Fertility Preservation

It is a novel effort to preserve ovarian functions of women in whom cancer is zeopardizing their fertility.

Indications

Medical: 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.

Social : 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.

Methods:

 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.This procedure is done at our centre.

 Transposition of the ovaries from the site of radiotherapy to save from damage.

 Freezing of ovarian tissue.

 GnRH agonists, they suppress the ovaries and thus reduce their sensitivity to cancerous cells. This therapy is still in trial phase and the protective effect of GnRH-a may not be sufficient in the case of more prolonged treatments and higher doses of chemotherapy.

 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.