[1] Fertility preservation procedures are indicated when it is predicted that there will be exposure to a cause of infertility, mainly cancer treatment but also ageing, sex reassignment surgery for those who identify as trans and conditions like Polycystic Ovary Syndrome (PCOS) or Primary Ovarian Insufficiency (POI).
Chemotherapy and radiation treatments for cancer and autoimmunity conditions like Lupus[2] and Multiple Sclerosis[3] have the ability to affect reproductive health.
The regimens that threaten ovarian and testicular function are mainly radiation therapy to the pelvic area and some types of chemotherapy.
Chemotherapies with high risk include procarbazine and alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine.
[4] On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluoruracil.
For some patients receiving chemotherapy or radiotherapy, the decrease or loss of reproductive function is temporary; many men and females, however, do not regain fertility after this treatment.
[8] A study indicated that fewer oocytes are recovered from cancer patients wanting to perform embryo preservation when compared with an age-matched control group, but the mean number of zygotes generated appears to be similar.
[11] Fertility preservation, such as ovarian tissue or oocyte cryopreservation, may also be used to prevent infertility, as well as birth defects, associated with advanced maternal age.
Ovarian deficiency causes a reduction in serum oestrogen levels which can lead to infertility, giving a reason for females to seek fertility treatment.
POI can result in a long term risk of serious physical symptoms including bone fragility and heart problems.
[18] According to a meta-analysis performed in 2017, the success rate of reestablishment of ovarian activity was 63.9%,[19] restoring normal fertility and endocrine function.
[20] Strips of cortical ovarian tissue can also be cryopreserved, but it must be re-implanted into the body to allow the encapsulated immature follicles to complete their maturation.
Furthermore, ovarian tissue is fragile under hard freezing conditions and putting it back into the body carries the risk of re-introducing cancerous cells.
[27] Anticoagulant prophylaxis is recommended to be administered only to selected subgroups of females such as those with other risk factors of hypercoagulability or those who do develop early OHSS.
[26] Transgender men should be given the opportunity to have counselling on preserving their fertility before undergoing any type of medical transition, otherwise they may be unable to have biological children in the future.
[29] Some fertility options in adults trans men present problems as they may require stopping hormone treatment for around 3 months to carry out the procedure,[28] as well as multiple transvaginal ultrasounds (a probe entering and scanning the inside of the vagina) - both of which may be distressing for a transgender individual.