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Fertility Preservation
The Reproductive Medicine Group of Tampa, Florida offers a comprehensive fertility preservation program which includes freezing of gamates (sperm or eggs) and embryos. Current studies suggest that sperm, eggs, and embryos can be safely frozen or “cryopreserved” and thawed for future use without a significant health risk to the resulting children. Sperm cryopreservation is most common and has been available for several decades. Healthy pregnancies have been achieved from sperm that has been thawed more than 10 years after initial cryopreservation. Embryo cryopreservation has been available for more than 20 years. Improvements in embryo cryopreservation techniques have allowed for more embryos to survive the thaw process and implant.
Children born from cryopreserved sperm, eggs or embryos have not been observed to have an increased incidence of congenital anomalies (birth defects) compared to the general population, suggesting that these technologies are reasonably safe and effective. Previously, egg cryopreservation (oocyte cryopreservation) was considered to be a more difficult procedure due to the inherent nature of the egg. Improved technologies have now made it possible to successfully freeze and thaw oocytes with pregnancy rates equivalent to those of cryopreserved embryos, resulting in healthy children.
All three fertility preservation programs listed above are available at The Reproductive Medicine Group.
Egg Freezing (Egg Cryopreservation)
Approximately 50,000 reproductive-age women in the United States are diagnosed with cancer each year. Earlier diagnosis and more aggressive treatment regimens have significantly improved survival and cure rates in children and adults with cancer. Although more effective, many of the current treatment regimens such as chemotherapy, radiotherapy, and medications associated with bone marrow transplant are toxic to the human oocyte, resulting in infertility or sterility. As such, reproductive age women facing cancer treatments need to consider all of their options in terms of potential future fertility.
In addition, women with certain non-cancerous disorders may face potential sterility associated with their disease or the treatment of their disorder. Removal of one or both ovaries performed to treat a benign (non-cancerous) tumor or conditions such as endometriosis can result in decreased fertility or in sterility. Women who test positive for the BRCA gene or who have a strong family history of ovarian cancer may elect to undergo prophylactic removal of the ovaries. Women with autoimmune diseases may be exposed to medications that are toxic to the oocyte or may experience premature (early) menopause. Finally, women who are age 30-40 and do not yet have a partner or for other personal or medical reasons need to delay pregnancy and wish to preserve their ability to have biologic children in the future, may choose to cryopreserve their eggs (otherwise known as egg freezing).
Previously, cryopreservation of embryos was the only option for women at risk for sterility due to the conditions outlined. However, cryopreservation of the human egg is now possible, becoming more common and is highly successful.
Egg cryopreservation requires retrieval (removal) of the eggs from the ovaries in the same manner as is performed for in vitro fertilization (IVF). Fertility medications are utilized to stimulate the development of multiple eggs within the ovaries. These medications are administered by subcutaneous (under the skin) injections for approximately 2 weeks to allow the eggs to reach maturity. Serial transvaginal ultrasounds (sonograms) and blood work are utilized to assess the development of the eggs. When these tests suggest that a reasonable group of eggs are likely to be mature, a final injection medication is given and then, 36 hours later, the woman receives complete sedation and the eggs are removed from the ovaries by placing a needle through the vaginal wall into each ovary using ultrasound guidance. The eggs are then frozen. The cost of egg cryopreservation is similar to the cost of an IVF cycle. Generally, an annual fee is charged for storage of the cryopreserved eggs after the first year. Intracytoplasmic sperm injection (ICSI) is required to fertilize the thawed eggs.
More than 1000 births resulting from cryopreserved eggs have been reported with no increased rate of chromosomal or birth defects noted. The Reproductive Medicine Group has been highly successful both in egg freezing and achieving healthy pregnancies with the fertilization of cryopreserved eggs. No longer considered experimental, egg freezing is now a viable and highly successful procedure for women who are not yet ready to start their families but want to preserve their chances to conceive with their own eggs in the future.
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Sperm Freezing (Sperm Cryopreservation)
Sperm cryopreservation is appropriate and available for several indications. Sperm can be frozen and stored at The Reproductive Medicine Group’s North Tampa location for short-term use or shipped to a long-term facility for later use. Sperm is often cryopreserved for men who anticipate undergoing chemotherapy, radiation therapy or certain surgical procedures to treat cancer. Some men undergoing vasectomy choose to cryopreserve sperm prior to the procedure. Couples who are actively attempting conception but anticipate that the husband will be geographically separated for an extended period of time may elect to cryopreserve sperm so that it is available when the woman is ovulating. Finally, for couples who are anticipating undergoing a cycle of IVF, if the male partner anticipates that he may have difficulty producing a semen specimen on the day of the female partner’s egg retrieval, sperm can be collected in advance under less stressful circumstances and cryopreserved. Generally, a single semen specimen can be divided into two or more vials or straws for storage purposes. Currently, the cost of semen cryopreservation is approximately $1,850. Blood test are required to freeze your semen sample. Men who are anticipating chemotherapy should contact our office as soon as possible to set up a collection appointment and blood work. Please call 813-914-7304 x1267 to speak with our lab supervisor.
