von Wolff M, Germeyer A, Nawroth F. Fertility preservation for non-medical reasons: controversial, but increasingly common.
DEUTSCHES ARZTEBLATT INTERNATIONAL 2015;
112:27-32. [PMID:
25657073 DOI:
10.3238/arztebl.2015.0027]
[Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND
Fertility-preserving measures for women are increasingly being performed for non-medical reasons in Germany. This is now a controversial matter.
METHODS
The authors searched the PubMed database for pertinent publications on the basis of their clinical and scientific experience and evaluated relevant data from the registry of the German FertiPROTEKT network (www.fertiprotekt. com). The various fertility-preserving measures that are available are described and critically discussed.
RESULTS
In most cases, the creation of a fertility reserve currently involves the cryopreservation of unfertilized oocytes, rather than of ovarian tissue. Most of the women who decide to undergo this procedure are over 35 years old. According to data from the FertiPROTEKT registry, most such procedures carried out in the years 2012 and 2013 involved a single stimulation cycle. The theoretical probability of childbirth per stimulation is 40% in women under age 35 and 30% in women aged 35 to 39. If the oocytes are kept for use at a later date, rather than at once, the maternal risk is higher, because the mother is older during pregnancy. The risk to the child may be higher as well because of the need for in vitro fertilization (IVF). Pregnancy over age 40 often leads to complications such as gestational diabetes and pre-eclampsia. IVF may be associated with a higher risk of epigenetic abnormalities. Ethicists have upheld women's reproductive freedom while pointing out that so-called social freezing merely postpones social problems, rather than solving them.
CONCLUSION
Fertility preservation for non-medical reasons should be critically discussed, and decisions should be made on a case-by-case basis.
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