Fertility Preservation By Dr Mary Birdsall Chair, Fertility Associates

Transcription

1 Fertility Preservation By Dr Mary Birdsall Chair, Fertility Associates

2 What can you put in the Freezer and why would you? Sperm Embryos Eggs Ovarian Tissue

3 Freezing Sperm 60 years ago first human pregnancy from frozen sperm 60 years ago first sperm bank

4 Men Spermatogenesis mid puberty Sperm freezing 1950s Able to freeze ejaculated sperm if low numbers present Thaws reasonably Use as insemination or ICSI

5 Who Should Freeze Sperm? Chemotherapy or radiotherapy or experimental medications Surgery eg prostatectomy or major pelvic surgery or orchidectomy Pre vasectomy or geographical challenges Pre gender reassignment surgery Sperm donors Klinefelters

6 Heterosexual couples Single women Lesbian couples Donor Sperm

7

8

9

10 Freezing testicular sperm Unable to ejaculate Spinal injury Vasectomy CBAVD Azospermia Testicular cancer

11 Should young men freeze sperm for later? Sperm quality reduces with age Increase in schizophrenia, autism, achondroplasia with increasing paternal age

12 Effects of age on sperm quality

13

14 Prepubertal boys and fertility preservation No mature spermatogenesis Testicular tissue currently not being frozen No proven method to transform immature germ cells into functional sperm In mice: germ cell extraction, cryopreservation and re-injection with recovery of fertility

15

16 Funding and the Law Pre cancer treatment sperm may be frozen free of charge Usual criteria for public funding for partners apply (woman less than 40, non smoker, BMI 19 to 32) May be stored for 10 years then must be discarded unless application for extension for storage made to ECART

17

18

19

20 Human Fertility

21 Even IVF can t overcome ageing

22 AMH Blood test Any time of cycle Can be done on COC, breastfeeding (is slightly lower), pregnancy Not funded $72 in Auckland Assay has been problematic (now more stable) Polycystic ovaries

23

24

25 AMH

26 Alana - AMH Aged 30 AMH = 10 pmol/l

27

28

29 Embryo Freezing First pregnancy embryo freezing 1983 Slow Cooling Vitrification

30

31 Vitrification Physical definition: Glasslike solidification of a solution molecular arrangement in a crystal molecular arrangement in a glass

32 Vitrification warming cycles 289 embryos warmed (1.1 per cycle) 279 embryos survived (96%) 258 embryo replacement cycles (98%) 115 pregnancies (44%)

33 Perinatal outcomes in Fresh IVF cycles vs Frozen cycles

34 Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systemic review and meta-analysis Pandey et al Human Reproduction Update, Vol 18, No. 5 pp matched cohort studies and 10 unmatched cohort studies n= 28,352 babies

35 Frozen vs Fresh: antepartum haemorrhage

36 Frozen vs Fresh: preterm labour

37 Frozen vs Fresh: SGA

38 Frozen vs Fresh: perinatal mortality

39 Fetal Abnormalities Frozen vs Fresh Reproductive Technologies and the Risk of Birth Defects M Davies et al NEJM South Australia population cohort study of more than 327,000 births Birth defects 8.3% after IVF vs 5.8% in spontaneous OR 1.47 (CI ) No increased risk seen in frozen embryos

40 Summary Fresh IVF vs Frozen Frozen embryo cycles appear to have fewer obstetric and perinatal complications compared with fresh IVF cycles Suggests that ovarian stimulation may have a detrimental impact? on endometrium So are frozen embryo pregnancy cycles comparable to spontaneous pregnancies?

41 Singletons after frozen transfer vs singletons after spontaneous conception Outcome FET pregnancies Overall effect (RR, 95% CI) Caesarean section ( ) Birthweight <2500g ( ) Birthweight <1500g ( ) Delivery at < 37 weeks ( ) Delivery at < 32 weeks ( )

42 Egg Freezing Fertility preservation: cancer, social, religious or ethical objections to embryo freezing, no sperm at IVF, rapid reduction of ovarian reserve Vitrification Not funded $10, babies

43

44

45

46

47 Ovarian Tissue Cryopreservation Oncological fertility preservation Only option for pre-pubescent girls Laparoscopy required Malignant cells being re-implanted a concern 32 babies in world

48

49 Ovarian cryopreservation in NZ 46 ovarian tissue samples stored Permission to store but not yet an approved procedure 2 pregnancies in Australia

50

51 Fertility Preservation Sperm Embryos Eggs Ovarian Tissue