Absolutely and I think you could use exactly the same thing to go back to the pelvic infection scenario that it’s happening in perhaps late teens or whatever. Maybe get treated, maybe don’t get treated and the consequences then come back and with a vengeance in a decade later and I think PCOS is another example. Sometimes you end up with ladies who as part of their pc PCOS profile present initially with a BMI in the high 30s and certainly in the UK when they very frequently need NHS treatment for their infertility, it can take them two or three years to get their BMI to a range where they’re even eligible and for lots of those ladies or couples they need the NHS treatment, they don’t have 5 000 pounds in the bank… unless they borrow from their parents or sell their car or whatever. I think there’s all these areas where in different ways delaying motherhood for all kinds of reasons causes more problems in terms of the underlying condition management of the condition and the one that causes me the most sadness I see more of it in Manchester even than I did in Sheffield is career women as well which is a different thing but I suppose, one thing that we are seeing more of now is a lot more women coming through to electively freeze their eggs, who are not in relationships, who are perhaps in there I think the only thing is at the moment we’re seeing a lot of them in their mid to late 30s, we might be better to see them in there around about 30 late 20s when they’ve really no idea where their life sort of pathways getting but they’re freezing oocytes at a point where they statistically have a much better chance of subsequently getting pregnant but it’s coming through into the psyche I think within the UK that for those ladies who are often doing very well in their careers or businesses or whatever, that actually they need to be thinking about it in terms of fertility before they’re actually ready to make those decisions in their own life and I think that’s again, in the last decades changing a lot, I think there’s an awareness coming through even from girls leaving school or going into college or whatever that it is something that, if they’re looking down long career pathways, they need to consider it whether they be medicine or law or business and finance and banking and all those things where you have to commit to probably your mid-30s before you’re necessarily in a position to step off the treadmill. So, I think the whole area of delaying motherhood is a massive issue because, as you say, from a clinical perspective very very relevant as well but also these these very large numbers of ladies who delay it for professional career-based reasons and I think they need to be actively encouraged to think about it when they’re 30 rather than suddenly when they’re approaching 40 realizing actually I’d really like to have a child now and it’s it’s heartbreaking, it’s it’s so so difficult. Lots of, lots of important issues there and yeah I think endometriosis is very important in terms of being missed, frequently missed. I’d have to say I think it’s not just missed in primary care, it’s missed in secondary care, there’s a lot of referrals go and it’s a difficult decision because gynecologists get criticized when they have a negative laparoscopy – those kind of things are audited and it isn’t always obvious from the history examination and sometimes scans and normal and things like MRI are valuable resources you don’t always have access to those but I think different gynecologists I know have different sort of levels of suspicion about it and have different trigger points for deciding whether someone needs a laparoscopy and there’s numerous examples through my career where ladies who’ve ended up being diagnosed with. I had a lady within the last five or six years, she ended up not having to have, she couldn’t have any children, she’d been seen by various gynecologists and I then referred to her. She changed practice because the GP wasn’t taken us seriously and she was a receptionist, a medical receptionist I just the first time I saw her I thought, I utterly believe you and I referred her through to one of my colleagues in Sheffield that I’ve worked with for many years who does a lot of endometriosis related to fertility and he, a few weeks later, he showed me the dvd of her laparoscopy and it was just about the worst pelvis he’d been in in a decade and she was 26 and he ended up doing as much surgery as he could to preserve her fertility but she’d been essentially criticized previously for requesting too much analgesia, people thought she was just not coping with the pain well – welcome to her world and she’s ended up now with curative surgery and she’s much better but the curative surgery was was very difficult and she’s not got any children and she’s probably about 30 now so, I think it’s a condition per se along with PCOS which is the other good example you brought up where diagnosis is frequently delayed put that way definitely in primary care but also often in secondary care, poorly managed in primary care and I think often poorly managed in secondary care as well and these are not rare. they’re very very common conditions and of great relevance to female health so, I think everyone needs to do better really from top to bottom really soon.
Fertility preservation is a procedure that allows women and men to preserve their fertility, their gametes (eggs and spermatozoa) and sometimes even the ovarian tissue. This allows women and men to have kids in the future because sometimes they know that they want to have kids but at that moment is not ideal because of work, economical circumstances, don’t have partner or because they are going through chemotherapy, for example, so by preserving the eggs and spermatozoa, they will have those gametes to use in the future. This means that they will stop the aging of the gametes and they will be able to use young gametes in the future. With aging, gametes start getting more abnormalities, chromosomal and genetic abnormalities, so by preserving the fertility, they will use young gametes. If for some reason, the preserved gametes wound have a bad quality, unfortunately when they thaw the gametes, they will have bad quality as well. This is why it is so important to have fertility consultation with specialists that can assess the patients.
Something that not all people think the same way. Some women I have seen want to get pregnant, they want to have a family since they are very very young and to the mentality of some other women and according to what we live during this era, many women prefer to follow their career and to do other stuff more important for their life. Because the reproductive window does not follow our well-being and because we have improved a lot of well-being the last 50 hundred years: we live longer, better quality of life. Unfortunately the reproductive clock is not following this improvement in our life, so the reproductive window is very strict: opens and closes at a very specific time for every woman. If this woman, she’s not sure about it, then she is very lucky that she has the option to freeze some of her eggs. Especially when your body is young and in a good condition.
