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Preservation of Fertility

Techniques for preserving fertility offer women the possibility of postponing motherhood if they wish to do so or who have cancer.

Preservation of Fertility

RECOMMENDATIONS:

  • Patients at risk of losing their ovarian function: women who have been diagnosed with cancer who are going to be treated with chemotherapy or radiotherapy, autoimmune diseases which require chemotherapy, bone marrow transplants, and women at risk of needing repeated ovarian surgery, for example to treat endometriosis.
  • When there is no medical indication, or for “social” reasons: women who decide to postpone motherhood for various reasons, or because their financial or work circumstances prevent them from having a child.

RESULTS

90% of patients who undergo an assisted reproduction treatment at IVI become pregnant.

TECHNOLOGY

IVI is a pioneer in the latest assisted reproduction technology in order to present the best results.

CARE

97% of our patients recommend IVI.
IVI provides personalised care and support during all stages of treatment.

PRICE/QUALITY

We are not the most expensive choice. We offer the most treatment options in order to achieve the best results.

TECHNIQUES FOR PRESERVING FERTILITY AT IVI

The following techniques are offered by IVI for the purpose of preserving fertility

Preserva

Vitrification of Oocytes:

The vitrification of oocytes allows the mature eggs obtained following ovarian stimulation to be cryopreserved so that they can be used at a later date, when the patient decides she is ready, with the same prognosis as at the point when they were vitrified. Due to the fact that ice crystals do not form, oocyte survival rates are high, allowing motherhood to be postponed with reasonable guarantees of success.

Preserva

Freezing of the ovarian cortex

Cryopreservation of the ovarian cortex is another technique used in the preservation of fertility through which various births have already been achieved around the world. This technique would enable ovarian function to be restored, meaning that spontaneous pregnancies could even be achieved, and in addition, due to having normal levels of hormones, the secondary effects of an early menopause (osteoporosis, hot flushes, and cardiovascular problems) would be avoided.

This could be used with:

  • Oncology patients who are going to be given chemotherapy or radiotherapy, or in any other situation in which this might be recommended.
  • The method of choice for girls who have not yet reached puberty, although it is also performed in adult women, and it can, furthermore, be made compatible with the vitrification of oocytes if there is time for carrying out both techniques.
  • Patients who have cancer and who need to start chemotherapy immediately, with no chance of waiting for the process of ovarian stimulation, or in cases in which such stimulation is contra-indicated.
Preserva

Ovarian transposition (oophoropexy):

Transposition of the ovaries is a technique for preserving fertility that consists of removing the ovaries from the field of irradiation in order to avoid their direct exposure to radiotherapy, and thus prevent the considerable damage that this can cause to the gonads when these are within the field of radiation.
Transposing the ovaries has certain specific indications and can be compatible with other techniques. Depending on the field of radiation, they can be secured in the upper part of the paracolic gutters or behind the uterus.

This provides protection of the gonads in up to 60% of cases, and preserves ovarian function in around 83-88% of cases, depending on whether the surgical method used is laparotomy or laparoscopy.

Some of the possible complications are: vascular lesions, Fallopian tube infarction and the formation of cysts.

PRESERVATION OF FERTILITY AT IVI: CANCER PATIENTS

At IVI we contribute to improving the self-esteem of patients suffering from cancer through the possibilities that the various assisted reproduction techniques can offer them. The improvements to oncology treatments and the efficiency of early screening programmes have led to the recovery and survival rates for some tumours increasing significantly. This increased life expectancy has caused us to turn our attention to the secondary effects of treatments using chemotherapy and radiotherapy, and in this respect, ovarian function and preserving fertility are two of the aspects which concern female cancer patients the most. For this reason, our professionals work hard to offer these patients possibilities in terms of reproduction.
The effects of cancer on fertility:

  • The ovarian cortex contains a limited number of follicles, which gradually decreases throughout a woman’s life as a result of ovulation and especially due to atresia. Radiotherapy and chemotherapy speed up the natural reduction of the number of follicles and prevent these from maturing. This, together with the fact that the ovaries cannot regenerate, can lead to premature ovarian failure.
  • The number of primordial follicles which survive following exposure to chemotherapy depends on many different factors such as age, the type of cancer, the agent used (chemotherapy or radiotherapy), the dose and the number of cycles.
  • Not everybody will lose their reproductive capacity, but continuing to menstruate is not synonymous with fertility. Although ovarian function may be recovered, the quality of oocytes may be suboptimal.
  • For pregnant women who had cancer during their childhood, a higher rate of miscarriage has been observed, as well as a greater incidence of intrauterine growth retardation and of premature birth.
  • Premature ovarian failure, in addition to putting an end to reproductive function, can also lead in the long term to vasomotor, skeletal and cardiovascular problems, as a result of the cessation of hormonal function.

