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In women, fertility starts declining in the late 20s and early 30s, while a rapid decline is seen after 35 years of age. By the time they reach puberty the quality and quantity of eggs decreases from millions to 30,000. We can say that age is the major factor why women suffer from infertility, although today’s generational habits, hormonal imbalance illness, and family history play a part in the declining fertility of women. Now, do we have any option? Fertility preservation is one such solution which is in talks presently. Understanding it through a case study.
“Mrs. Mamta, aged 35 years old, obese with a BMI of 27 kg/m² has been struggling with infertility for the last five years. One diagnosis was found that she has a history of anovulatory cycles and hysterosalpingography (HSG) revealed tubal blockage. The anovulatory cycle is when the egg is not released from the ovaries during menstruation. In the case of tubal blockage, fallopian tubes don’t allow egg and sperm to meet. Both lead to infertility,” shared Dr. Jasneet Kaur, Consultant and Clinical Director – Reproductive Medicine, Milann Fertility Center, Chandigarh.
She added, “Along with this, she also had borderline hypertension and a family history of diabetes, so in general she had impaired glucose tolerance or prediabetic. She was also diagnosed with bilateral fimbrial blockages and a positive test for tuberculosis (Koch’s disease) in her endometrial tissue causing atypical complex hyperplasia, which is the abnormal growth of endometrial cells (uterine lining), and well-differentiated endometrioid adenocarcinoma (Grade 1) means cancer cells are almost exactly replicating the endometrial cells, and slowly progressing towards cancer.
Based on the analysis, she was prescribed to undergo definitive surgery which could have possibly eliminated her natural conceiving, but she opted for fertility preservation.”
What is Fertility Preservation?
It is a process to preserve your eggs, embryo, sperm, and reproductive tissues for future use. It is usually recommended for those with cancer, and other health issues – autoimmune diseases, age, or transgender.
Fertility preservation can be categorized under two types – minimizing the impacts of drugs or diseases on reproductive tissues while getting treated for cancer and removing or freezing reproductive organs.
Procedure for Fertility Preservation
The procedure is mostly personalized based on body conditions and functioning. The process starts with ovary stimulation. And then hormones are injected. Eggs are drawn using needles under proper sedatives. This process is done under ultrasound guidance. Then eggs are directly frozen or after fertilization, it is done.
“But in her case, the team decided to treat her hormonal therapy beginning megestrol acetate 80 mg three times a day and placing a levonorgestrel intrauterine contraceptive device (LNG-IUCD) for treating cancer with the preservation of her reproductive organs. In addition, she resumed metformin for glucose control and was advised to lose weight for overall improved health,” she explained.
“The process was done under regular observation. After three – and – six months when the cancer was negative, hormonal therapy followed by assisted reproductive technology was done. Given her condition, controlled ovarian stimulation (COS) was started with a progestin-primed ovarian stimulation (PPOS) protocol. Ovarian stimulation was successful, giving rise to four mature oocytes: all were fertilized, making two blastocysts of high quality that have been frozen, “she added.
The embryos or fertilized eggs are then placed in the womb of the mother or someone else’s womb who’ll conceive your child. Ultimately, Mrs. Mamta had to choose surrogacy due to the return of cancer, although it didn’t spread it made unable her to carry the child.
People should opt for conceiving naturally instead of going through many artificial procedures until it is needed for artificial methods. And also, this case suggests that woman should at least do a fertility test in their 20s to 30s.
