Overview of fertility preservation methods
| Intervention . | Eligible patients . | Standard of care? . | Advantages . | Disadvantages . |
|---|---|---|---|---|
| Embryo cryopreservation | Adult women | Yes | Well-established method with high live birth rates | Hormonal stimulation required (risk of ovarian hyperstimulation, thrombosis) |
| Offers possibility of preimplantation genetic diagnosis | 10-12 d from initiation of ovarian stimulation until oocyte retrieval using random-start protocols | |||
| Requires a male partner or sperm donor | ||||
| Oocyte cryopreservation | Adult women | Yes | Live birth rates likely similar to embryo cryopreservation | Hormonal stimulation required (risk of ovarian hyperstimulation, thrombosis) |
| Does not require a male partner/sperm donor | 10-12 d from initiation of ovarian stimulation until oocyte retrieval | |||
| May be more preferable for patients with ethical concerns or in countries with restrictions on embryonic tissues | ||||
| Ovarian tissue cryopreservation | Adult women | No | Live birth rates may approach those of oocyte/embryo cryopreservation | Requires laparoscopic abdominal surgery to obtain and to reimplant tissue orthotopically |
| Prepubertal girls | Restores normal hormonal milieu as well as fertility | Risk of malignant cells contaminating tissue | ||
| May be performed immediately (no treatment delay) | ||||
| Only option for prepubertal girls | ||||
| Hormonal manipulation (GnRHa) | Adult women | No | May be only option when cancer-directed therapy must be offered emergently | Unproven efficacy; should not be relied on as sole method of fertility preservation if other options are feasible |
| May protect ovarian function to preserve normal hormonal milieu | Patients may experience menopause-like symptoms | |||
| Menstrual suppression | Osteoporosis | |||
| Oocyte in vitro maturation | Adult women | No | Short course or no ovarian stimulation | Limited numbers of live births |
| May be performed immediately (no treatment delay) | ||||
| No risk of malignant contamination | ||||
| Sperm cryopreservation | Adult men | Yes | Generally readily available | Oligospermia is frequent in men with cancer |
| Low to no risk | Stress of cancer diagnosis or religious/personal/ethical concerns may impair ability to masturbate | |||
| Alternative methods to collect sperm (TESE, penile vibratory stimulus, electroejaculation) are possible | TESE requires surgery to obtain tissue | |||
| Testicular tissue cryopreservation | Adult men | Yes | May be used to obtain sperm for cryopreservation if patient unable to provide a sperm sample | Requires surgery to remove testicular tissue |
| Prepubertal boys | No | Only option for prepubertal boys | Requires surgery to remove testicular tissue | |
| Risk of malignant cells contaminating tissue | ||||
| Development of oocytes or sperm from oogonial or spermatogonial stem cells, embryonic, or induced pluripotent stem cells | All patients | No | May become an option for pre-pubertal children | May require surgery to obtain tissue |
| No risk of malignant contamination | Not yet in clinical use/trials |
| Intervention . | Eligible patients . | Standard of care? . | Advantages . | Disadvantages . |
|---|---|---|---|---|
| Embryo cryopreservation | Adult women | Yes | Well-established method with high live birth rates | Hormonal stimulation required (risk of ovarian hyperstimulation, thrombosis) |
| Offers possibility of preimplantation genetic diagnosis | 10-12 d from initiation of ovarian stimulation until oocyte retrieval using random-start protocols | |||
| Requires a male partner or sperm donor | ||||
| Oocyte cryopreservation | Adult women | Yes | Live birth rates likely similar to embryo cryopreservation | Hormonal stimulation required (risk of ovarian hyperstimulation, thrombosis) |
| Does not require a male partner/sperm donor | 10-12 d from initiation of ovarian stimulation until oocyte retrieval | |||
| May be more preferable for patients with ethical concerns or in countries with restrictions on embryonic tissues | ||||
| Ovarian tissue cryopreservation | Adult women | No | Live birth rates may approach those of oocyte/embryo cryopreservation | Requires laparoscopic abdominal surgery to obtain and to reimplant tissue orthotopically |
| Prepubertal girls | Restores normal hormonal milieu as well as fertility | Risk of malignant cells contaminating tissue | ||
| May be performed immediately (no treatment delay) | ||||
| Only option for prepubertal girls | ||||
| Hormonal manipulation (GnRHa) | Adult women | No | May be only option when cancer-directed therapy must be offered emergently | Unproven efficacy; should not be relied on as sole method of fertility preservation if other options are feasible |
| May protect ovarian function to preserve normal hormonal milieu | Patients may experience menopause-like symptoms | |||
| Menstrual suppression | Osteoporosis | |||
| Oocyte in vitro maturation | Adult women | No | Short course or no ovarian stimulation | Limited numbers of live births |
| May be performed immediately (no treatment delay) | ||||
| No risk of malignant contamination | ||||
| Sperm cryopreservation | Adult men | Yes | Generally readily available | Oligospermia is frequent in men with cancer |
| Low to no risk | Stress of cancer diagnosis or religious/personal/ethical concerns may impair ability to masturbate | |||
| Alternative methods to collect sperm (TESE, penile vibratory stimulus, electroejaculation) are possible | TESE requires surgery to obtain tissue | |||
| Testicular tissue cryopreservation | Adult men | Yes | May be used to obtain sperm for cryopreservation if patient unable to provide a sperm sample | Requires surgery to remove testicular tissue |
| Prepubertal boys | No | Only option for prepubertal boys | Requires surgery to remove testicular tissue | |
| Risk of malignant cells contaminating tissue | ||||
| Development of oocytes or sperm from oogonial or spermatogonial stem cells, embryonic, or induced pluripotent stem cells | All patients | No | May become an option for pre-pubertal children | May require surgery to obtain tissue |
| No risk of malignant contamination | Not yet in clinical use/trials |
TESE, testicular sperm extraction.