There are currently several different options and treatments available to cancer patients for maintaining their fertility:

  • Vitrification of ovocytes
  • Freezing of the ovarian tissue
  • Transposition of the ovaries
  • Medical protection of the gonads (GnRH agonists): this could prevent follicles from reaching their sensitivity threshold to chemotherapy by suppressing granulosa cells. In tests done on rats treated with GnRH-a, inhibition of the recruitment process of small follicles from the reserve and their development into large follicles was demonstrated, which would subsequently proceed to development and atresia. The protective effect of GnRH-a may not be sufficient in the case of more prolonged treatments and higher doses of chemotherapy, in contrast to the shorter protocols used with animals.
    Although its use is very controversial, the most recent randomised prospective studies seem to show it to be beneficial. However, its use should be restricted to controlled clinical trials. It has no applications for men..
  • In vitro maturation of oocytes (IVM): this consists of recovering immature oocytes from small antral follicles which have not been stimulated or which have only been minimally stimulated, and their cultivation in a suitable medium until they reach maturity. In this way it is possible to avoid ovarian stimulation, and as a result it is a potential alternative to a standard IVF cycle. It may be useful in patients for whom, for one reason or another, it is in their interests to avoid ovarian stimulation, such as patients with hormone-dependent tumours.

Nowadays, IVM should be considered as a complementary technique to ovarian stimulation, useful in cases where there is no time to carry out ovarian stimulation, or when immature oocytes are obtained following stimulation, and as a complement to obtaining ovarian tissue.

These treatments targeting the preservation of fertility for cancer patients cannot guarantee that pregnancy will be achieved in the future, but they do mean that it will at least be possibly to try.

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The effects of cancer on fertility:

  • The ovarian cortex contains a limited number of follicles, which gradually decreases throughout a woman’s life as a result of ovulation and especially due to atresia. Radiotherapy and chemotherapy speed up the natural reduction of the number of follicles and prevent these from maturing. This, together with the fact that the ovaries cannot regenerate, can lead to premature ovarian failure.
  • The number of primordial follicles which survive following exposure to chemotherapy depends on many different factors such as age, the type of cancer, the agent used (chemotherapy or radiotherapy), the dose and the number of cycles.
  • Not everybody will lose their reproductive capacity, but continuing to menstruate is not synonymous with fertility. Although ovarian function may be recovered, the quality of oocytes may be suboptimal.
  • For pregnant women who had cancer during their childhood, a higher rate of miscarriage has been observed, as well as a greater incidence of intrauterine growth retardation and of premature birth.
  • Premature ovarian failure, in addition to putting an end to reproductive function, can also lead in the long term to vasomotor, skeletal and cardiovascular problems, as a result of the cessation of hormonal function.

There are currently several different options and treatments available to cancer patients for maintaining their fertility:

  • Vitrification of ovocytes
  • Freezing of the ovarian tissue
  • Transposition of the ovaries
  • Medical protection of the gonads (GnRH agonists): this could prevent follicles from reaching their sensitivity threshold to chemotherapy by suppressing granulosa cells. In tests done on rats treated with GnRH-a, inhibition of the recruitment process of small follicles from the reserve and their development into large follicles was demonstrated, which would subsequently proceed to development and atresia. The protective effect of GnRH-a may not be sufficient in the case of more prolonged treatments and higher doses of chemotherapy, in contrast to the shorter protocols used with animals.
    Although its use is very controversial, the most recent randomised prospective studies seem to show it to be beneficial. However, its use should be restricted to controlled clinical trials. It has no applications for men..
  • In vitro maturation of oocytes (IVM): this consists of recovering immature oocytes from small antral follicles which have not been stimulated or which have only been minimally stimulated, and their cultivation in a suitable medium until they reach maturity. In this way it is possible to avoid ovarian stimulation, and as a result it is a potential alternative to a standard IVF cycle. It may be useful in patients for whom, for one reason or another, it is in their interests to avoid ovarian stimulation, such as patients with hormone-dependent tumours.

Nowadays, IVM should be considered as a complementary technique to ovarian stimulation, useful in cases where there is no time to carry out ovarian stimulation, or when immature oocytes are obtained following stimulation, and as a complement to obtaining ovarian tissue.

These treatments targeting the preservation of fertility for cancer patients cannot guarantee that pregnancy will be achieved in the future, but they do mean that it will at least be possibly to try.

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