The Fertility Center | Blog

Cryopreservation and fertility

By Dr. Jesús Alberto Félix Atondo

Egg and sperm cryopreservation is an alternative that has become increasingly common for people undergoing definitive birth control treatment (a fallopian tube ligation, or a vasectomy) but who wish to have children at some point in their life or, in people affected by an oncological condition and whose treatment has gonadotoxic side effects that can cause infertility.

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What is cryopreservation?

It is a procedure to preserve the patient´s fertility by vitrifying or freezing the gametes, either from the man or the woman for future use, that is, the ovules or sperm. Cryopreservation is recommended when motherhood or fatherhood must be postponed for a very distant future, whether for natural, social or pathological reasons. For example, a man who does not want children and who decides to have a vasectomy can preserve a sperm sample to use in 10 or 15 years (or whenever he wants) to have children.

The most common reason why people seek cryopreservation is due to the diagnosis of oncological or autoimmune diseases, since during treatment they could lose the possibility of having children as their gametes are damaged.
 

How it is performed?

The patient must go to a fertility specialist for a previous treatment in order to prepare the eggs and sperm. The men will leave a sperm sample collected by masturbation in the clinic, and later they will be dehydrated to remove the water, since it can form crystals.

In the case of women, treatment is provided to stimulate the production of ovarian follicles in order to make them mature and extract them by puncture under local anesthesia. After extraction, the ovules are dehydrated to prevent the formation of crystals.

In both cases, after dehydration, the sample is placed in liquid nitrogen at -196°C to vitrify them in a matter of seconds, maintaining their qualities for several years.
 

When should it be done?

Cryopreservation is performed in reproductive age patients and when their gametes are sufficiently mature, that is, between 18 and 38 years in women. If you opt for this procedure due to an oncological disease, it is very important to do it before starting treatment, such as chemotherapy, radiotherapy or surgery involving the reproductive system.

In addition, prior to the procedure, an analysis of the semen sample of men, or of the ovarian reserve of women, is carried out to ensure that there are no infectious diseases, that they are samples of good quality and without defects.
 

Who can NOT cryopreserve their gametes?

There are cases in which cryopreservation is not recommended, such as pre pubertal patients, who cannot produce mature gametes due to their age.
 

Why is cryopreservation recommended for cancer?

In many cases, cancer treatment carries increased risks of interfering with a patient’s reproductive ability and affecting their ability to conceive. In general, the risk of infertility after treatment varies depending on:

  • The patient´s age and development stage.
  • Type of cancer
  • Administered treatment (immunotherapy, stem cell transplant, hormone therapy, physical therapy, or radiation therapy).
  • Treatment dose
  • Type of surgery and its extent.

However, some types of cancer require surgery to remove a tumor that is in or near a reproductive organ, such as the fallopian tube, cervix, or testicles, as in the case of a tumor in the abdomen, colon, rectum, or anus. Even some tumors that appear in the nervous system, such as the spinal cord or the brain, can also affect fertility.

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In women, breast cancer and other cancers require surgeries that can cause scarring or adhesions in or around the reproductive organs. These adhesions block the ovaries, fallopian tubes, or uterus and prevent mature eggs from being fertilized by sperm.

For their part, radiation treatments that use high energy beams to destroy cancer cells can damage reproductive organs when they are directed at the pelvis or abdomen. In women, when radiation is directed into the vagina, the ovaries absorb a large amount of radiation, which can cause early menopause and thus infertility.

Chemotherapy, on the other hand, works by killing rapidly dividing cells in the body, and the oocytes (cells produced in the ovaries) also divide very rapidly, so they are affected by chemo, causing a women enter early menopause. Now, there are drugs associated with a high risk of infertility when used in very high doses, such as bulsufan, carmustine or procarbizine, to name a few; other medications have less risk, such as bleomycin, cytarabine, epirubicin, among others.

It is important to talk with the oncologist about the consequences of cancer treatment and the risk they cause to fertility.
 

Can ovarian tissue be cryopreserved?

In some types of cancer, where radiation has to be directed through the vagina (such as a vaginal tumor), the ovarian tissue can be cryopreserved for future reimplantation.

If you are thinking about cryopreservation to have children at some point in your life, we invite you to contact us. At Fertility Center we will advise you so that you can make the best decision for your personal situation. Write to us through your contact form where we will gladly assist you!
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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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