions about fertility preservation options should be documented in the medical record 1
Special Populations
- Pre-pubertal children have more limited options, with tissue cryopreservation being the only feasible approach 1, 3
- Women over 35 years of age should be counseled about lower success rates (approximately 30% chance of childbirth per stimulation cycle compared to 40% for women under 35) 4
- Non-medical fertility preservation ("social freezing") is becoming more common but carries additional ethical considerations and potential health risks related to advanced maternal age 4
Common Pitfalls to Avoid
- Delaying fertility preservation discussions until after treatment has started significantly reduces options 1
- Assuming fertility preservation will delay necessary medical treatment—modern protocols can often accommodate urgent treatment timelines 1
- Relying solely on GnRH agonists for fertility preservation in women—these should not be the only method used 1, 2
- Failing to consider the psychological impact of potential infertility, which can significantly affect quality of life 1, 5
Fertility preservation techniques continue to evolve rapidly, and international registries tracking outcomes are strongly recommended to improve future counseling and treatment options 1.