Fertility Preservation By Dr Mary Birdsall Chair, Fertility Associates

Fertility Preservation By Dr Mary Birdsall Chair, Fertility Associates

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

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

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

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

Heterosexual couples Single women Lesbian couples Donor Sperm

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

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

Effects of age on sperm quality

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

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

Human Fertility

Even IVF can t overcome ageing

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

AMH

Alana - AMH Aged 30 AMH = 10 pmol/l

Embryo Freezing First pregnancy embryo freezing 1983 Slow Cooling Vitrification

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

Vitrification 2013 262 warming cycles 289 embryos warmed (1.1 per cycle) 279 embryos survived (96%) 258 embryo replacement cycles (98%) 115 pregnancies (44%)

Perinatal outcomes in Fresh IVF cycles vs Frozen cycles

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 485-503 2012 20 matched cohort studies and 10 unmatched cohort studies n= 28,352 babies

Frozen vs Fresh: antepartum haemorrhage

Frozen vs Fresh: preterm labour

Frozen vs Fresh: SGA

Frozen vs Fresh: perinatal mortality

Fetal Abnormalities Frozen vs Fresh Reproductive Technologies and the Risk of Birth Defects M Davies et al NEJM 2012 366 1803-13 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 1.33-1.62) No increased risk seen in frozen embryos

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?

Singletons after frozen transfer vs singletons after spontaneous conception Outcome FET pregnancies Overall effect (RR, 95% CI) Caesarean section 2947 1.76 (1.65-1.87) Birthweight <2500g 2947 1.27 (1.05 1.52) Birthweight <1500g 2787 1.51 (1.01 2.27) Delivery at < 37 weeks 2947 1.39 (1.20 1.61) Delivery at < 32 weeks 2947 1.45 (0.98-2.13)

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 $10,000 3000 babies

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

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

Fertility Preservation Sperm Embryos Eggs Ovarian Tissue