Pregnancy, increasing cases of oocyte preservation

In the same years, the European society for human reproduction and embryology (Eshre) also endorsed the use of oocyte preservation planning for fertility preservation. Since then, the offer of public and private services for oocyte preservation has grown exponentially.

Oocyte preservation is already available in Italy in second- and third-level PMA centres accredited with the National Health Service and in several private facilities. The technique consists of collecting the eggs (pick up) after ovarian stimulation with drugs containing gonadotropins, which are then stored at very low temperatures in liquid nitrogen in special biobanks. After years they can be thawed and used for medically assisted procreation techniques.

Progress in the field of oncology has been one of the decisive factors in the development of increasingly efficient egg preservation techniques. Thanks to scientific research, survival after a cancer diagnosis has improved significantly in recent years. For some cancers, such as breast cancer, the percentage of people alive five years after an early diagnosis is close to 90%. Both radiotherapy and chemotherapy, however, are potentially gonadotoxic therapies that can damage the ovaries. That is why today women of childbearing age can have their oocytes harvested in order to preserve them and use them, if they wish, after completing the course of treatment.

Cancers, however, are not the only diseases for which life-saving therapies potentially toxic to the reproductive organs are used. Some autoimmune or blood diseases such as rheumatoid arthritis, lupus, dermatomyositis, haemolytic anaemia and autoimmune thrombocytopenia require undergoing cycles of chemotherapy and, therefore, present the same fertility risks as cancer therapies. In this sense, the mere existence of the possibility of conserving oocytes represents a concrete existential, psychological and emotional support for those diagnosed. Still uncommon, but no less important, is the recourse to oocyte preservation due to non-fatal pathologies that may nevertheless compromise fertility, such as endometriosis, a chronic gynaecological pathology linked to the presence of endometrial tissue outside the uterus, which affects about 15% of women.

Besides these reasons related to a diagnosed pathology, oocyte preservation also offers the possibility of postponing motherhood for other reasons, such as achieving professional or economic stability.

However, there is a disparity in access to these techniques. The cost of the procedures varies from facility to facility, but is between 2 and 5 thousand euros. In Italy, the procedure is free of charge for women under 40 years of age who are diagnosed with cancer. However, there are other pathologies that do not currently entitle them to any reimbursement from the National Health Service. These include endometriosis endometriosis .

The first freezing of female gametes dates back to 1986 and Italy, with the Sant'Orsola Hospital in Bologna, played a pioneering role in fertility preservation. Since 1996, the team of Professor Eleonora Porcu, gynaecologist and former director of Bologna's 'Infertility and medically assisted procreation' facility, has been experimenting with the oocyte cryopreservation technique: 'The first ever pregnancy was obtained in 1986 in Australia, but we were the first to apply the technique continuously for cancer patients. Until then it was thought that it was useless to freeze oocytes, but women with cancer had no alternative'.

The results recounted by Professor Porcu cover about 25 years of activity at the Policlinico Sant'Orsola in terms of fertility preservation in cancer patients. These data then became a study published in 2022 in Cancers where, for the first time, a large case series and information on the growth and medium-term development of children born with this technique were reported. "These are happy stories of children who, had the oocytes not been placed safely under liquid nitrogen, would never have come into the world," says Eleonora Porcu.

The study analysed the histories of 508 patients diagnosed with mainly breast, gynaecological and haematological malignancies who between 1996 and 2021 chose to freeze their oocytes before starting cancer treatments, comparing them with those of 1,042 women who, during the same time period, had resorted to medically assisted procreation for infertility derived from other causes.

In detail, of the 432 cancer patients who completed the follow-up, 156 suffered premature ovarian failure. Of these, 44, once cured, sought a pregnancy through the use of previously cryopreserved oocytes: out of a total of 194 thawed oocytes, 157 survived (80%), resulting in 18 pregnancies, 15 of which were successfully completed.

'This technique is more effective than other medically assisted procreation techniques not only in terms of success, and the results speak for themselves, but also because the embryos in this case are not fertilised from donor seeds,' explains Professor Porcu, 'and therefore from unknown fathers, but they are oocytes that can be fertilised years later when you find the partner of your life. In short, this procedure puts the woman at the centre'.

In fact, oocytes can be stored even for decades, provided that all the indications for their freezing are observed. Placing them in liquid nitrogen at very low temperatures is in fact indispensable for the success of the procedure.

'Fertility must be considered a desire to reproduce and not an imposition,' Eleonora Porcu concludes. 'Politics must also take this into account in order to support the reproductive journey of all women.

Since the birth of the first girl conceived through in vitro fertilisation, millions of boys and girls have thus been born thanks to advances in reproductive medicine. Guaranteeing everyone the same rights of access to this procedure throughout the country is a start, but much remains to be done in terms of dissemination and commitment to support scientific research. Promoting better knowledge of the safety, risk and efficacy profiles of these techniques means taking an important step towards protecting the freedom of choice to become parents.