Fertility preservation has become a recognized branch of study in Reproductive Medicine. Many female cancer patients can achieve motherhood with their own gametes after having overcome the disease. The concept primarily developed with the aim of helping cancer patient undergoing treatment to preserve their fertility, this discipline is now no longer restricted to cancer patients but to all those who face the risk of fertility failure or want to postpone childbearing for some reason.  Fertility preservation helps all the patients facing fertility-threatening treatments retain their fertility, or the ability to reproduce. With evolving times and changing lifestyles, many women are choosing to postpone childbearing for later in life for social, career, or financial reasons. Postponement of fertility is emerging as one of the novel indications of fertility preservation.

With celebs openly discussing about their egg freezing on social media and announcements by Facebook and Apple about insurance coverage benefits for the egg freezing has resulted into increasing public awareness about egg freezing. It is likely that in the future women wishing to postpone childbearing may constitute the main group of patients requesting fertility preservation.

Indications for Fertility Preservation:

• Malignant Diseases

• Ovarian surgery, chemotherapy, and radiotherapy

• Benign Diseases
• Social Reasons

• Personal reasons or anticipated gamete exhaustion

• Transgenders

• Before Medical or surgical transition

Every woman is born with a finite number of ovarian follicles that continue to undergo atresia throughout her lifetime by apoptosis and ovulation. The fecundity of women begins to decline gradually from the age of years becoming much rapid after the age of 37 years.

With change in the demands of society, there has been an increase in the mean age of mothers, as education and career have become important factors in women’s decisions to delay marriage and motherhood. Age affects the naturally ability of women to get pregnant. With the development of sensitive tools to assess the ovarian reserve, the remaining follicular pool in the ovary can be predicted. Knowing the extent of ovarian reserve can help women to make informed decisions for voluntary fertility preservation.

Endocrine and surgical treatment of transgenders often compromise their fertility. Desire for parenthood is predominant among them, and thus there is an important need for fertility preservation. Specific care is required in the management of transgender men.

• Transfriendly clinic environment. Use of gender-neutral language.
• Education of healthcare professionals and supporting staff in transgender care
• Drugs used
• Fertility preservation counselling prior to undergoing gender-affirming hormone treatment
• Development of specific protocols and approaches

Mechanism:

• Apoptosis of growing follicles
• Vascular injury
• Cortical Fibroids
• Patients age and AMH
• Type and Stage of cancer being treated
• Drugs used
• Mode of Administration
• Extent and radiation field
• Radiation regimen intensity and dose

  Pretreatment Risk Assessment:

• The risk of gonadotoxicity should be assessed in all patients
• Pretreatment AMH levels should be assessed
• It also helps to predict high or low response to stimulation for fertility preservation
• For women with reduced ovarian reserve, (Bologona criteria, AMH <0.5 ng/mL) fertility preservation is not recommended.

The American Society of Reproductive Medicine (ASRM) practice committee recommends a multidisciplinary approach in the care of patients facing fertility threatening therapies. Interdisciplinary collaboration is important between oncologists, reproductive endocrinologists, urologists, counsellor, and reproductive surgeons trained in fertility preservation techniques to help the patient.

Reproductive Counselling:

• Fertility regardless of age and marital status before initiation of therapy
• Possible reproductive consequences of cancer treatment
• Alternatives available such as donor embryos, donor gametes, and adoption
• Potential safety of future pregnancy after the treatment
• Possibility of gestational surrogacy, if receiving pelvic radiation therapy
• Disposition of cryopreserved gametes and embryos in the event of death
• Infectious disease testing

The choice of fertility preservation strategy depends on patient treatment factors:

• Patient’s age
• Type of disease
• Spread of the disease
• Planned treatment
• Time available
• Whether she has a partner

The scope of fertility preservation has widened from cancer to all patients who anticipate gamete exhaustion naturally or due to any iatrogenic causes. Fertility preservation gives hope to these patients of future reproduction. Multidisciplinary tea approach is the key to its success. Fertility preservation should be discussed with all the patients of reproductive age group about to embark on fertility threatening therapy. Multiple techniques are available or fertility preservation among which embryo and oocyte cryopreservation are the only established techniques of fertility preservation. Many new promising methods will be available in the future.

This article has touched upon the Basics in Fertility preservation. However, in reality the concept of fertility preservation is vast. Being an important topic in Reproductive Science, it is extremely important for medical practitioners to get a hold on this concept in depth. The Fellowship in Reproductive Medicine, is an amazing program for medical practitioners in this field. Beyond what has been covered in this article, it includes the following:

• Embryo Cryopreservation
• Mature Oocyte Cryopreservation
• Ovarian Stimulation in the Menstrual Phase
• Ovarian Stimulation in the Preovulatory Phase
• Ovarian Stimulation in the Luteal Phase
• Random Start Ovarian Stimulation
• Double Stimulation
• Ovarian stimulation in Breast Cancer Patients
• Ovarian Stimulation for Fertility preservation in Transgender Men
• GnRH Agonist Trigger to reduce the incidence of Ovarian Hyperstimulation Syndrome
• Possible Drawbacks to Superovulation in Young Women with Cancer
• Fertility-Sparing Surgeries in Female
• Oophoropexy
• In Vitro Maturation of Oocytes
• Ovarian Tissue Cryopreservation
• Fertoprotective Adjuvant Therapy
• Gonadotrophin-releasing Hormone Analogs
• Post-treatment Fertility Preservation
• Patient Reassessment Prepregnancy
• Pregnancy after Cancer Treatment
• ESHRE Guidelines

The Future:

In future, it would be possible to create gametes from stem cells in lab by means of “In Vitro Gametogenesis,” a promising fertility preservation option that is actively being developed for both males and females. Currently a research procedure, In Vitro Follicle Maturation and Culture, holds promise for young cancer patients who wish to preserve their fertility.

With the developments today, and for the purpose of maintaining the reputation of our nation globally, it is extremely important that India gives a tough competition. And, how do we do that with a full-time fellowship program?

Well, Medline Academics, headed by Padma Shri Prof. Dr. Kamini A. Rao offers a 1-year, hybrid Fellowship in Reproductive Medicine. This program by Medline Academics is designed in a way that it can accommodate the working schedules of the medical practitioners- whether they are working in day-shift or night-shift. The Fellowship in Reproductive Medicine includes the following:

• Online Theory Modules
• Live Classes every week
• Simulation Training - Offline
• Clinical Posting in Dr. Kamini Rao Hospitals
• Mid-Term Examinations – Conducted in Online Mode
• Online Revision Lectures and Case Discussions before examination
• A special session on Instruments and Drugs by Dr. Kamini Rao herself
• Final Examination – Term End - Offline
• Convocation Ceremony – Weekend, Offline

Till date, Medline Academics has successfully trained more than 500+ doctors with 100% results. The hybrid program has not only given them an opportunity to continue their medical education, but also helped them do it without leaving their current practice.

Students in Medline Academics are also posted in Dr. Kamini Rao Hospitals for their Clinical Attachment. Being one of the Best IVF Treatment Centres in Bangalore, it has huge demand for treatment as well as learning. While patients receive the best treatment from the expert team, medical students want to observe and learn about multiple cases. This institution has the best of both world for the patients and the practicing doctors. From menarche to menopause and beyond, Dr. Kamini Rao Hospitals has the treatment to every problem.

For further information about our educational institution and hospitals, please visit our website.