When to Consider Fertility Preservation Options

Why might someone want to preserve their fertility? Here are a few possible reasons for the decision.

Personal Preference

The desire to delay childbearing is one reason to pursue fertility preservation. "Many people simply aren't ready to build a family yet because of career demands, financial readiness, not having the right partner, or just needing more time," says Li-Shei Lin, MD, PhD, a board-certified obstetrician-gynecologist and a reproductive endocrinologist at Reproductive Partners Fertility Center in San Diego.

Cancer Treatment

Cancer treatments like chemotherapy and radiation can sometimes damage the reproductive organs. "Preserving fertility before those treatments begin gives patients a chance to protect their ability to have biological children in the future," says Dr. Lin.

• Chemotherapy kills the cells that produce the hormones needed to release eggs from the ovaries.
• Radiation therapy can damage reproductive organs like the uterus, cervix, and ovaries.
• Hormone therapy may lead to early menopause.
• Surgery on the uterus or other reproductive organs may make it difficult or impossible to conceive and carry a baby.

"For individuals facing a life-threatening diagnosis who need to pursue treatment that could have the unintended consequence of infertility, an option is to do upfront fertility preservation before they get chemotherapy or medication or radiation, to try to bank materials that will never be exposed to these medical interventions," says Jessica Walter, MD, a reproductive endocrinology and infertility specialist at Northwestern Medicine in Chicago. After treatment ends, they can use those materials to try to conceive.

Reproductive Conditions

Autoimmune Diseases

• Lupus
• Autoimmune thyroiditis, such as Hashimoto’s
• Type 1 diabetes
• Celiac disease
• Myasthenia gravis

Transgender Care

The timing of fertility preservation is important. How soon to start treatment depends on your gender and situation.

When Should You Freeze Your Eggs?

"Biologically speaking, the earlier the better," says Lin. The quantity and quality of eggs start to decline in a woman's thirties, and drop more steeply after age 35.

When Should You Freeze Sperm?

When Should You Freeze Embryos?

Going through surgery and then freezing embryos is a big step, says Dr. Walter. It's important to carefully consider the decision when time is available. But the decision about when to freeze eggs or embryos may not be up to you. People who have a serious medical condition like cancer and want to conceive will need to undergo fertility preservation before they start any treatment that might damage their reproductive organs.

"Today, many oncologists include fertility preservation as part of the initial consultation," says Lin. "Ideally, we begin the egg or embryo freezing process as soon as possible after diagnosis. With newer protocols, we can often start treatment within days and complete the egg retrieval process in as little as two weeks."

If there isn't enough time to do fertility preservation before treatment, there may still be things a specialist can do afterward to improve the chance of starting a family, says Walter.

Your doctor will recommend fertility preservation options depending on your gender, age, and reason for wanting to preserve your fertility.

Egg Freezing

Sperm Freezing

Embryo Freezing

Whether to freeze eggs or sperm, or to create embryos and then freeze them, depends on the situation and family-building goals. "If you have an individual who's in a long-term relationship or who is anticipating starting a family very soon and has a partner or is planning to use donor sperm, it can be more straightforward to freeze embryos," says Walter.

Ovarian or Testicular Tissue Freezing

Ovarian Transposition

If you're interested in fertility preservation, start the process by seeing a reproductive endocrinologist — a specialist who is trained in techniques like ovarian stimulation, egg removal, and IVF. A gynecologist or gynecologic oncologist can perform ovarian transposition. Ovarian tissue freezing may be done by a pediatric surgeon in a child or teen, or by a reproductive endocrinologist in an adult, says Walter.

If you've been diagnosed with cancer, ask your oncologist for a referral. "Many cancer centers now have a network of fertility specialists they trust and collaborate with," says Lin. You can also check the website of a professional organization like the American Society for Reproductive Medicine (ASRM) or the Society for Assisted Reproductive Technology (SART) to locate a fertility center near you.

To ensure the best outcome, look for a doctor who is board-certified in reproductive endocrinology and infertility, and who has a good track record with many positive patient reviews, says Lin.

• Fertility preservation involves freezing eggs, sperm, embryos, or tissue from the ovaries or testicles to start a family later.
• This technique may be an option for people who are undergoing treatments for cancer, autoimmune diseases, or other conditions that may affect their fertility.
• Some people choose fertility preservation when they want to delay conception because of their career, relationship, or other life decisions.
• Reproductive endocrinologists and fertility specialists work together with oncologists and other doctors to plan and perform fertility preservation techniques.