Currently, four different options exist for fertility preservation prior to gonadotoxic therapy. These are listed below:
Fertility preservation
Fertility protection
Downregulation of the ovaries during chemotherapy with a so-called GnRH agonist.
- Low inconvenience and immediately feasible (e.g., as a monthly or 3-monthly injection)
- not recommended as a sole method for fertility preservation due to inconsistent study data on effectiveness
- Possible application in combination with cryopreservation of oocytes and/or ovarian tissue, depending on time available before cytotoxic therapy is administered
Cost:
| Germany: | Self-pay service |
| Switzerland: | Self-pay service |
| Austria: | Self-pay service |
Harvesting of oocytes after ovarian stimulation
- Required time frame at least 14 days, multiple procedures are possible depending on the time available and, depending on the individual oocyte reserve, this may also be advisable.
- chances depend on age, number of retrieved mature oocytes and underlying disease
- later ICSI necessary
- later follow-up costs in terms of co-payment analogous to other MAR (medical assisted reproduction) depending on insurance status
- later embryo transfer also possible if no ovarian activity is left
Cost:
| Germany: | Costs (including storage costs) are covered since 01.07.2021 after publication of the first cryopreservation guideline by the G-BA (Joint Federal Committee), provided that the conditions for coverage are met (possibly billing problems at the universities) |
| Switzerland: | Cost coverage incl. storage costs for 10 years. |
| Austria: | In case of an existing partnership, 70% cost coverage by the IVF fund is possible, provided that the conditions for coverage are met, storage as a self-payer service. |
Freezing of ovarian tissue
- can be carried out at very short notice, time required is approx. 2 days
- spontaneous pregnancies and restoration of natural ovarian activity is possible
- only option for preserving fertility in children and adolescents
- Risk of transferring malignant cells during subsequent transplantation (depends on tumor type)
Cost:
| Germany: | Cost coverage planned by the G-BA for women after menarche until 40. birthday, currently still a self-pay service, currently positive individual case decisions by health insurance companies possible |
| Switzerland: | Cost coverage incl. storage costs for 10 years. |
| Austria: | Self-payer benefit. |
Surgical relocation of the ovaries from the radiation area
- useful in case of sole radiation of the ovaries
- scattered radiation at high dose despite ovarian relocation may reduce fertility
- possibly restriction of fertility after co-irradiation of the uterus
- surgical intervention required for subsequent relocation of the ovaries to archive spontaneous pregnancy
- not recommended as the sole method of fertility preservation
- possible in combination with cryopreservation of oocytes and/or ovarian tissue, depending on time available before cytotoxic therapy
Cost:
| Germany: | Self-pay service (if no other abdominal surgery is required). |
| Switzerland: | Cost coverage |
| Austria: | Cost coverage |
Measures after chemotherapy:
Even after chemotherapy and/or radiation, fertility-preserving measures may still be possible. We therefore recommend counseling in this situation as well. Another important topic of discussion after therapy can be endocrinological (= hormonal) aftercare.
All these procedures can be combined with each other – if reasonable and desired.
One way to facilitate the patient’s decision after the consultation regarding fertility preserving measures is the “decision aid” online tool “linked here”.
It is a digital decision aid developed by psychologists, psychotherapists and reproductive physicians.
(Chap. 3) (german version)
An english version can be bought: Fertility Preservation in Oncological and Non-Oncological Diseases a practical guide by Michael von Wolff & Frank Nawroth ISBN 978-3-030-47567-3 from Springer.com
Part III page 169ff.