Your doctor will recommend fertility preservation options depending on your gender, age, and reason for wanting to preserve your fertility.
Egg Freezing
Some women choose to freeze their eggs, also called egg cryopreservation, to delay having children or when a disease has damaged their ovaries. Walter says this process is similar to in vitro fertilization (IVF) treatment for infertility. It starts with taking hormone medications that stimulate the ovaries to grow and produce several eggs (this is called ovarian stimulation). Once the eggs have matured, the doctor removes them during an outpatient procedure. The eggs are stored in liquid nitrogen tanks until you are ready to conceive.
The hormones used for ovarian stimulation can cause side effects like mood swings, hot flashes, headaches, and nausea, but they are usually mild. Some people experience cramps, bloating, and bleeding after the egg retrieval procedure.
Sperm Freezing
The decision to freeze sperm is often made because of cancer treatment, low sperm count or quality, or for the option to have children after a vasectomy. Collecting the sperm is relatively easy. The fertility clinic will provide a special container to masturbate into. They’ll treat the semen with a special chemical to protect it from the cold temperatures, and then store it in a tank containing liquid nitrogen.
There’s no risk involved with collecting the semen sample. But sometimes sperm can become damaged during the freezing process.
Embryo Freezing
The process of freezing embryos is very similar to egg freezing. First, the eggs are removed from the ovaries. Then they’re fertilized with sperm from a partner or donor to produce embryos. Finally, the embryos are frozen. They can be thawed later and transferred into the uterus.
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.
Embryos can be damaged during the freezing process. Sometimes a transplanted embryo doesn’t result in a pregnancy. And when more than one embryo is implanted in the uterus, it may result in a multiple pregnancy.
Ovarian or Testicular Tissue Freezing
“This is a more advanced technique, typically reserved for prepubescent patients or those who need to begin cancer treatment urgently,” says Lin. Part of the ovary containing immature eggs is removed during a surgical procedure. The tissue is then frozen until cancer treatment is finished and the person is ready to start a family.
The ovarian tissue is reimplanted later, with the hope that it will start to produce eggs or hormones and restore fertility. Transplanting ovarian tissue results in a pregnancy about one-third of the time.
Testicular tissue freezing is still experimental. It’s not clear whether sperm will grow once the tissue is unfrozen, because the technology is so new.
Ovarian and testicular tissue harvesting carry the same risks as other surgical procedures that are performed with anesthesia. In people who have cancer, there is a risk that implanting the thawed ovarian tissue might reintroduce cancer cells.
Testicular tissue harvesting may leave the affected testicle slightly smaller.
Ovarian Transposition
This minimally invasive procedure, also called oophoropexy, can be an option for women who get radiation treatment to their pelvis (for example, to treat a gastrointestinal or pelvic cancer) and want to preserve their fertility. The surgeon separates the ovaries and sometimes the fallopian tubes from the uterus and moves them outside of the radiation field to reduce the risk of damage.
Because the ovaries can’t be reattached in the future, and the uterus may be damaged or made inflexible by the radiation, it probably won’t be possible to conceive naturally or grow a fetus to term. People who have ovarian transposition will likely need to use IVF and a gestational carrier (surrogate).