Frozen Assets? Preserving Sperm, Eggs and Embryos

Progress Educational Trust
Great Hall, Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ
25 October 2016
This public event was organised by the Progress Educational Trust (PET), was supported by the Scottish Government, and was held at the Royal College of Physicians of Edinburgh.
Fertility preservation is an option offered to people who have an illness or an occupation, or who are undergoing a treatment, which places them at risk of infertility.
This is especially important in relation to cancer, because some cancers and many cancer treatments affect patients' fertility. It may also be appropriate following the diagnosis of any condition, or prior to any treatment for disease or injury, where there is a chance that the condition and/or the treatment could affect the reproductive system.
Fertility preservation can involve the cryopreservation (freezing) of eggs, sperm or embryos. It can also involve the freezing of tissue from the ovaries or testicles. This year, a cancer patient in Edinburgh became the first woman in the UK to have a child following a transplant of her frozen ovarian tissue.
Many experts and authorities, in the UK and elsewhere, have argued that every cancer patient should be given accurate information about risks to their fertility and how their fertility might be preserved. This is usually recommended regardless of whether or not there are local facilities for fertility preservation in the patient's vicinity. For example, the National Institute for Health and Care Excellence has recommended that 'at diagnosis, the impact of the cancer and its treatment on future fertility should be discussed between the person diagnosed with cancer and their cancer team'.
In reality, however, not every cancer patient is given this sort of information. When the priority is treating cancer, there may be little time left to discuss fertility. And if cancer treatment is particularly urgent, then it may be unavoidable that patients' options are limited. Even so, there are worrying examples of clinicians seemingly neglecting to consider fertility, as well as examples of fertility preservation being impractical due to poor coordination of care between specialities.
Female cancer patients in particular say they are not given enough information about the risk posed to their fertility by treatment. A recent survey by the charity Breast Cancer Care found that more than half of younger women diagnosed with breast cancer have no discussion with healthcare professionals about fertility preservation options, despite the majority of these women undergoing chemotherapy (which can cause infertility). The same charity has previously estimated that thousands of breast cancer patients across the UK miss out on fertility referrals every year.
Other patients who may need fertility preservation include the small (but growing) number of transgender and transsexual people who wish to undergo gender reassignment while still retaining the option to have children. Fertility preservation may also be appropriate for people entering high-risk occupations.
This event explored:
When fertility preservation should - and should not - be offered to patients.
What options exist for fertility preservation, how successful they are, and whether and to what extent they are (or should be) publicly funded.
Why some patients are not being counselled about the potential impact on their fertility of their disease and/or their treatment, and what can be done to rectify this.
What happens when a patient conceives with their partner and has embryos cryopreserved, if the relationship subsequently breaks down and there is a dispute over what should happen with the embryos. There have been numerous difficult court cases, in the UK and elsewhere, involving such scenarios.
What should happen to cryopreserved gametes, gonadal tissue or embryos in the longer term. There are three options at any given time - use these 'frozen assets' to try to establish a pregnancy, have them destroyed, or do nothing and keep the previous two options open.
What the future might offer, in terms of further innovations and new options for preserving fertility.

Alison Hume
Breast Care Nurse Specialist at the Edinburgh Breast Unit at Western General Hospital, and contributor to Breast Cancer Care's Fertility Toolkit
Richard Anderson
Professor of Clinical Reproductive Science and Head of Obstetrics and Gynaecology at the University of Edinburgh's Centre for Reproductive Health, and Consultant in Reproductive Medicine at the Royal Infirmary of Edinburgh and the Edinburgh Clinic
Allan Pacey
Trustee at PET, and Professor of Andrology at the University of Sheffield
Dr Mary Neal
Senior Lecturer in Law and Director of Teaching and Learning at the University of Strathclyde's Law School

Alison McTavish
Cofounder and Nurse Manager at Aberdeen Fertility Centre

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