If you’ve always dreamed of being a parent ‘someday’, but the time is still not right, be proactive and ensure that when the right time comes, you can still achieve your dream. Fertility preservation is a way to pause your reproductive biological clock by saving eggs, sperm or reproductive tissue for later use.
Dr. Lee Caperton from Caperton Fertility Institute discusses fertility preservation with Dreaming of Baby.
Daniela: Good morning, and welcome to Dreaming of Baby! We have with us today Dr. Lee Caperton, with whom we shall be discussing fertility preservation. It’s a pleasure to welcome you Dr. Caperton! Before we start with our discussion, it would be great if you could introduce yourself and your work in this field.
Lee Caperton, MD: Thanks for inviting me Daniela, you chose a topic very close to my heart and one that I am passionate about. I am Dr. Lee Caperton, Founder, CEO, and Medical Director of Caperton Fertility Institute, a rapidly growing, concierge, full-service IVF and fertility practice with offices in New Mexico and Texas, USA.
What is fertility preservation?
Daniela: Thank you for this introduction, Dr. Caperton. To start our discussion, what is fertility preservation?
Lee Caperton, MD: Fertility Preservation is the practice of attempting to preserve fertility potential for patients that either have an immediate threat to fertility (chemotherapy or other toxic therapy that may injure the ovaries or testis including planned surgery) or who are attempting to delay child-bearing in order to have a partner or more appropriate timing for raising children in the future.
Daniela: So would these instances be the ones where fertility preservation is recommended?
Lee Caperton, MD: Yes, usually in a circumstance where there is a planned medical procedure or treatment that has the risk of damaging the sperm or eggs; or, when patients would like to protect fertility for future child-bearing. The consequences of aging, particularly in the female, are so dramatic with time, that many patients are now becoming more pro-active in attempting to preserve the potential for fertility well into the advanced years of normal reproductive life. Fortunately, we live in a world where women are now encouraged to seek higher education and are empowered to attain professional careers, and this has sometimes come in conflict with the timing of starting a family.
How is fertility preserved?
Daniela: Thanks for clarifying, Dr. Caperton. In terms of processes, is there any difference between fertility preservation because of an immediate threat to fertility, and preservation to delay child-bearing?
Lee Caperton, MD: Of course, in terms of fertility preservation for a life-threatening condition, there is an immediate need – in some patients, treatment starts the exact day that they contact our office. With fertility preservation for delaying child-bearing to a different time, there is much more flexibility in the timing of the assisted reproductive techniques.
Lee Caperton, MD: In general however, the technology is similar. Similar techniques are used to create eggs (oocytes) or sperm for freezing. Or, if partners are prepared to create embryos, that can be accomplished for fertility preservation as well. In terms of techniques, sperm can either be ejaculated and frozen immediately or, if not accessible, a testicular biopsy or sperm extraction process can recover gametes prior to freezing for long-term storage. On the female side, the ovary generally must be stimulated for approximately a week, with hormones made by the brain and sometimes other medicines, to get more than a single egg, which is the natural physiologic product in a unstimulated menstrual cycle.
Lee Caperton, MD: When this is possible, which is always the case for fertility preservation in a non-urgent manner, we tend to get 8-15 eggs for freezing, and insist that vitrification, or the newest technology in freezing, is used to ensure the highest likelihood that the eggs will survive when thawed at a later time. If stimulation is not a possibility, the science becomes more experimental. Tissue must be harvested from the ovary with the idea that it be matured later at some point in the laboratory, or re-implanted into the women’s body to create mature oocytes that are competent for fertilization. These techniques are MUCH less successful, but there is a lot of ongoing work in maximizing the potential with some of these laboratory processes.
Lee Caperton, MD: In the last decade, the technology for freezing and thawing eggs has become so robust, that I believe that fertility preservation will massively expand in patients who would like to delay child-bearing for a period of time. We are already starting to see that expansion and interest in the US, and large companies are starting to offer fertility preservation as one of their perks to attract fantastic young professionals.
