Fertility preservation for medical reasons

Medical fertility preservation is offered when a disease or its treatment may endanger fertility. Certain treatments, such as ovarian or testicular surgery, chemotherapy, radiotherapy, or certain genetic conditions, can damage the ovaries or testes. These are often cancer treatments that may be harmful to fertility. Such treatments are called “gonadotoxic.”

In this context, it is recommended to plan fertility preservation if possible before starting treatment. The medical field that assesses fertility risks and offers preservation techniques in cancer cases is called oncofertility. Oncofertility concerns women and men of reproductive age, as well as adolescents and children.

It is also important to know that certain non-cancerous diseases, such as benign hematological diseases (e.g., sickle cell disease) or autoimmune diseases, also require gonadotoxic treatments. Some genetic diseases can be associated with premature ovarian failure or risk of testicular insufficiency. Fertility preservation may also be indicated in these cases. Fertility preservation may also be considered if a surgical treatment risks reducing ovarian reserve, such as endometriosis surgery.

The INAMI/RIZIV covers only part of these indications.

Various methods of gamete cryopreservation have been offered at Erasmus Hospital for around twenty years. Cryopreservation is a technique that allows human cells and tissues, including oocytes, sperm, and ovarian tissue, to be preserved long-term at -72°C.

Fertility preservation in girls and women

Oocyte and/or embryo preservation

If you are a young woman and your gonadotoxic treatment can be postponed for a few weeks, ovarian stimulation may be considered to collect oocytes via transvaginal aspiration. Depending on your preference, these oocytes can be frozen as-is and/or fertilized with your partner’s sperm or donor sperm. Oocytes are stored for 10 years, and embryos for 5 years. Storage periods can be shortened or extended upon request. In case of future infertility, these oocytes or embryos can be thawed and used for pregnancy. As with any assisted reproductive procedure, success cannot be guaranteed. The INAMI/RIZIV covers this procedure up to age 37. In Belgium, the maximum age for fertilization of oocytes is 45, and for embryo transfer 47.

Ovarian tissue preservation

When gonadotoxic treatment must start urgently, has already started, or in adolescents or children, an alternative to oocyte preservation is to harvest an ovarian fragment or whole ovary via laparoscopic surgery under general anesthesia. The goal is to cryopreserve ovarian tissue fragments, which contain a large number of oocytes. This procedure can be offered up to age 36. Storage of ovarian tissue fragments is 10 years, which can be shortened or extended upon request. If there is a desire for pregnancy after recovery, and fertility has been irreversibly affected, the ovarian tissue can be transplanted to restore fertility. Before transplantation, further analysis is needed to exclude tumor cells. Transplantation must occur before age 45. In Belgium, the maximum age for fertilization of oocytes from transplanted tissue is 45, and 47 for embryo transfer. Over 200 children have already been born worldwide using this technique, including several at Erasme Hospital. Success cannot be guaranteed, and this technique is considered innovative.

Fertility preservation in boys and men

Sperm preservation

Cryopreservation of mature sperm obtained from ejaculate (by masturbation) has existed for many years and is a simple method to preserve male fertility long-term.

Depending on your diagnosis and urgency of treatment, you will have multiple appointments (usually 3) at the andrology lab to preserve several samples for 10 years, which can be shortened or extended upon request. In case of infertility following gonadotoxic treatment, the frozen sperm can be used to achieve pregnancy with your partner. Depending on the quality and number of samples, artificial insemination or IVF with ICSI may be considered. If sperm cannot be obtained via ejaculation, a testicular biopsy under general anesthesia may be performed.

In children, it is also possible to harvest and store testicular tissue in collaboration with other hospitals. Currently, this technique remains experimental, and no pregnancies have yet been achieved from testicular tissue collected from children.

Before starting your treatment or upon diagnosis of a disease, it is important to discuss the possible impact on fertility with your treating physician. You may be referred to one of our fertility preservation specialists, who will inform you about the options according to your personal situation.

In Belgium, under certain conditions, fertility preservation procedures may be reimbursed by INAMI/RIZIV for women under 38 and men under 45, if they are insured.