Optimizing advice and approaches for elective fertility preservation

Abstract

Elective fertility preservation enables women to extend their reproductive window, potentially reducing the need for ineffective fertility treatments later in life. Oocyte cryopreservation (OC), an established fertility preservation technique, is often seen as a means of reproductive autonomy, though its impact remains debated. To avoid detrimental effects of aging it is suggested that OC should be done by 37 years. Freezing ≥20 mature oocytes before 38 years gives a 60–70°% possibility of pregnancy. Success of ovarian tissue cryopreservation and transplantation (OTCT) in cancer survivors has encouraged its use in reproductive aging. OTCT provides a longer reproductive window, allows for spontaneous conception and restores ovarian endocrine function but is highly invasive. Ethical concerns raised for elective fertility preservation include medicalization of reproduction, idealization of the right time for pregnancy, psychological effects of advanced age parenthood and promotion of social inequity. With an increasing demand for elective oocyte freezing there is an urgent need to create awareness about the pros and cons of the techniques, the risks of pregnancy complications at an advanced maternal age and long term health of children born. Gamete preservation cannot guarantee a child. Profertility counselling should be a part of the discussion as there is no substitute for spontaneous conception at a younger age.