Fertility Preservation Srinivasan Krishnamurthy FRCS(Ed) FRCOG Associate Professor & Chief of Gynecology Director of Gynecological Ultrasound McGill University & McGill University Health Centre, Montreal, Quebec, Canada

Fertility preservation by oocyte cryopreservation women at risk of early menopause – pre- C/T or R/T for cancer, SLE, auto-immune disorders, multiple sclerosis - Turner syndrome preservation of fertility in women who are not ready to have children

Preservation of fertility in young women undergoing C/T or R/T >600,000 invasive female cancers/yr in N.A. (8% < 40 years) improved survival for many children and young adults with cancer need to consider future fertility prior to treatment women face cancer treatment better if they believe they can still have children

Six distinct issues should be considered Fertility preservation in cancer patient The risk of sterility with the proposed treatment program The overall prognosis for the patient The potential risks of delaying chemotherapy The impact of any future pregnancy upon the risk of tumor recurrence The impact of any required hormonal manipulation on tumor itself The possibility of tumor contamination of the harvested tissue

Social oocyte storage for fertility preservation! Women are born with a fixed number of oocytes Reproductive aging from to years results in poorer health outcomes infertility 7% % Down syndrome 1/1440 – 1/68 miscarriage 10% - > 50%

Social oocyte storage for fertility preservation! There is no controversy about men freezing sperm if they have cancer As women invariably lose their fertility as they age Greater likelihood if they have familial, genetic, endocrine, endometriosis, or any other major medical condition Social oocyte storage would be preventative medicine.

Social oocyte storage for fertility preservation! Advent of OC, women’s liberation and changing social norms have led to delay in childbearing resulting in relative aging of population and dire societal consequences; perhaps over time, even actual decline of certain populations!

Social oocyte storage for fertility preservation! Less educated women have children younger Involuntary childlessness at 34 has increased in all age groups over the past 30 years

Social oocyte storage for fertility preservation! Women who take time off work to have children face significant loss of income and career impediments when they return to work A major problem is lack of awareness of decline of fertility even in the educated public

Social oocyte storage for fertility preservation! A study at UBC showed that 20% of students believed fertility stays the same from menarche to menopause while 3% actually believed women remain fertile for a few years after menopause!

Social oocyte storage for fertility preservation! Another study reported that 63% of Stanford and UC students were unaware fertility declines between % believe IVF always works 78% believe exercise and diet preserve ovarian function 51% were in a relationship, only 29% would stop education or careers to have babies.

Social oocyte storage for fertility preservation! Clearly, it would be ideal if all women can have children at a young age and society should be re-organized to help them achieve this, since childbearing is not just for individual benefit but for societal good as well Unfortunately, this is not always possible and social fertility preservation becomes useful

Social oocyte storage for fertility preservation! Oocyte vitrification (OV) was initially developed help women at risk of early menopause – pre-C/T or R/T for cancer, SLE, auto-immune disorders, multiple sclerosis, Turner syndrome, IBD, severe endometriosis, F/H early menopause and most major illnesses

Social oocyte storage for fertility preservation! While intact ovarian transplantation, ovarian tissue freezing and freezing IVF or IVM embryos all allow fertility preservation, the easiest way nowadays for social fertility preservation is IVF and OV

Social oocyte storage for fertility preservation! A number of studies, largely using egg donation as the model, have suggested that vitrified thawed donor eggs, produce almost comparable pregnancy rates as fresh oocytes In a study of IVF OV in 38 infertile women, we achieved 81% oocyte survival rate, 45% clinical pregnancy rate/cycle and 40% live birth rate/cycle started

Social oocyte storage for fertility preservation! There is also a need to remove the double standard that exists between men and women reproducing in their forties or early fifties and a good model is that of Israel, where free OV for 20 eggs is allowed and can be used until 54 years of age. There has to be a new paradigm of thinking and SOV should be encouraged and one day, young women will routinely create their own personal egg bank, which they may even will to their own daughters.