Healthcare professionals call for better practices in preserving future fertility for cancer patients, transfolk, and others.
Today (4 January), at the Fertility 2018 meeting in Liverpool, the British Fertility Society will present brand new guidelines for clinicians on fertility preservation for people assigned female at birth. Fertility preservation is a rapidly growing specialty and the latest tools, techniques, and opinions must be considered when discussing future fertility with patients.
Professor Adam Balen, Chair, British Fertility Society said “There are a number of situations where the preservation of fertility is needed. This has to happen at a time before a person is ready to start a family and can sometimes be the only hope for becoming a parent in the future. Our guidelines are designed to help our members and the wider fertility community to decide on the best course of treatment, in consultation with these patients.”
Dr Melanie Davies, University College London Hospitals, an author on the paper, which is published today in the British Fertility Society journal, Human Fertility said “Embryo preservation is the most established technique but it isn’t suitable for people who don’t have the sperm of a partner to fertilise eggs or are as yet unsure about committing to having a child with their partner.
“It is far more common now to freeze unfertilised eggs, and this is now considered an established method of fertility preservation. But there are also promising experimental approaches coming to the fore. For example, a person can now have part of an ovary frozen that can later be transplanted back into their body. This may be a particularly suitable technique for patients who have not yet reached puberty or where there is not enough time to undergo ovarian stimulation and egg freezing. The birth rates following this new technique are looking good and we hope that soon it will be available nationwide.”
Ephia Yasmin, from University College London Hospitals, is lead author on the paper, she added “As well as storing embryos, eggs, or ovarian tissue for the future, there are alternative techniques that spare fertility during medical treatment. For example, ovarian transposition – where an ovary is moved away from the site receiving radiation treatment – has proven to be an effective strategy and reduces the need for invasive fertility treatment later on.”
For women undergoing cancer treatment, the medicine that cures them can also render them infertile. This can be down to the damaging effects of chemotherapy drugs, or the directed action of radiation treatment for pelvic and abdominal cancers. The fact that parents are increasingly waiting until their 30s or 40s to start a family also means that the likelihood of a person having not given birth prior to cancer treatment is ever higher.
Fertility preservation has never been more important for this group and the discussion of fertility preservation should happen as early as possible in the cancer treatment pathway. Preventing any delay to the cancer treatment should be a high priority.
Genetic, congenital and other conditions
There are also a number of conditions that lead to infertility. For example, a young person diagnosed with Turner Syndrome will be able to carry a baby in future but cannot produce her own eggs. Although it is a relatively rare condition, the Society is finding that mothers of children with Turner Syndrome are prepared to donate and freeze their own eggs so that their daughter has an opportunity to become pregnant, if and when the time is right for her.
People who have undergone stem cell transplantation, for reasons other than cancer, such as sickle cell anaemia, for example, can also suffer infertility because of the medicines they are given during their treatment.
Fertility preservation should be considered for all these conditions – not just for cancer patients.
For people who are diagnosed with gender dysphoria – their gender identity does not match their physical sex – medical interventions, such as hormone treatment and surgery, may be necessary and can reduce or destroy fertility. By freezing eggs, embryos, or ovarian tissue, there is still the opportunity for transfolk to have a child who is biologically related to them, through pregnancy or surrogacy.
Dr James Barrett, Charing Cross Hospital, is presenting at Fertility 2018 on fertility preservation for transfolk. He said “The number of people coming forward with gender dysphoria has increased rapidly over the past decade. But the consistent provision of NHS funding for fertility preservation for this group has yet to catch up. My clinic sees around half of the patients being referred for difficulties with gender identity in the UK and although we do discuss future fertility with them, they are not always able to self-fund for the necessary procedures and ongoing storage of material. Infertility is a real disease and it is hugely frustrating that the whole NHS is not always able to help our patients with that part of their lives.”
In 2013 NICE (the National Institute for Health and Care Excellence) updated guidance on fertility, including a recommendation that the criteria for NHS fertility treatment should not apply to women seeking fertility preservation, and that no lower age limit should be used. In reality, the provision of fertility preservation treatment is patchy, with local CCGs (Clinical Commissioning Groups) deciding on the availability of funds to enable people to take advantage of the latest clinical developments.
There is also a need to coordinate the storage of and access to eggs, embryos or ovarian tissue, nationally. And to do so in a flexible way because it is as yet unclear how many people who preserve fertility will actually go on to use the stored material.
“Fertility preservation for medical reasons in girls and women: British Fertility Society Policy and Practice guideline” is published today in Human Fertility.
British Fertility Society Press Office
Tel: +44 (0)117 405 7357 / +44 (0) 7748 653 582
About the British Fertility Society
The British Fertility Society was founded in 1972, by a small group with a common interest in infertility. Since then the burgeoning knowledge in this exciting area of medicine has resulted in the development and introduction of many new reproductive technologies and into clinical practice. The British Fertility Society has grown alongside the development of our speciality and now actively promotes the sharing of knowledge, further education and raising standards of practice.
Today, the Society recognises the multi-disciplinary nature of science and practice of reproductive medicine and welcomes andrologists, counsellors, embryologists, endocrinologists, nurses, and other professional groups working in this field, into its membership.
About Fertility 2018
The 2018 Joint Conference of the Association of Clinical Embryologists, British Fertility Society and the Society for Reproduction & Fertility returns to the ACC Liverpool on 4-6 January 2018.
The conference is now the largest of its kind in the UK bringing together over 700 fertility experts to enjoy a packed three day programme showcasing the latest scientific and clinical developments and updates in fertility, sexual health and reproductive biology.