Fertility Preservation Solutions for Female & Male
Why Canberra Fertility Centre?
Australia’s leading experts in Fertility Preservation for 29 years with the very latest cryopreservation technology
Good News! Under the Medicare system cryopreservation of oocytes (eggs) is eligible for benefits similar to those available for conventional IVF. There is no benefit available for cryopreservation of either sperm nor oocytes or cost of ongoing storage.
Preserving Fertility Four Categories 1. 2.
Women Freezing Eggs for medical reasons Women Freezing Eggs/Embryos for social reasons • Waiting for Mr Right • Delaying having a baby • Donating eggs/embryos
3. 4.
Men Freezing Sperm for medical reasons Men Freezing Sperm for social reasons • Waiting for Mrs Right • Delaying insemination • Donating Sperm
For the Woman – Why am I here?
Women and Children •
In the US along with most other Western Nations including Australia the average Age of women’s first birth has increased to an all time high.
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In the US in 2006 1 in 12 first births was at age 25 or greater compared to 1 in 100 in 1970
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The cause of the delay in child bearing is thought to be multifactored stemming from both social and economic factors.
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This delay in attempted child bearing comes at the cost of an increase in age-related infertility.
What is the Biological Clock? • Few topics arouse such anxiety and confusion as the effect of aging on female fertility and ultimately pregnancy. • If defer pregnancy to mid 30s one third will have fertility problems. • If defer pregnancy to 40+ 50% will seek infertility treatment.
Egg Numbers: natural attrition • Fertility starts to decline after age 35: the number of eggs reduces naturally until menopause. The eggs have a predetermined life span that cannot be altered. • Using oral contraceptives does not preserve egg numbers • Unlike sperm there is no new production of fresh healthy eggs in women.
Birth
Puberty
Menopause
• 1-2 million • 100 000 • 100-1000
• 400 eggs are ovulated in a lifetime.
Age: Ovarian Reserve and Egg Quality are not the same
Gonadotoxicity • Ovaries and testes contain cells that are vulnerable to the effects of chemotherapy and radiotherapy • Hormone production and proper maturation of sex cells (sperm and eggs) can be damaged - either temporarily or permanently - by cancer therapies • We refer to such therapies as being “gonadotoxic”
Gonadotoxic Chemotherapy
Fertility Preservation (FP) now a Regular Part of Pre-Treatment Planning • Advances in treatment have meant patients can often expect to live long, fulfilling lives • Evidence suggests fears of pregnancy exacerbating recurrence in hormonally dependent tumors (e.g. breast cancer) not always justified
Effect of Chemotherapy • Chemotherapy produces a “burnout effect” on the ovaries • The eggs progress through maturation and loss much faster than normal • This depletes the pool of remaining eggs so that very few are left after chemo • Even if women resume their periods, the ovarian reserve can be too low to enable pregnancy to occur
Should All Cancer Patients Have FP? • Some patients are too sick • Survival is the most important factor • Financial issues need to be considered • Need to be realistic about prognosis
When to freeze eggs • To what extent does FP increase the probability of having a baby? • At what age should oocytes be cryo preserved? • Is there a financial cost associated with banking oocytes that may never be used?
Optimal Egg Freezing •
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The answer to the first 2 questions was recently addressed in an article appearing in the journal Fertility & Sterility vol 103 June 2015. The authors used a decision tree model to arrive at the following conclusions using a horizon of 7 years.
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For women who require marriage to have a child the optimum age to store oocytes is 35 years.
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For women who are prepared to use donor sperm, or sperm from a nonspousal partner or marriage the optimum age to store oocytes is 37 years.
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The authors have provided access to this model for patients + doctors at the following address www.UNCfertility.com/egg-bankingcalculator Caution: The data used to compile this model is obtained from social statistics in the united States not Australia.
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Optimal Age to Freeze Eggs • This model assumes that stored eggs are only used if natural conception fails. • The model provides a measure of the advantage of freezing eggs over doing nothing. • This is summarized and better explained by referring to the accompanying table calculated for various ages and horizons.
Optimal Egg Freezing
Example of Calculation • Current age: 37 • Horizon : 7 years Would use donor sperm to help conceive without partner.
Preserving fertility starts asap
Why I need IVF • At the moment human eggs can only be successfully used if the eggs are “mature”. • IVF is when eggs are matured in the body using a regime of hormone drugs. • Traditionally they can be removed and fertililised outside the body “traditional IVF” or for FP the eggs can be removed and cryopreserved before fertilisation.
Egg / Embryo Freezing Facts
Egg/Embryo Freezing – The process
Embryo Cryopreservation • Commonest technique employed for cryopreservation. • Woman undergoes an IVF cycle • Two weeks of stimulation medication, then egg collection and fertilization with partner’s sperm • Embryos can be frozen for many years – at day 1 post fertilization stage or up to five days post fertilization • Embryo transfer can be easily arranged once patient has completed treatment and is in remission
Oocycte Vitrification •
The ocyte is the largest cell in the human body, hence it contains the most water.
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Water is enemy No1 in any tissue/cell cryopreservation procedure.
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Water’s thermodynamic properties, namely its property to expand when freezing, hence ice floats, are responsible for internal damage to sensitive biologcial structures in cells.
