Who is the fertility preservation procedure for? What is its purpose?
The preservation of fertility is designed for a woman who is looking to preserve her fertility potential, prior to an expected deterioration in her level of fertility.
A distinction must be made between two different cases:
Preserving fertility for medical reasons
The preservation of fertility for medical reasons is designed for a woman who was diagnosed with cancer, and is about to undergo chemotherapy / radiation therapy which may impair her fertility.
The preservation is carried out in a number of ways: Medication therapy that reduces ovarian sensitivity and vulnerability, freezing eggs / embryos, and even freezing ovarian tissue for the purpose of future implantation.
The preservation method used must be personally adapted to each patient.
It is highly recommended and even necessary during the medical procedures to treat cancer, to consult with a fertility expert on fertility preservation and the various ways to perform the procedure.
Preserving fertility for social reasons
The preservation of fertility for social reasons is designed for women in the ages of 30 and up, who are looking to preserve their fertility potential prior to an expected decline in egg quality.
Usually it is about preserving fertility due to late bachelorhood, and even due to the partner’s severe fertility problem, due to which no sperm cells were found (Azoospermia), in anticipation of future solutions which will enable a successful sperm extraction: repeated searches / operations, fertilization using primal sperm cells (round spermatids), and more.
According to the Ministry of Health’s approval from 2011, any woman between the ages of 30-41 can have a fertility preservation procedure for social reasons, when the law enables to perform up to 4 treatment cycles, or up to the extraction of 20 eggs, the earlier of the two.
However, it will be noted that the procedure is not included in the health package, and it is privately financed, but in some of the health funds and hospitals, it can be done at a discount.
Why is it important to preserve fertility?
Unlike a man, who continues to produce sperm cells throughout his adult life, and age has a relatively small impact on the production of sperm, in a woman, age constitute a significant factor in terms of the quality of eggs produces, when as of the age of 32, begins a certain decline in their quality, which increases from the age of 35.
Having the procedure at a young age, has priority in terms of the number of eggs that can be produced in each treatment (when the younger she is, her body responds better to hormonal stimulation, and the possibility of reaching a large number of eggs in one treatment cycle increases significantly).
However, the main reason is the quality of the eggs:
Many comprehensive studies point to the fact that the percentages of performing a successful fertilization which ends in a normal pregnancy, is very different depending on the woman’s age, when if at the age of 30 there is more than 40% chance per treatment cycle, at the age of 40 and up, the rate is only about 4%-5% only. Also, there is higher risk of giving birth to a child with Down Syndrome and as such, when we are dealing with the eggs of an older woman. These facts are unrelated to the woman’s gynecological environment, such as the state of her uterus, but only to the quality of her eggs.
For this reason, there is high priority for performing fertilization with the eggs of a young woman, whose changes of a successful IVF procedure resulting in a healthy child are considerably higher.
It can be fully and clearly stated, that it is preferable to undergo fertilization with 5 eggs of a 30 year old woman, than with 20 eggs of a 40 year old.
Performing the procedure
The execution of the fertility preservation procedure is similar to the procedure of a normal IVF, up until the reimplantation stage.
The patient undergoes a treatment protocol in which she is administered a combination of injections containing various hormones, some designed to stimulate the ovaries to mature a large number of eggs, and others to prevent spontaneous ovulation prior to the aspiration time, and towards the end of the procedure, she is administered an additional injection to complete the maturation of the eggs for the purpose of aspiration.
The treatment protocol is specifically designed for each patient in accordance with her hormonal profile.
In the next stage, the eggs are extracted under anesthetic, using a special needle connected to a vacuum pump and guided by an ultrasound. This procedure takes about 10-20 minutes, after which the patient remains to recuperate for one to two hours.
How are the eggs preserved?
After the aspiration, the eggs undergo advanced freezing in a glazing process (Vitrification), in which they are frozen in a speedy process inside a preserving solution, which prevents the formation of inter-cellular ice crystals which may impair the quality of the eggs. The frozen eggs are then transferred into a container which contains liquid nitrogen that preserves the eggs at a temperature of minus 196 degrees, and it is possible to store them in this manner for many years. The survival rates of eggs after being frozen are at close to 90%.
From a regulatory stand point, the freeze is for 5 years, when at the end of this terms, the IVF Unit must be requested to continue the freeze.
How to approach the fertility preservation procedure?
First, an appointment with the treating physician must be scheduled. At this meeting, the doctor will review the woman’s medical file, and examine her level of suitability for the procedure.
In the next stage, the doctor will refer the woman to a large number of comprehensive tests, which are divided into several parts: General tests for examining the integrity of the gynecological system (such as a PAP test). Tests to rule out certain health problems. Performing a complete hormonal profile (on the 3-5 day of menstruation) for the purpose of adjusting a precise hormonal stimulation protocol for the patient, and more.
An additional very important test that needs to be performed is the AMH test (ovarian reserve), which provides an indication for the measurement of the woman’s fertility potential.
Supervising the frozen eggs
A religious woman who is interested in religious supervision over the frozen eggs, can obtain the supervision services from various aid organizations for the fertility challenged, such as the ‘Puah Institute’, or The ‘Bonei Olam’ Organization, upon prior arrangement.
Repeat Implantation Failures
The phenomenon of repeat implantation failure (RIF) is relevant to many patients undergoing IVF treatments.
The condition is expressed by the lack of implantation after 3-4 reimplantations of good quality embryos.
So, what do we do?
It is important to thoroughly examine all of the factors responsible for achieving a healthy embryo and obtaining implantation: the eggs, the uterus, the sperm and the embryo, when for each, there are several relevant investigations to be made.
It would often seem, that in the frame of the investigation, they forget to conduct an in-depth examination into the man’s condition, but we must remember, the sperm contributes 50% of the embryo’s genetic material!
Dr. Barak, who specializes in both the woman as well as male fertility, and due to his vast experience, has significant tools for conducting in-depth investigations into repeated implantation failures. Our clinic specializes in the treatment of this phenomenon.