Dr. Lee Caperton: “The technology for freezing and thawing eggs has become so robust, that I believe that fertility preservation will massively expand in patients who would like to delay child-bearing for a period of time.”
Deciding on fertility preservation as a couple
Daniela: Thank you for this overview, Dr. Caperton. For a couple wishing to preserve their fertility, and are unsure which path to follow, what factors are taken into consideration when analyzing whether to opt for egg/sperm freezing or embryo freezing? Are there different success rates for positive pregnancy outcomes between the two?
Lee Caperton, MD: That is a great and timely question. At our Institute, we are lucky to have one of the pioneers of egg freezing in our laboratory. We have also introduced new technology over the last several years that suggests that, with respect to success rates, there is little difference between freezing eggs versus freezing embryos. But technology, customized medical stimulation protocols, and the correct hands in the laboratory are essential to that success being similar.
Lee Caperton, MD: So, if you asked me that question even a few years ago, the answer would have been that freezing embryos is far superior to freezing eggs – not true anymore!
The big issue that really comes up now is the ethical issue of having embryos frozen in the laboratory that may or may not be used over time. So, freezing eggs or sperm removes that ethical issue, until fertilization is completed at a later time.
Daniela: I can completely understand the ethical side of the issue – it’s also very positive that outcomes with egg freezing have improved so much.
Lee Caperton, MD: Sperm freezing is a little different because the effects of aging are not usually very prominent in men until 50 years of age. In women, the current science suggests that there is a steady decrease in fertility potential in most women starting about age 29, and between 38-40 women are losing approximately 50% of their fertility potential annually. After 40, that acceleration continues more rapidly, likely in the neighborhood of a 66% a year decrease in fertility potential through age 42.
Daniela: Wow, that is a staggering figure!
Lee Caperton, MD: After that, pregnancy with one’s own eggs becomes much rarer, and the data suggests even a faster decline in fertility potential as a result of natural aging on the female side. The trouble with reproductive aging is that although our life expectancy and general health have changed so dramatically over time, reproductive aging does not seem to have slowed. It appears that the clock is not modifiable through current technology.
Dr. Lee Caperton: “The trouble with reproductive aging is that although our life expectancy and general health have changed so dramatically over time, reproductive aging does not seem to have slowed.”
Are there any adverse effects?
Daniela: That is an interesting observation. In short then, preserving your fertility is a sort of insurance protection towards parenthood… With the aim of presenting a well-rounded picture of fertility preservation, are there any adverse effects related to the preservation process, particularly in women?
Lee Caperton, MD: No, the evidence really supports that when done in practices like Caperton Fertility Institute, where we focus on low-dose stimulations to give you a better quality of eggs than quantity, there are negligible risks to the process in the short-term, and no long-term risks that are scientifically substantiated. The one thing that you have to keep in mind is that prolonging pregnancy to a later age, particularly into the 4th and 5th decade of life, is clearly associated with higher risks of pregnancy-related complications.
What are the requirements for fertility preservation?
Daniela: Thank you for sharing this insight with us, Dr. Caperton. Are there any requirements that should be met before fertility can be preserved? Is there an ideal weight, dietary history, etc.?
Lee Caperton, MD: A healthy lifestyle and a BMI as close to 25 is paramount when considering fertility preservation. Sooner is better, because of the issues related to natural aging on the female side, and the reduction of fertility potential with time. And I think patients need to carefully consider where they choose to go for these techniques – a supportive, connected, caring environment lessens the stress and I would say is almost as important as the science in place.
Daniela: Thank you, Dr. Caperton, on a final note, what would be that one piece of advice that you’d always share with someone thinking of preserving their fertility?
Lee Caperton, MD: Be positive, even when things may not seem positive – it matters!
Daniela: Thank you for your time today. It’s been a truly enlightening discussion!