Pre-Vasectomy and Vasectomy Reversal Sperm Freezing
The Reproductive Medicine Group offers their patients the option of freezing their sperm at the time of a scheduled vasectomy reversal. The frozen sample is sent to an approved storage facility. The Reproductive Medicine Group is the only facility in the Tampa Bay area to offer this service. By freezing the sample, the patient is assured that sperm is available for future use in the event that the vasectomy or vasectomy reversal was not successful, or if scar tissue later forms, closing the area of the reversal.
Embryo Freezing (Embryo Cryopreservation) & FET (Frozen Embryo Transfer)
Embryo freezing is available for couples undergoing in vitro fertilization (IVF) who:
- Elect to have genetic/chromosomal screening (PGT)
- Who are at high risk for hyperstimulation (to avoid that serious complication)
- Who are at risk for decreased implantation rates due to high estrogen levels associated with fertility stimulating medications necessary for the IVF cycle
- Who produce more embryos than would be appropriate to transfer into the uterus at the time of the fresh cycle (for future FET or Frozen Embryo Transfer)
- Women who are preserving their fertility prior to radiation or surgical removal of the ovaries
Studies have demonstrated higher pregnancy rates achieved with FET compared to fresh cycle transfers in women above age 40. The cost of a FET cycle is significantly lower than a fresh cycle. While medications are necessary to prepare the uterus for frozen embryo transfer, fertility drugs which are costly are not required for a FET cycle.
It is not possible to predict with certainty which eggs (eggs) will fertilize and embryos. Therefore, when normal appearing eggs are fertilized, sometimes more embryos will form than should safely be placed into the uterus during a fresh cycle. In anticipation of “extra” embryos, couples must decide what to do with them.
Embryos are “graded” prior to selection for transfer to the uterus, or prior to biopsying and freezing the embryo. Embryos are graded on day 5 or 6. The laboratory staff evaluates the embryos under the microscope for quality. This evaluation is based on standardized laboratory assessment criteria that include cell shape and size. The embryos are not able to be be evaluated for genetic abnormalities by looking at them. Evaluation for chromosomal abnormalities requires biopsy of the embryo prior to freezing. The cells that are removed are sent for genetic analysis (PGT) to determine if the embryo has the correct number of chromosomes. The embryos are frozen and stored at The Reproductive Medicine Group for transfer when the results are available a few weeks later.
Options for embryos that are not frozen:
- Disposal of embryos according to the ART Program’s practices and procedures at that time.
- Use of the embryos for scientific education or research, followed by disposal.
Couples must make their choices in writing, in advance of the ART cycle, when they sign their consent forms with their physicians.
Embryos will be frozen and transferred in a subsequent cycle, if the plan is for PGT testing, freezing all embryos for future use, or should pregnancy not occur in a transfer cycle. They may also be used to establish a sibling pregnancy at a later time if pregnancy occurs with the initial transfer cycle. Once frozen, the viability of the embryos is generally not thought to decline even after years of storage. However, we encourage couples to use them for transfer or decide on disposal within a reasonable time. One year is the original storage agreement, which can be renewed annually.
Some or all of the embryos may not survive the freezing and thawing process. Previously, about 60% survived the thaw, however, newer freezing techniques have resulted in significantly higher rates of thawed embryo survival. PGT tested embryos have a survival rate of at least 90%.
There does not appear to be an increased risk to the fetus by embryo freezing and thawing.
High-quality embryos that are Grade I or II can be frozen. Lower grade embryos are unlikely to survive the thaw or result in pregnancy.
Some factors to consider when deciding to cryopreserve embryos include:
A. Expenses involved in cryopreserving and storing embryos.
B. Costs of a cryopreserved frozen embryo transfer cycle are significantly less than a fresh stimulation cycle.
C. Pregnancy rates from FET(frozen embryo transfer)are equivalent or somewhat higher than for a fresh transfer. IVF Success Rates
D. Not all embryos survive the cryopreservation and thaw process.
Couples who store frozen embryos have an obligation to notify their physician and the ART program in writing of any change in their address. There is a fee associated with the freezing and storage of embryos. Unforeseen increases in the cost of freezing may dictate an increase in couples storage costs.
