Testing & Preservation
There are two ways you can test your current fertility. One involves a test you can do at home, which is relatively inexpensive. The second is a more accurate and comprehensive assessment that needs to be ordered by your doctor and done in a laboratory.
There are a few different home fertility tests that can be purchased at some local drug stores (e.g. First Response Fertility Test for Women). These tests measure the level of follicle stimulating hormone (FSH) in your body – providing an estimation of the quality and quantity of your remaining eggs (your ovarian reserve). Ovarian reserve is one of the main indicators of a woman’s fertility potential. Higher FSH levels are associated with declining fertility.
If you are over 35 or you have a family history of early menopause, you should consider having your doctor or fertility specialist do a more thorough assessment of your current fertility. This involves 3 blood tests, typically on the third day of your menstrual cycle. As noted above, Day 3 FSH measures your ovarian reserve. Day 3 Estradiol measures the level of estrogen being produced which can affect the quality of your eggs. Luteinizing Hormone (LH) is the hormone your pituitary gland releases to trigger ovulation. This is also an important indicator of your current fertility.
Another, more recent test available at some laboratories and fertility clinics is the anti-mullerian hormone test (AMH test). This test can be done at any time during your cycle and is another indicator of the remaining supply of eggs in your ovaries (ovarian reserve). Anti-mullerian hormone is a substance produced by small cells in the ovary known as antral follicles. The level of AMH declines throughout a woman’s reproductive lifespan, with higher AMH levels indicating the availability of more eggs (greater ovarian reserve). However, AMH levels reflect egg quantity not egg quality, so they are only one important indictor of your current fertility status. Also, most medical plans do not cover AMH testing, so you may have to pay as much as $200.00 for this test.
There are two ways you can test your current fertility – using a home test or by providing a fresh semen sample for analysis at a local laboratory or fertility clinic.
Home fertility tests for men (e.g. Spermcheck Fertility) are relatively new and may not be readily available in some areas. You may have to order a home test on the internet, for home delivery. This type of home test measures sperm count – the number of sperm in your semen. A count over 20 million per milliliter of semen is considered within the normal range.
But sperm count is only part of the story when it comes to assessing your fertility. You can have a “normal” sperm count, but there may be problems with the movement (motility) and shape or quality (morphology) of your sperm. Problems with motility or morphology can significantly affect the ability of your sperm to fertilize an egg. These additional tests need to be ordered by a doctor and done at a medical laboratory or fertility clinic, using a fresh semen sample. Your doctor will need to interpret the results of this type of more comprehensive sperm analysis.
If you have concerns about your current fertility, besides consulting a fertility specialist, you may want to look into possible ways to enhance your overall reproductive health. You may decide that if you want to have kids, you should start trying now, rather than risk the chance that your fertility might be even more compromised in a few years time. Or, if you’re not ready to have children yet, or you aren’t sure you even want to have kids but you definitely want to keep your options open, you may want to consider fertility preservation.
If you want to have a child at some point in the future, but not right now, or you’re not sure if you even want kids but want to keep this option open, you may want to freeze your eggs for future use. This procedure must be done at a fertility clinic. You first take fertility medications known as gonadotropins that stimulate eggs to be developed in your ovaries. During a procedure at a clinic known as egg retrieval, these eggs are removed from your ovaries. They are then frozen (cryopreserved) and stored in liquid nitrogen. Read more about the procedure used to harvest eggs for cryopreservation here.
In the future when you’re ready to start a family, these eggs are thawed and fertilized using your partner’s sperm or sperm from a known or anonymous donor. Depending on their quality, one or two of the resulting embryos are transferred to your uterus, while any remaining embryos are cryopreserved for later use.
This type of treatment is fairly new and isn’t yet available at all fertility clinics. The Canadian Fertility and Andrology Society currently views this treatment as experimental. Women’s eggs are fairly fragile so when they’re thawed, some are damaged and can’t be fertilized. It also isn’t clear how long the eggs can be preserved, although estimates range from 5 to 10 years. Finally, the success rates of fertilizing previously frozen eggs vary – based on a number of factors including the quality of your eggs at the time they were frozen. We do know that the success rates decline with age, so the earlier you consider this option, the better. Recent success rates are posted on sites such as the American Society for Reproductive Medicine or the Canadian Fertility and Andrology Society.
Although egg freezing can be quite expensive, this form of fertility preservation is continuing to be improved, leaving women with an increasingly more reliable option for potentially prolonging their fertility.
Embryo freezing is another fertility preservation option. This involves the same procedure as detailed above, where medications known as gonadotropins stimulate eggs to develop in your ovaries, which are then retrieved during a procedure at a fertility clinic. But with this option, your eggs are first fertilized with your partner’s sperm or the sperm of a known or anonymous donor, and the resulting embryos are frozen (cryopreserved) for later use. Embryos tend to be more robust than eggs and so generally are more successful surviving the freezing/thawing process. Embryo freezing can be used by couples or by single women who aren’t yet ready to become parents and want to avoid the risks associated with age related fertility declines.
If you are a man who wants to have kids at a later date and you are concerned about potential declines in your fertility or the risks associated with fathering a child later in life, sperm freezing is a good option to consider. This relatively simple procedure involves producing a fresh semen sample at a fertility clinic. The sperm are then washed in the lab, frozen in liquid nitrogen (cryopreserved) and stored for use at a later date. Because there are so many millions of sperm in the average sperm sample, a high percentage of sperm usually survive the defrosting process – making sperm freezing a fairly easy and very reliable fertility preservation option for men.
Cancer and Fertility Preservation
Sperm freezing prior to cancer treatments is a very good option for men who want to preserve their fertility. For women undergoing cancer treatment, ovarian tissue cryopreservation and ovarian transposition is available at some fertility centres. With these techniques, small pieces of your ovary are removed and frozen prior to chemotherapy, and transplanted following treatment. There is recent evidence to suggest that this may be a more effective and reliable method of fertility preservation when compared with egg freezing. It is important that you talk to your medical provider for more information about this form of fertility preservation, before you undergo chemotherapy, radiation, or surgery.
The Canadian Fertility and Andrology Society has a useful information sheet on cancer and fertility preservation here.