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Fertility Preservation
What is fertility preservation?
Our ovaries and testes are vital reproductive organs in our body. They are extremely sensitive to injury from medications, diseases, chemotherapy and radiation. Fertility preservation refers to strategies hoping to retain one’s fertility from the damage of such anti-cancer treatment or medical treatments that renders his/her infertile, offering a chance to have their biological offspring in the future.
Who should be considering fertility preservation?
Patients with Malignant Conditions
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Patients with Benign Conditions
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Available methods for fertility preservation
For Men
Sperm Freezing
Freezing the sperm before surgery or anti-cancer treatment is a simple and effective mean for preserving fertility in men. Their sperm can be thawed and used later with the aid of assisted reproductive technology when they are married and fully recovered from their cancer.
For Women
Fertility preservation in women is more complex. It will depend on the time available before anti-cancer treatment and whether she has a male partner or not.
Embryo Freezing
The most established method is freezing embryos. In this procedure, hormones are given to the patient to stimulate her ovaries to produce a certain amount of mature eggs. These eggs are then collected surgically. The eggs will be fertilized with her husband’s sperm to create embryos. These embryos will then be frozen for future use and transferred back into her womb when she has fully recovered from her cancer.
This method is suitable for female cancer patients who are already married and have adequate time for ovarian hormonal stimulation before their anti-cancer treatment. It is not suitable for those who need to have their anti-cancer started immediately. Moreover, during the ovarian stimulation process, there is a temporary increase in the hormones level which may lead to regrowth of some tumor cells.
What if I am single?
Freezing Mature Eggs
In case you are single, you can consider freezing your mature eggs. In this method, the mature eggs are collected surgically and frozen after hormonal stimulation. However, again, this method requires time for ovarian stimulation causing possible delay in starting anti-cancer treatment. It will also lead to temporary increase in hormone levels which may lead to regrowth of some tumor cells. In addition, according to current literature, you need to freeze at least 15-20 mature eggs in order to have a reasonable chance of having a baby born. Thus, some patients may need to undergo more than one cycle of ovarian stimulation.
What if I don’t have time for ovarian stimulation?
The following treatments are being developed in Prince of Wales Hospital but at present we can refer to centres with established service.
Freezing Immature Eggs
In case you don’t have time for ovarian stimulation, you can consider collecting the immature eggs surgically without ovarian stimulation. However, this procedure is not available in our unit yet.
Freezing Ovarian Tissue
Ovarian tissue freezing, also known as ovarian tissue cryopreservation, is a fertility preservation method that involves surgically removing a portion of ovarian tissue, which contains thousands of immature eggs, and then freezing it for future use. This technique is particularly useful for the following patient groups:
- Female who need to start anti-cancer therapy immediately.
- Female who cannot tolerate the hormonal medications which are required for egg retrieval – certain medical conditions have risks associated with stimulating egg growth.
- Girls who have not yet started puberty and therefore cannot undergo egg retrieval.
When the patient is ready to attempt pregnancy, the ovarian tissue can be thawed and re-implanted back into her body, either in the remaining ovary or other site in hopes that it will restore the natural function. If this is successful, and the patient starts ovulating, there’s a possibility for pregnancy to occur through natural processes. If not, IVF techniques may be used to attempt pregnancy using any eggs produced from the grafted tissue.
Our unit and Prince of Wales Hospital has developed a pilot scheme on this procedure to help our patients.
For Children
If you want to know more about the children fertility preservation service, please contact the ART Unit at (852) 3505 1456 or email us at ivfhkmed@cuhk.edu.hk.
Fertility Preservation Strategies Summary
Are there any regulations in Hong Kong concerning fertility preservation?
Yes, the Code of Practice on Reproductive Technology and Embryo Research from the Council on Human Reproductive Technology has set regulations on fertility preservation. For details, please visit https://www.chrt.org.hk/english/publications/files/code2024.pdf or contact our staff.
How much does the fertility preservation service costs in our unit?
At this moment, fertility preservation service in our unit is still provided as a private service only. For fees details, please contact our centre at (852) 3505 1456.
Fertility Preservation Support Service
Cancer treatment may have an adverse impact on fertility. Patients may consider undergoing a fertility preservation (FP) programme (i.e., embryo, eggs, sperm or reproductive tissue freezing) before cancer treatment. FP is an option for young adult cancer survivors to preserve their fertility ability. However, FP treatment is expensive and may only be affordable for some. Hong Kong Cancer Fund has launched the "Fertility Preservation Support Service". The Chinese University of Hong Kong provides professional medical services to help young cancer patients aged 18 to 35. If you have any inquiries, please call the Hong Kong Cancer Fund at 3656 0800 for a free consultation.
You may also visit the website of Hong Kong Cancer Fund for more details about Fertility Preservation Support Service: https://www.cancer-fund.org/en/blog/fertility-preservation-support-service-programme/