Fertility preservation methods can be a great way for people to put having kids on hold, or preserve their fertility if they need to for medical reasons. Here we go through the main procedures available to women and those assigned female-at-birth.

Quick facts:

• Fertility preservation involves freezing eggs, sperm, embryos or tissues for future use.
• There are several different fertility preservation methods available. 
• It can be explored by people for medical or social reasons. 
• If you’re looking to preserve your fertility, we can help you explore egg freezing.
• You can also speak to our specialists about finding the right treatment for you.

What is fertility preservation?

Fertility preservation involves freezing your eggs, embryos, reproductive tissues or sperm, so they can be used in the future and you can hopefully have a biological family.

For women or those assigned female-at-birth, there are a few different fertility preservation methods available. Which one is right for you will depend on your age, medical history and personal fertility goals. 

Each method involves removing either eggs or tissues, freezing and storing them in liquid nitrogen—a process called cryopreservation. When you are ready to use them, they can be thawed and used to help you conceive. 

These processes are all designed to help those at risk of potential infertility or to assist those who can’t conceive naturally.

Who might use fertility preservation?

There are lots of different reasons why someone may undergo fertility preservation. Generally, the reasons can be categorised as either medical or social preservation. 

In the UK as of July 2022, you can store your eggs for 55 years for both medical and social reasons, as long as you renew your consent every 10 years.

Medical fertility preservation

Medical fertility preservation is for anyone undergoing fertility preservation for medical reasons. This could include possibly losing their ability to conceive naturally because of impending medical treatment.

Reproductive health conditions

Some reproductive health conditions such as Premature Ovarian Insufficiency (POI) and early menopause can affect fertility. Additionally, conditions such as endometriosis or fibroids might require surgery around the pelvic organs to manage it, your doctor may suggest fertility preservation before this in case there is a risk of damage to the ovary.

Cancer

Certain cancers and cancer treatment, including chemotherapy and radiotherapy (especially targeting the pelvic organs), or surgeries impacting the ovaries, can impact our fertility. Egg freezing may be suggested on a case-by-case basis for those who are looking to have children post-cancer treatment.

Gender-affirming care

If you’re undergoing gender-affirming care, you might want to preserve your fertility before starting hormone therapy or having reconstructive surgery.

Although anyone with or undergoing the above may still be able to get pregnant naturally, there might be a risk of impacting their ovarian reserve, which may make it difficult to conceive. This is why considering fertility preservation is recommended before starting therapy. 

Social fertility preservation

Social fertility preservation is when you freeze your eggs or embryos for ‘social’ reasons. This can include if we are worried about our natural fertility decline with age, but we aren’t quite ready to have children yet. Or if we aren’t sure if we want children at all, but would like to keep our options open for the future. 

As we age, our egg quantity and quality decline. This can make getting (and sometimes, staying) pregnant more difficult. Age, also increases the risk of pregnancy-related complications, like miscarriage, genetic disorders in the baby and gestational diabetes, especially after our mid to late 30s.

In our early to mid-20s, we are at our most fertile—but there’s still only a 25–30% chance of us getting pregnant each cycle. This gradually reduces during our 30s to around 5% by age 40. 

What are the different types of fertility preservation?

Fertility-preservation options for women and AFAB people include egg freezing, embryo freezing, ovarian tissue cryopreservation, ovarian transposition and gonadal shielding.

Egg freezing (Oocyte cryopreservation): 

Egg freezing is a medical procedure which can help us to plan for our future fertility. It’s what’s known as a ‘fertility preservation method’, or scientifically speaking, ‘oocyte cryopreservation’.

Egg freezing involves taking medicine to encourage the growth of the eggs in our ovaries, which will then be collected during a short surgical procedure. Viable eggs will be frozen and stored in liquid nitrogen (-196°C). They do not decline in quality—like they would do if they remained in your ovaries as you age. 

These eggs can be thawed at a later date whenever you are ready to start a family through fertility treatment. This whole process is what’s called an ‘egg freezing cycle’. 

Technically, you can freeze your eggs at any age before menopause, but eggs retrieved in your 20s and early 30s usually result in better outcomes than those in your late 30s and 40s. This is largely to do with the quality of the eggs at the time they are retrieved, as generally, our eggs begin to decline more rapidly from 35 onwards.

Embryo cryopreservation (embryo freezing)

This is a procedure that involves removing eggs from the ovaries, fertilising them with either a partner or donor sperm to create embryos and then freezing the resulting embryos for future use. Embryo cryopreservation would usually require an in-vitro fertilisation (IVF) cycle. 

The egg retrieval process is similar to the one used in egg freezing. Once retrieved the eggs will be analysed in the lab by an embryologist and then fertilised with sperm from your partner or donor once. They are then placed into an incubator to allow the resulting fertilised egg (embryo) to develop. 

The embryos are then frozen and stored in liquid nitrogen. Once you are ready to conceive, the embryo will be thawed, cultured and will be transferred to the uterus. 

The number of embryos transferred is dependent on your age, the quality of the embryo(s) and if you have had failed IVF cycles in the past. It’s generally preferred to transfer just one embryo because this reduces the chances of complications associated with multiple pregnancies. 

If you have good-quality embryos left over at this stage, you can opt to freeze them for future cycles, discard them or donate them to someone else. Sometimes, if a sufficient number of embryos are not collected in one cycle, your doctor will recommend another cycle.

Ovarian tissue cryopreservation

Ovarian tissue cryopreservation is the only fertility preservation option to help younger people who have not gone through puberty. It is also may be used for those  who can’t undergo egg or embryo-freezing treatment because of oestrogen-sensitive cancers such as breast cancer.

The procedure is performed under general anaesthesia. A short keyhole operation (laparoscopic oophorectomy) is performed. During the operation, surgeons will check both ovaries and then remove tissue from them. 

This tissue is then transported to the laboratory and prepared for freezing. The tissue containing the immature eggs is cut into thin strips and carefully placed in a preservative fluid. This protects the tissue from any damage during the freezing process. The ovarian tissue is then stored safely in the ‘tissue bank’.

Ovarian transposition

Radiation treatment for cancer and other conditions can harm fertility, especially if it is used in the pelvic area. This is a process specifically for people undergoing radiation therapy for cancer. This is where the ovaries are surgically moved higher in the abdomen, away from the radiation field.

This is to minimise exposure and potential damage before radiation treatment. Although it is very effective for those undergoing radiotherapy, it does not protect against potential damage caused by chemotherapy.

Gonadal shielding

This is another treatment to protect fertility during radiation therapy. Depending on the location of the cancer, the pelvic area can be protected against radiation with a lead shield, known as gonadal shielding. Some radiation treatments use modern techniques to aim the rays in a very small area and it will depend on the type of treatment being used.

Thinking about undergoing fertility preservation treatment?

If you’re thinking about egg freezing, Hertility can help. Whether you’re just curious about the egg freezing process, or actively looking for a fertility clinic, we’re here to help. Our pathways to care consist of highly accredited and vetted clinics, that can guide you through your fertility journey, whichever path it is you choose to take.

References:

1. https://www.hfea.gov.uk/treatments/explore-all-treatments/ 
2. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/fertilitypreservation 
3. Kim CH, Jeon GH. Fertility preservation in female cancer patients. ISRN Obstet Gynecol. 2012;2012:807302. doi:10.5402/2012/807302