Resources for Patients and Health Professionals

Sperm Banking (Semen Cryopreservation)

PROCESS
  • Sperm collected through masturbation at Magee-Womens Hospital
  • 1-3 samples, 48 hours apart
  • Infectious disease testing for storing frozen samples
TIME FRAME
  • 1-2 days to schedule
  • 1 day for collection
  • Second collection 48 hours later if desired
SUCCESS RATE
  • Sperm can be kept frozen indefinitely
  • 4-10% live birth rate per cycle with IUI
  • 36-61% live birth rate per transferred embryo with IVF or ICSI
RISK
  • Unable to collect semen sample
  • Unable to freeze due to low sperm count
COSTS
  • $263 per analysis, includes freezing and first year storage fee
  • $360 Annual storage fee after Year 1
  • $270 Infectious disease testing (usually covered by insurance)
  • Patients referred by Children’s Hospital of Pittsburgh may be eligible for the CHP Free Care Fund
  • Inquire about discount programs for cancer patients (LiveStrong Foundation)
  • Inquire about research study participation (might cover partial cost)
LONG-TERM IMPLICATIONS
  • Limited source of material for future infertility treatment
  • Future costs for assisted reproductive procedures to use frozen sperm
OTHER CONSIDERATIONS
  • Return for semen analysis periodically (every 1-2 years) to monitor fertility status
  • Not an option for prepubertal boys

Testicular Tissue Freezing (Testicular Tissue Cryopreservation)

      PROCESS

  • 30-60 min surgical procedure at CHP Same Day Surgery Center
  • Small incision to the testicle under anesthesia
  • Remove a portion or one entire testicle
  • Infectious disease testing for storing frozen samples
  • The goal is to freeze testicular stem cells to restore fertility or produce sperm
TIME FRAME
  • 1-2 weeks to schedule
  • 1 day outpatient procedure
  • Cancer therapy can start the day after the procedure
SUCCESS RATE
  • Experimental procedure
  • Unknown fertility outcome at this point
RISK
  • Bleeding
  • Minimal pain and swelling
COSTS
  • Surgical costs covered by research study
  • Tissue processing and first year of storage covered by research study
  • $360 Annual storage fee after Year 1
LONG-TERM IMPLICATIONS
  • Protocols to use tissue are under development
  • Use of tissue may require another procedure (stem cell transplantation)
  • Future costs for assisted reproductive procedures to use frozen tissue
OTHER CONSIDERATIONS
  • 25% of the harvested tissue will be donated to research
  • Annual Follow-up with study team

Egg Freezing (Oocyte Cryopreservation)

PROCESS
  • 8-12 days of ovarian stimulation
  • Multiple self-administered injections
  • Monitor ovarian response with blood tests and vaginal ultrasounds
  • Egg retrieval under sedation
  • Infectious disease testing for storing frozen reproductive cells
TIME FRAME
  • 1-3 days to schedule
  • 2-3 weeks procedure time
SUCCESS RATE
  • 36%-61% live birth per embryo transfer
  • Similar to the success rate of embryo transfers using fresh eggs
RISK
  • Side effects of medication
  • Ovarian hemorrhage
  • Pelvic infection
  • Ovarian hyperstimulation
COSTS
  • Procedure: $7563; covers repeat ultrasound and blood tests, egg retrieval, egg freezing, first year of storage
  • Discounted rate for cancer patients: $5000; requires clearance from oncologist
  • Medications: up to $4000 (financial aid may be available for cancer patients)
  • Annual storage fee after Year 1: $360
  • Patients referred by Children’s Hospital of Pittsburgh may be eligible for the CHP Free Care Fund
LONG-TERM IMPLICATIONS
  • Costs for long-term storage
  • Future costs for assisted reproduction using frozen eggs: $5000-$10,000
OTHER CONSIDERATIONS
  • Not an option for prepubertal girls

Embryo Freezing (Embryo Cryopreservation)

PROCESS
  • 8-12 days of ovarian stimulation
  • Multiple self-administered injections
  • Monitor ovarian response with blood tests and vaginal ultrasounds
  • Egg retrieval under sedation
  • Sperm needed from partner or donor
  • Infectious disease testing for storing frozen reproductive cells
TIME FRAME
  • 1-3 days to schedule
  • 2-3 weeks procedure time
SUCCESS RATE
  • 35% live birth per embryo transfer
RISK
  • Side effects of medication
  • Ovarian hemorrhage
  • Pelvic infection
  • Ovarian hyperstimulation
COSTS
  • Procedure: $10,200; covers ultrasound and blood tests, egg retrieval, egg freezing, first year of storage
  • Discounted rate for cancer patients: $5000; requires clearance from oncologist
  • Medications: up to $4000 (financial aid may be available for cancer patients)
  • Annual storage fee after Year 1: $360
LONG-TERM IMPLICATIONS
  • Costs for long-term storage
  • Future costs for assisted reproduction using frozen eggs: $5000-$10,000
OTHER CONSIDERATIONS
  • Not an option for prepubertal girls

