Fertility Preservation: Protecting Your Future Fertility Through Egg, Embryo and Sperm Freezing

Egg freezing is the most established fertility preservation method for women without a male partner or for those who do not wish to create embryos at this stage. The process involves controlled ovarian stimulation with hormone injections (the same stimulation used in IVF) to develop multiple eggs, followed by egg retrieval under sedation, and vitrification of the mature eggs in the embryology laboratory.

An egg freezing cycle takes approximately 2 weeks from the start of stimulation to egg retrieval.

Women under 35 typically need 10 to 15 mature eggs per desired child. Women 35-37 need 15-20. Women above 38 may need 20+ (multiple cycles may be required).

Above 85 to 90 percent of vitrified eggs survive thawing at Samarth IVF.

Thawed eggs are fertilised using ICSI (not standard IVF) as the zona pellucida undergoes changes. ICSI fertilisation rates of 70 to 80 percent per thawed mature egg are achieved.

Vitrified eggs are stored in liquid nitrogen at minus 196 degrees Celsius. Storage can be maintained for many years with no deterioration in egg quality.

Embryo freezing is a well-established fertility preservation option for women or couples who have a male partner at the time of preservation. Eggs are retrieved using the same IVF stimulation process, fertilised with partner or donor sperm in the laboratory, cultured to the blastocyst stage, and the resulting embryos are vitrified for future use.

Frozen embryo transfer (FET) cycles use vitrified blastocysts; the chance of pregnancy depends mainly on the age at which the embryos were preserved.

Advantage over egg freezing: Embryos are more robust to vitrification than eggs. Embryo survival rates after thawing are above 95 percent. Embryo freezing is the preferred option when a partner is available.

Legal and ethical considerations: Frozen embryos are jointly owned by both partners. Decisions about storage, use, donation, or disposal must be agreed by both. This is an important consideration for couples who may separate in the future.

Onco-fertility use: For female cancer patients with a partner, embryo freezing before cancer treatment is the most reliable fertility preservation option available.

Sperm freezing is the simplest, least invasive, and most long-established fertility preservation method. A semen sample is provided, processed to concentrate and select the best sperm, and the prepared sample is divided into multiple vials and vitrified for storage. Stored sperm can be used for IUI, IVF, or ICSI at any point in the future.

Indications: Cancer treatment, surgery affecting ejaculatory function, progressive deterioration in semen parameters, planned vasectomy, or military deployment.

Number of vials: Multiple vials are stored from a single sample to provide for multiple future treatment attempts.

Recovery after cancer treatment: Sperm production often recovers after chemo/radiotherapy, but recovery is not guaranteed, takes 1 to 2 years, and may be incomplete. Freezing before treatment is strongly recommended.

Surgical sperm freezing: For men with azoospermia, sperm retrieved surgically via TESA, PESA, or micro-TESE can be frozen for future IVF-ICSI use.

Involves removing a portion of the ovarian cortex (the outer layer of the ovary, which contains thousands of primordial follicles with immature eggs) by laparoscopic surgery, slicing it into thin strips, and vitrifying these strips for future use. When ready, the tissue is thawed and transplanted back onto the remaining ovary or into the pelvic cavity, where it re-establishes blood supply and resumes producing hormones and developing follicles.

Particularly valuable for prepubertal girls who have not yet undergone puberty and for whom egg or embryo freezing is not possible. Also the fastest option for adult women who cannot delay cancer treatment long enough for a full stimulation cycle. Now classified as an established rather than experimental technique.

Chemotherapy, particularly alkylating agents such as cyclophosphamide, ifosfamide, melphalan, and busulfan, is profoundly gonadotoxic. These agents damage the primordial follicle pool in women and the spermatogonial stem cells in men, potentially causing premature ovarian insufficiency (POI) in women and azoospermia in men. The degree of gonadotoxicity depends on the specific drugs, doses, and duration of treatment.

All patients of reproductive age who are about to undergo potentially gonadotoxic chemotherapy should be referred for urgent fertility preservation counselling before treatment begins. Even when the urgency of treatment is high, the 2-week window for egg or embryo freezing can usually be accommodated without compromising cancer outcomes in most solid tumour types. Your oncologist and Samarth IVF specialist will work together to optimise the timing.

Radiotherapy directed to the pelvis, abdomen, or spine above the pelvis can damage the ovaries and uterus. Ovarian transposition (oophoropexy), moving the ovaries out of the radiation field before radiotherapy, can reduce ovarian radiation exposure. Ovarian or embryo cryopreservation before radiotherapy provides additional protection. Uterine damage from pelvic radiotherapy may reduce the capacity for future pregnancy even if ovarian function is preserved.

Women facing bilateral oophorectomy (surgical removal of both ovaries) for large bilateral endometriomas, ovarian torsion, or other benign conditions benefit from fertility preservation before surgery. Even women facing unilateral oophorectomy benefit from egg or embryo freezing if the contralateral ovary has reduced reserve or if future ovarian failure is a concern.

Women carrying the FMR1 premutation (fragile X carrier) have a significantly elevated risk of premature ovarian insufficiency before age 40. Early referral for fertility preservation counselling and egg or embryo freezing before reserve declines is strongly recommended. Turner syndrome (45,X) is associated with rapid ovarian failure in adolescence and early adulthood. In selected cases, fertility preservation in adolescent Turner syndrome patients may be possible before reserve is exhausted.

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Each frozen egg has only a modest chance of becoming a baby, so several eggs are usually frozen. 10 to 15 eggs frozen at this age give a reasonable cumulative probability of success.

The chance per egg becomes lower still. 15 to 20 eggs are recommended.

Per-egg probability is 2 to 3 percent. Multiple stimulation cycles may be required to freeze sufficient numbers.

Per-egg probability is low. Social egg freezing at this age has limited effectiveness. Counselling will address whether egg donation is a more realistic option.

A semen sample is provided by masturbation after 2 to 5 days of abstinence. The sample is processed using density gradient centrifugation to select the best quality sperm. The prepared sample is divided into multiple vials (typically 5 to 10 depending on the total motile count) and each vial is vitrified separately. Frozen vials are stored in liquid nitrogen in clearly labelled cryostorage straws. Each vial contains sufficient sperm for one IUI, IVF, or ICSI cycle.

For azoospermic men or men who cannot produce an ejaculated sample, sperm retrieved surgically via TESA, PESA, or micro-TESE can be divided and frozen in multiple vials. This allows a single surgical retrieval to provide sperm for multiple future ICSI attempts without repeat surgery.

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