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.