Fertility preservation aims to preserve our fertility whether men or women over time or because our fertility is threatened by a medical intervention or medical condition, our body suffers such as in cancer patients. Normally, in cancer patients, we know that in most of the cases, an ongoing oncotherapy will follow in the form of chemotherapy or radiotherapy – both of them may have a temporal or a permanent negative impact on the men’s or on females fertility. So, for these people that their fertility is threatened by a medical condition or by time, they now have the option to preserve their fertility whether this is a sperm or the eggs and safeguard them in an effort, in an attempt to use them when the time is right for them for the body or for their life.
Fertility preservation is becoming more and more known nowadays and this is a very nice thing to see as well. Patients, male patients become more aware of the fact that they might have to store sperm. It’s not always cancer that can be the primary reason that the patient needs store sperm before the patient needs to start their chemo, radiotherapy or before they need to have the surgery but it can be other factors, for example, it can be because of their profession if someone is being exposed to chemicals all day or if they’re using any kind of dangerous equipment for example.
Fertility preservation can be definitely as well – we call this in the lab – safety policy. Someone can store sperm although a patient might be completely normozoospermic, a man can be normozoospermic but he can decide to store sperm just to be on the safe side if something happens to him in the future.
It can be, as I said, someone who has just been diagnosed with cancer and needs to store sperm. It can be someone who cannot be and doesn’t want to be, for example, a father right now but he might be thinking that he might be want to be having children later on in life and with a different partner but because he doesn’t know if he will be able to conceive naturally in the future, he decides to store some sperm in case his sperm quality deteriorates with advancing age
Fertility preservation is good for women that want to postpone getting pregnant to a later stage. It can be a personal choice due to career due to studying or not having found the right partner and therefore want to delay parenthood to later on.
Fertility preservation has been revolutionized for eggs on the egg side. We could not successfully freeze eggs in the past but a vitrification technique that was developed a few years ago has assisted us to successfully freeze and warm the eggs that are frozen later on for use. It is very useful for social reasons as mentioned but also very useful for patients that are going through medical treatments. If we have women that are going through cancer treatment, chemotherapy, radiotherapy which can impact the quality and the quantity of the eggs they have in their ovaries, it can completely unfortunately destroy the eggs they have so what we can do is before they start the treatment to freeze eggs and save them for future for when they have recovered to be able to have a child later on in life.
There is age-related fertility preservation as well so if you want to freeze your eggs, it’s advisable that you do it when you are in your early 30s or late 20s. As you get older the quantity and the quality of eggs we can get for freezing then it becomes significantly rich in use. If you are a 30 year old woman and you would like to, for whatever reason, freeze your eggs, you can freeze much better quality eggs and a higher number of eggs than in comparison to a 38 or a 39 year old woman who decides to freeze her eggs. If you have an intention of having a child later on in life you can certainly think about freezing your eggs and saving it for your future.
Ovarian tissue freezing involves removing a special piece of ovarian tissue from the one ovary – cutting it into tiny slices and then freezing then later when you are ready to try to conceive, the ovarian tissue slices are grafted back into your pelvis so around 9 months cellular the grafted ovarian tissue can start to produce reproductive hormones and follicular development the pregnancy may be achieved either with ovarian stimulation and IVF or perhaps even naturally. Before you begin chemotherapy or any treatment some of your semen also can be contained in sperm so it can be frozen and kept until you wish to start a family. Men, in case of men who have to travel overseas for work in dangerous situations for example, will also want to have their sperm frozen for use in the future. For other men particularly, for example those men who have small amounts of non-mature sperm in their ejaculate, sperm can sometimes be retrieved by surgery and then it can be collected using some methods that are not able to fertilize an egg on their own. They will need to be injected into a neck during a process that is called ICSI Intracytoplasmic Sperm Injection.
Fertility preservation is the procedure that patients always do to kind of put up a pause button on their fertility until a future date to decide to conceive. Fertility preservation is usually done for others for medical reasons. Medical reasons for example are in the cases of cancers where patients have to undergo cancer treatment. They have the option of freezing eggs, embryos or sperm to be used at a later date to help them conceive. It can also be used for social reasons when people have not decided when or yet have kids or babies. They have the option of freezing their sperm or even embryos to be used at a late date when to have children
Fertility Preservation is an option to save biological material of patients who cannot conceive right now or are going to be treated with gonadotoxic treatment. Mainly we are talking about fertility preservation in the field of oncology when a patient is going to have some gonadotoxic treatment or surgery. Another important point of fertility preservation is social freezing especially for female patients.
Fertility preservation is a very important part in the treatment of patients with oncological diseases who cannot have many doubts regarding the outcome of the main treatment and their future life being. Right now it’s well known that patients who have saved their own material before starting their treatment of an oncological disease sometimes have more successful outcomes of their main treatment.
Fertility Preservation is a technique to preserve, to store gametes. Usually we store eggs and sperm but we can also store ovarian tissue that is especially for oncological patients. Technique itself is just mainly to have something set aside after the event that we consider harmful for the ovaries, for example chemotherapy treatment for cancer patients but it can also cause age fertility decline – we can have something to use to get pregnant with our own eggs. That is the purpose of fertility preservation. It is just to have something stored just in case we need to use it. The options that we have available right now are mainly: for women: the option for egg freezing, also known as oocyte vitrification and the ovarian tissue preservation which is the more research technique that is used for oncological patients when we don’t have time to do ovarian stimulation. Then for men, we have an option of freezing sperm samples. Usually we freeze several samples and then with that we have enough to have stored and have a better chance of having pregnancy in the future.