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Vitrification is a method of freezing cells by forming a vitreous (glass) “solid”.
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This is accomplished by placing the cells/tissue into incredibly small volumes and dropping the temperature at tens of thousands of degrees/minute.
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Vitrification is not a new technology but the successful vitrification of oocytes has only been perfected over the last 5-10 years.
Fewer Oocytes in Oncology Patients • Women with recent cancer diagnoses tend to yield fewer eggs per pickup than age-matched women without cancer • Why this occurs is not clear. • Some evidence that BRCA mutation carriers have inherently LOWER ovarian reserve • Stimulation protocols may be “gentler” • Stress may also contribute
Live Birth Rate (LBR) after Oocyte Vitrification
• Oocytes are more sensitive to cryopreservation than embryos and appear to be more age sensitive in their survival rates. • The best information available on LBR from oocyte vitrification comes from a presentation in 2014 at the European Society for Reproduction Meeting in Munich. • This paper presented outcome data on 40741 vitrified donor oocytes that were thawed into 3446 treatment cycles. • The cumulative live birth rate (CLBR) was presented.
Egg vs Embryo Cryopreservation For & Against • For Embryos – Higher success rates as embryos cryo-preserve more effectively than eggs.
• Against Embryos – Need a partner – If the relationship breaks down need consent of both parties before embryos can be used.
• Example…..
Embryo Cryopreservation For & Against •
In the US Sofia Vergara star of the sitcom “Moden Family” is being sued over the use of 2 frozen embryos created in an IVF procedure in 2013.
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The suit has been brought by her ex-partner Nick Locob to prevent Vergera destroying the embryos
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Court papers allege the couple created the embryos with a plan to eventually have children together.
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This highlights the ethical and legal issues that can arise when embryos are involved.
What does Egg/Embryo Freezing cost? Approximate Out-of-Pocket cost including 5 years Storage
$4500* * Medicare patient
• Fees are dependant upon treatment • Fees Information Booklet available at seminar, from CFC, and also on website www.cfc.net.au • Please ring Merran at Canberra Fertility Centre to discuss fees for your individual treatment PH: 02 6282 5458
Preserving Fertility Four Categories 1. 2.
Women Freezing Eggs for medical reasons Women Freezing Eggs/Embryos for social reasons • Waiting for Mr Right • Delaying having a baby • Donating eggs/embryos
3. 4.
Men Freezing Sperm for medical reasons Men Freezing Sperm for social reasons • Waiting for Mrs Right • Delaying insemination • Donating Sperm
For the Man - Why am I here?
Facts about Sperm • Sperm has been successfully frozen for over 100 years • Easy to obtain • Vast numbers – 3 million per ejaculate • Available anytime within 5 minutes • Average age of 45yrs before decline in quality (DNA fragmentation) • Some evidence of increased risk of ADHD & schezophrenia in offspring of older males.
Sperm Cryopreservation • A widely used method for FP in men with cancer • Several samples collected prechemo, prepared in laboratory and frozen in straws • Sperm can freeze for many years satisfactorily • However, only 10-15% of men return to use their frozen sperm • A large proportion of men recover testicular function in 12-24 months after chemotherapy
Sperm Freezing – The Process
LBR after Sperm Freezing • Human sperm survive cryopreservation comparatively well compared to oocytes. • This is primarily due to the very large numbers of sperm cells and the very low water content in sperm cells. • There is very little information on specific outcomes. • Outcomes from donor sperm programs using cryopreserved sperm show values of 8-20% for IUI and 10-40% for IVF per treatment cycle with female age being the largest determinant of outcome. • There is often enough cryo preserved sperm for many treatment cycles.
What does Freezing Sperm cost? Approximate < $1000 per ejaculate cost including tests analysis and 5 years Storage
• Fees are dependant upon treatment (rates for oncology lower) • Fees Information Booklet available at seminar, from CFC, and also on website www.cfc.net.au • Please ring Merran at Canberra Fertility Centre to discuss fees for your individual treatment PH: 02 6282 5458
Fertility Preservation in Females • The process of gamete collection is significantly complicated, expensive and involves some risk. • It should only be contemplated if you suspect or know that your ovarian reserve/egg quality will be geatly affected over a horizon period of 5-10 years. • A 23 year old woman contemplating marriage and children at age 30 is unlikely to use stored oocytes and would see little benefit however the same woman facing treatment for breast cancer is looking at a loss in ovarian function of 50-70% and would be recommended to store eggs if able.
Fertility Preservation in Males • The process of gamete collection is relatively easy, inexpensive and virtually risk free. • However it should only be contemplated if you suspect or know your sperm count is likely to be adversely affected over a horizon period of 5-10 years. • For males undergoing certain cancer treatments or surgical procedures sperm storage is strongly recommended otherwise there is little advantage to future fertility.
Posthumous use of Gametes • If you are contemplating FP due to a risk to your fertility from cancer treatment. • If the prognosis of survival is poor. • If you want those gametes to be used posthumously then you must provide explicit instructions on your wishes. • We suggest a consultation with a family lawyer and that this wish be explicitly explained in a will.
