What is a medically indicated fertility preservation?

For some patients, fertility preservation is considered medically necessary if they have not yet had the chance to start or complete their family, and require treatment or medication that can cause impairment or loss of fertility. For example, fertility preservation may be considered medically necessary with individuals who are starting gender-affirming treatment. Fertility preservation can also be medically necessary with adolescents or adults undergoing treatment who may experience infertility as a side effect of chemotherapy or pelvic radiation. In anticipation of these outcomes, patients are encouraged to consider the option of freezing sperm, eggs, or embryos before starting treatment.

 

Ideally, fertility preservation should be discussed as early as possible when planning any sort of potentially fertility-compromising treatment. If you are receiving or have received fertility-compromising treatment, it may still be possible to pursue fertility preservation but each situation needs to be assessed individually. A care provider must send us a referral so we can discuss all available options. When required, we can expedite referrals for sperm banking and for those wanting to receive a medical consultation to discuss their medical and cancer-associated fertility risks.

Medically Indicated Fertility Preservation

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Fertility preservation for those who produce sperm

If you are interested in fertility preservation , first talk about it with your primary care provider. They can refer you to Mount Sinai Fertility.

Consultation and Preliminary Testing

At Mount Sinai Fertility, we’re here to support each patient throughout their fertility journey. Our involvement begins with an initial consultation and preliminary testing. During this session, we will work to develop an understanding of your situation, and conduct important tests to help you prepare for the next steps.

Sperm Sample Collection

For patients who produce sperm, the goal is to bank sperm for future use. The sperm sample is produced by masturbation and collected in a sterile container. We have collection rooms on site, or you can produce at home if you prefer. If the sample is produced off site, it must be delivered with 45 minutes to the clinic. The sperm sample must be collected after 2 to 5 days of sexual abstinence (no ejaculating/having intercourse). Ejaculating more or less often than this can lead to a lower sperm count. You must bring your valid Ontario Health Card to this appointment. If you do not Have an Ontario Health Card please contact our clinic to discuss other accepted forms of identification.

Sperm Wash and Cryopreservation

The andrologistst in our lab will process the sperm, dividing the sample(s) into different vials or straws. They will also assess the quality and quantity of the sperm. The sperm then goes through a washing process in the laboratory and is then frozen (banked) for future use. You will be informed of the number of vials stored and if it is recommended you produce additional samples.

Future Use

When the you decide it’s time to start a family, you will meet with one of our physicians to discuss options and determine a plan. If you are using banked sperm, the frozen sperm sample will be thawed and used for treatments such as intrauterine insemination (IUI), or in-vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Despite sophisticated technology, sperm banking is not perfect. On average, approximately 70% of the viable sperm survive the freezing and thawing process. Therefore, the success rates of pregnancy cannot be guaranteed. However, techniques such as ICSI may allow fertilization to occur even with compromised sperm samples. Successful pregnancy has been achieved with sperm stored for more than 10 years. Please note that when storing sperm with a clinic, patients will be billed a storage fee, usually every year. Patients must make sure to keep their clinic updated with their current contact information.

Fertility preservation for those who have ovaries

If you are interested in fertility preservation , first talk about it with your primary care provider. They can refer you to Mount Sinai Fertility.

Consultation and Preliminary Testing

At Mount Sinai Fertility, we’re here to support each patient throughout their fertility journey. Our involvement begins with an initial consultation and preliminary testing. During this session, we will work to develop an understanding of your situation, and conduct important tests to help you prepare for the next steps.

Controlled Ovarian Stimulation and Cycle Monitoring

You will be given injectable fertility medications to stimulate the ovaries to produce and grow more mature eggs. Some patients will also be given oral medications in addition to the injections, each patient is unique and your fertility care team will determine the most appropriate plan for you. Most patients need to take injectable fertility medications every day for 9 to 12 days. Over this period, we will perform blood tests and internal (transvaginal) ultrasounds to track the development of the follicles in the ovaries. While taking the fertility medications, you should expect to visit our clinic 4 to 6 times. These appointments are scheduled in the early morning. You may be asked to return every 1 to 2 days until they are ready for the egg retrieval procedure.

Trigger

Once the follicles have developed to an appropriate size and number, you will be prescribed a medication that helps the developing eggs complete their maturation process. The timing of this medication is very important. Our fertility care team will provide specific instructions on the time to perform this injection.

Egg Retrieval

The egg retrieval procedure is when eggs are removed from your ovaries using a needle and an internal ultrasound. The needle travels through a special cover attached to the internal ultrasound probe. It passes through the vagina and into each ovary. The follicles are drained and all the fluid sent to the lab. The embryologists working the in the lab carefully examine the fluid under the microscope to find the eggs.

The doctor will give you sedative medications through an IV before the procedure begins, to help relax you and provide pain relief. While you will not be asleep, you should be comfortable. The procedure takes about 15 to 20 minutes. Afterwards, you will stay in our recovery area for about 1 hour before going home. Once the eggs are retrieved, the mature eggs will be frozen. If the patient has opted for embryo freezing, the eggs will be fertilized either through IVF or ICSI. An embryologist will follow the growth of the fertilized eggs growth in the lab for 5 or 6 days before freezing for future use.

Embryo Freezing vs. Egg Freezing

Embryo freezing offers the best chance of pregnancy because the odds of an embryo surviving the freezing and thawing process, and implanting in the uterus, is higher than the odds of creating a pregnancy from frozen eggs. However, not all patients have a partner with sperm or are interested in using donor sperm; therefore, egg freezing is also an option.

Future Use

When you decide it’s time to start a family, you will meet with one of our physicians to discuss options and determine a plan. Although future fertility cannot be guaranteed, many people who have undergone fertility-compromising treatments are able to achieve a successful pregnancy through the use of assisted reproductive technologies. Please note that when storing eggs or embryos with a clinic, patients will be billed a storage fee, usually every year. Patients must make sure to keep their clinic updated with their current contact information.