Fertility preservation gives you the opportunity to have children later in life, even when facing barriers such as age, health conditions, or medical treatments.
The practice of fertility preservation involves saving and protecting embryos, eggs, sperm, and reproductive tissue to help patients maintain their chances for reproduction in the future. Fertility preservation is common among people whose fertility is compromised by health conditions or diseases, as well as for people who want to delay having children for personal reasons.
Since the 1980s, fertility preservation has been primarily used to help cancer patients undergoing treatments that could affect their fertility. However, in the last decade, it has gained popularity for personal and lifestyle reasons (1 ). There are multiple methods available for both females and males. Here’s everything to know about fertility preservation.
What is fertility preservation? Fertility preservation aims to help patients maintain their ability to have biological children in the future regardless of health conditions. There are two main types of fertility preservation:
Medically indicated preservation: When a condition or disease puts the patient's fertility at risk. Elective preservation: When individuals choose to undergo fertility preservation for personal reasons, such as prioritizing a career or waiting to find the right partner. >>MORE: How Many Eggs Does A Woman Have? Fertility At Every Age
Reasons for fertility preservation The main reasons that someone may want to preserve their fertility include:
Age: Fertility declines as you age. If you’d like to have children later, fertility preservation can help protect your eggs before your fertility starts to diminish. Age reduces the quantity and quality of a woman’s eggs typically in their mid-30s before reaching perimenopause and menopause (2 ). More people are having children later in life. Between 2000 and 2014, the number of women aged 30 to 34 delivering their first child increased by 28%, and the number of women aged 35 or older rose by 23% (3 ). Common reasons for delaying parenthood include career advancement, furthering education, or waiting for the right partner. Cancer: Cancer and its treatment such as chemotherapy, radiation therapy, and surgery can impair fertility. Autoimmune diseases: Conditions like lupus and rheumatoid arthritis, along with their treatments, may cause fertility problems. Reproductive health conditions: Conditions like endometriosis , where the tissue similar to the uterine lining grows outside the uterus, and uterine fibroids can impact fertility (4 ). Gender-affirming treatments: Individuals transitioning from male to female may wish to preserve sperm, or those transitioning from female to male may want to freeze their eggs before undergoing gender-affirming surgery (5 ). Methods of fertility preservation Fertility preservation methods vary by sex and typically involve removing and freezing eggs, embryos, sperm, or reproductive tissue for future use. Some methods focus on reducing the impact of cancer treatments on reproductive organs.
Since childhood cancer and other conditions can affect a child’s future fertility, any freezing options are generally available only after puberty. Other methods include radiation shielding and ovarian transposition.
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Fertility preservation methods for females: Egg freezing (oocyte cryopreservation): Treatment includes injecting hormones to trigger egg production in the ovaries. Eggs are then extracted by a physician with a needle to be frozen and stored. This process takes about two weeks (6 ). Embryo freezing: Often part of in-vitro fertilization (IVF), this involves removing eggs from your ovaries, and fertilizing them with sperm (either from a partner or donor) in a lab to create embryos. The embryos can be implanted in your body immediately or stored for future use. Ovarian tissue freezing (ovarian cryopreservation): Typically a treatment used for patients who need cancer treatment and can't wait the two to six weeks needed for egg retrieval. In these cases, the ovarian tissue is surgically removed and frozen, and can later be reinserted after treatment. Once thawed and implanted, the ovarian tissue may resume function, stimulating hormone and egg production, and potentially leading to a natural pregnancy or pregnancy via IVF (7 ). Ovarian transposition (oophoropexy): This procedure protects the ovaries from the damage of radiation treatments. The ovaries are surgically removed from the pelvis and placed into the abdomen so it can avoid the treatment area. If the fallopian tubes aren’t damaged by surgery or radiation, the ovaries may release eggs in their new place allowing a natural pregnancy. Radiation shielding: A lead shield or precise radiation technology is used to protect your ovaries during radiation treatments. Fertility preservation methods for males: Radiation shielding: Similar to radiation shielding for women, this method limits the exposure of radiation to the testicles by shielding them or using precise radiation technology and techniques. Sperm freezing: A semen sample is collected, frozen, and stored for future use. Testicular tissue freezing: In cases where men don’t have sperm in their semen, a sample of testicular tissue is removed and examined for sperm. Any sperm found are then extracted and stored. Success rates and considerations Fertility preservation doesn’t guarantee future pregnancy. Success rates depend on a variety of factors such as age, body mass index, health conditions, and past medical history. Ovarian tissue freezing and ovarian transposition procedures are less common, and their effectiveness are still being studied.
There are also some risks to fertility preservation:
Some procedures can cause bleeding and infection. IVF can increase the chances of multiple births, premature delivery, miscarriage, and low birth weight. Ovarian procedures may trigger raised estrogen levels which can increase the risk of blood clots and estrogen-dependent cancers. Hormone injections increase estrogen levels which can cause side effects such as mood swings, bloating, and other physical discomfort plus possible abdominal pain post-retrieval (8 ). In rare cases, severe ovarian hyperstimulation syndrome (OHSS) can occur. The ovaries swell and fluid leaks into the body, primarily around the lungs. This happens to roughly 1% of women undergoing egg freezing and is more common among individuals with polycystic ovarian syndrome (PCOS ).
Costs of fertility preservation is another significant consideration. Starting costs for a single cycle of egg freezing can range from $10,000 to $15,000, with an additional $4,000 to $6,000 for medications, and around $500 annually for storage (10 ). Doctors may also recommend multiple cycles of egg retrieval to have better success rates, driving up the overall costs. Some insurance plans and employers offer fertility benefits to reduce costs.
Fertility preservation: the bottom line If you’re considering fertility preservation, it’s important to evaluate factors such as age, costs, health risks, and more. Success rates are generally higher when fertility preservation is done before any cancer treatments and before the age of 35. A 2022 study found that the success rate for having a baby was 70% for women who froze their eggs before the age of 38, compared to 39% for women who froze their eggs at 38 or older (11 ). However, freezing your eggs in your early 20s may increase your risk of hyperstimulation due to larger egg reserves at a younger age. Discussing your options and risks with your doctor is crucial.
Fertility preservation offers a way to protect your reproductive future against challenges related to health, age, and life circumstances. Whether you want to prioritize your career, wait for the right partner, or pursue parenthood independently, fertility preservation empowers you to take control of your reproductive timeline.
