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Fertility Preservation for Oncology or Medical Reasons
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Some patients are diagnosed with an illness before they have had the chance to start or complete their family. Unfortunately, infertility is a possible side effect of a variety of treatments, most commonly cancer treatment. As a result, many patients may want to consider the option of preserving their fertility through gamete (egg or sperm) or embryo freezing before starting treatment.
Fertility preservation options are often limited for patients who have already started treatment. To preserve the full range of options, fertility issues should be discussed as early as possible when planning any sort of potentially fertility-compromising treatment. At the Centre for Fertility and Reproductive Health, we expedite referrals for males in the oncology sperm banking program, and for females wanting to receive a medical consultation to discuss their medical and cancer-associated fertility risks and fertility preservation options.
We encourage male and female cancer patients to access Fertile Future’s Power of Hope program which provides financial assistance to qualifying cancer patients, to see if you are eligible.
Please note, at this time, the Centre for Fertility and Reproductive Health does not offer egg freezing for women who want to delay childbearing for non-medical reasons.
Referral Form
Download the Oncology Sperm Banking referral form to give to your family physician (195 KB pdf)
Oncology Tissue & Sperm Bank
Sperm banking is the process of freezing and storing sperm for later use with Assisted Reproductive Technologies (ART). The first baby born using frozen sperm and artificial insemination was in 1953.
Why Bank Sperm?
There are many reasons to bank sperm. One of the most important reasons is to preserve reproductive capacity in men who will be undergoing cancer treatment. Surgery, chemotherapy, radiation and cancer drugs may diminish sperm quality and quantity, or permanently prevent sperm formation or ejaculation.
Process
It is recommended that you do not ejaculate or have intercourse for 2 – 3 days prior to collecting the sperm specimen, unless otherwise instructed by your physician. The sample must be collected by masturbation in a sterile container. No gels, cream, saliva or lubricants can be used during the sperm collection, as they may harm sperm motility (the ability of the sperm to move properly). A private collection room is provided in our clinic. When the lab receives your sample, the sperm cells are mixed with a substance called a cryoprotectant that reduces cellular injury, and the sample is then frozen. Once frozen at an extremely low temperature, the sperm are stored in liquid nitrogen at -196° C. Sperm frozen in this manner can be stored indefinitely.
Future Use
When you have decided that it is time to start your family using your banked sperm, the frozen sperm cells will be thawed and used, through treatments such as intrauterine insemination (IUI) and in-vitro fertilization (IVF). Despite sophisticated technology, sperm banking is not perfect. On average, only 40-60% of the viable sperm survive the freezing and thawing process. Therefore, the success rates of pregnancy cannot be guaranteed. However, newer techniques, such as intracytoplasmic sperm injection (ICSI), may allow fertilization to occur even with compromised sperm samples. Successful pregnancy has been achieved with sperm stored for more than 10 years.
Referral Form
Download the Mount Sinai Centre for Fertility and Reproductive Health Referral Form to give to your family physician (37 KB pdf )
Ovarian Stimulation with In Vitro Fertilization (IVF) and Cryopreservation (Freezing)
Options for preserving fertility diminish rapidly with many treatment protocols. Thus, decisions about fertility preservation must be made relatively quickly following diagnosis of an illness.
Ovarian stimulation with or without in-vitro fertilization (IVF) is a time-sensitive procedure that must synchronize with the menstrual cycle. Fertility treatment requires at least 2 weeks from the onset of menstruation. Treatment begins within the first three days of a menstrual cycle and involves medication to stimulate the ovaries to produce multiple follicles. Follicles are sacs of fluid that contain an egg. Stimulation medication is usually taken for 10-12 days, and is then followed by the egg retrieval (harvesting) procedure.
For women with breast cancer, adding a medication called letrozole to the stimulation medication may help block estrogen from being able to stimulate breast cancer cells. So far, studies do not show that ovarian stimulation treatment or pregnancy after breast cancer causes cancer recurrence.
Once eggs are retrieved, they can be frozen as oocytes (unfertilized eggs), or embryos (eggs fertilized with sperm). Donor sperm from a sperm bank can be used to create embryos for women who do not have a partner. Frozen embryos and oocytes can be stored indefinitely.
Embryo versus Oocyte Cryopreservation
With respect to cryopreservation and storage, embryos survive the freezing and thawing process better than individual eggs (oocytes), so they have a much better chance of creating a successful pregnancy. In addition, oocyte cryopreservation is currently considered experimental. As such, statistical outcomes, such as live births per frozen oocyte, cannot be accurately predicted at this time. Preliminary assessment indicates that one would need to freeze at least 14-20 oocytes to possibly achieve a successful live birth. Given the limited window of time to complete an ovarian stimulation cycle prior to initiating treatment, most women are only able to undergo the process once, and thus may not be able to obtain this number of oocytes.
Why Cryopreserve?
There are many reasons to cryopreserve embryos or oocytes. Surgery, chemotherapy, radiation and cancer drugs may diminish ovarian function or cause reproductive aging and, in some cases, permanent infertility. One of the most important reasons to cryopreserve is to preserve reproductive capacity in women who may be at risk of infertility due to certain treatments.
Future Use
When you have decided that it is time to start your family using your frozen oocytes or embryos, one of our physicians will meet with you to discuss your options and determine a plan. On average, 85% of embryos survive the freezing and thawing process. Although subsequent fertility cannot be guaranteed, many people who have undergone fertility-compromising treatments are able to achieve a successful pregnancy through the use of assisted reproductive technologies (ART).