Fertility Preservation and Ethics

Question 1

We can preserve both male and femal fertility, which is harder?

Answer 1

Female is harder as oocytes are more difficult to freeze and thaw due to large size.

Sperm can be effectively frozen in liquid nitrogen for many years as they are small.

Thawed in a less cold environment as it allows the formation of ice crystals inside bacterial filled cytoplasms, which form water, then re-form ice-crystals (which lyses bacteria) of the embryo

Ice crystals are damaging so have to work around that?

Question 2

Can embryos be readily frozen?

Answer 2

Yes. Their cell size is much smaller and thereare mutiple.

If you damage 1, the remaining 8 or 16 will most likely recover.

Many clinics now use a ‘freeze-all’ technique and put them back into the women in a non-stimulated cycle

Question 3

Is it appropriate to obtain gametes from boys who have childhood cancer?

Answer 3

The boys isn’t consenting to children, he’s simply consenting to testis biposied, is he competant for this?

But if he isn’t allowed to consent to cancer should he be for this? is this life saving in terms of his ability to create life.

Stem cells in testis can be cultured to make sperm

Question 4

Success rates with freezing oocytes?

Answer 4

Freezing fast and thawing fast.

2007: ~90% oocyte survival, but only 11% live birth

2012: ~85% occyte survived, but only 15.8% live birth
Maternal age had a big impact!!

Even today, technology is continuing to improve and get better.

Question 5

Is it appropriate to obtain gametes from young girls who

1. Have childhood cancer
2. Who might undergo premature ovarian failure (genetically present)

Answer 5

What procedure will be required for this (pump full of hormones? take some ovarian tissue?). The issue of preventing abnormalities in our society, should we interfere at all? Or let natural selection take control. Who’s going to pay for it in the first place, and then pay for the subsequant storage?

What type of cancer does she have, and will her ovaries be damaged in cancer treatment?

Question 6

Excised strips from ovarian cortex, transplanted this tissue into their forearms, from natural and induced cycles they grew a follicle which could be obtained and fertilised!!!

Nowadays cortical strips are taken, frozen and thawed and later reattached/stitched to the ovarian medulla (usually to only one ovary because they may not be damaged by therapy, and so is beneficial to the woman to still have one!)

Does this work??

Answer 6

Some of these then undergo spontaneous ovulations, IVF pickups and then in vivo fertilsation.

So this therapy is working!

((all slow frozen.))

Question 7

1. Apple and Facebook are offering to freeze eggs for femal employees in an effort to attract more women onto their staff.
   This costs >$10,000 not including storage.
2. Pre-deployment fertility preservation for Military Families

Is this a good thing?

Answer 7

For medical Reasons

• Those undergoing gonadotoxic therapies

For social Reasons:

• Want to delay onset of family/advance career
• Not sure about current partner
• Don’t have current partner
• and many more…..

Question 8

Should we allow the preservation of fertility for non-medical reasons??

Eg; social reasons primarily for female reasons

Answer 8

• If we have the technology, why not use it?
• Expense to society
• Big ticklist you have to meet
• Creates disparity in those that cannot afford that kind of treatment?
• What’s the psychological impact of the child?
• We don’t know the impact on the baby!

Question 9

Mum can have a uterus transplant under immunosuppression!

Answer 9

These women were menstruating, and delivered a healthy baby.

• Good for non-functional uterus