Ovarian Tissue Freezing (Ovarian Tissue Cryopreservation)

PROCESS
  • Laparoscopy with 3 small incisions under general anesthesia
  • Removal of one ovary
  • Infectious disease testing for storing frozen reproductive cells
  • The goal is to freeze ovarian tissue containing follicles to restore fertility and hormonal balance after cancer treatment
TIME FRAME
  • 1 week to schedule
  • 1 day outpatient procedure
  • Cancer therapy can start 1-3 days after procedure
SUCCESS RATE
  • Experimental Procedure
  • Over 60 live births from frozen ovarian tissue to date
RISK
  • Bleeding
  • Infection
  • Trauma to adjacent organs
COSTS
  • Surgical costs covered by research study
  • Tissue processing and first year of storage covered by research study
  • $360 Annual storage fee after Year 1
  • Uncertain future costs to use the frozen samples
LONG-TERM IMPLICATIONS
  • Costs for long-term storage
  • Use of tissue may require another surgery(ovarian tissue transplantation)
  • Possible future costs for assisted reproduction: $5000-$10,000
OTHER CONSIDERATIONS
  • Risk of malignant contamination may prohibit ovarian re-implantation
  • In vitro maturation of oocytes not established to date
  • 20% of the harvested tissue will be donated to research
  • Annual follow-up with study team

Lupron (Ovarian Suppression)

PROCESS
  • Best if started two weeks before chemotherapy.
  • Monthly injection during chemotherapy
  • The goal is to suppress ovarian function and prevent eggs from maturing
TIME FRAME
  • A few weeks before chemotherapy and during chemotherapy
SUCCESS RATE
  • Conflicting results about efficacy
RISK
  • Bleeding
  • Infection
  • Hematoma
COSTS
  • $900 per injection
  • May be covered by insurance for certain conditions
LONG-TERM IMPLICATIONS
  • None
OTHER CONSIDERATIONS
  •  N/A

Testicular Sperm Extraction (TESE)

PROCESS
  • For men and boys over the age of 13 who do not have sperm in their semen sample
  • A surgical procedure where testicular tissue is obtained by biopsy and examined for presence of sperm
  • Infectious disease testing for storing frozen samples
TIME FRAME
  • 1 week to schedule
  • 1 day procedure
  • Cancer therapy can start the day after the procedure
SUCCESS RATE
  • TESE success rates are around 50%
  • 30% live birth rate per transferred embryo with ICSI
  • Sperm can be kept frozen indefinitely
RISK
  • Bleeding
  • Minimal pain and swelling
COSTS
  • $525 TESE procedure
  • $598 TESE surgery
  • $360 Annual sperm storage fee
  • $270 Infectious disease testing (usually covered by insurance)
  • Inquire about discount programs for cancer patients (LiveStrong Foundation)
LONG-TERM IMPLICATIONS
  • Limited source of material for future infertility treatment
  • Future costs for assisted reproductive procedures to use frozen sperm
OTHER CONSIDERATIONS
  • Possibility of not finding any sperm
fertilityriskcalculatorpicClick the “Fertility Risk Tool” below to learn how common cancer treatments could impact reproductivity.  This educational tool was developed by the LIVESTRONG foundation and is not meant to be a substitute for diagnosis, treatment, or professional medical advice.

Fertility Risk Tool

  

Chemotherapy and radiation treatments for cancer or other conditions can cause permanent infertility. The effects of therapy on fertility are drug and dose dependent. Alkylating drugs (e.g., busulfan and cyclophosphamide), whole body radiation and radiation to the gonads are particularly damaging to fertility.

To aid in counseling patients about the reproductive risk of their treatment we use the Cyclophosphamide Equivalent Dose (CED) calculator described by Dan Green and his colleagues at St. Jude Children’s Research Hospital and the Childhood Cancer Survivor Survey (Green et al., 2014). The Fertility Preservation Program in Pittsburgh considers a CED of 4000 mg/m^2 to be associated with a high risk of infertility.

Radiation treatments  (and doses) associated with infertility are listed in a table at the bottom of the page.

Radiation Doses

Total body irradiation (TBI) All doses
Cranial radiation > 40 Gy
Testicular radiation > 2.5 Gy in men
> 6 Gy in boys
Whole abdominal or pelvic radiation > 6 Gy in adult women
> 10 Gy in post-pubertal girls
> 15 Gy in pre-pubertal girls
References
  1. Green DM, et al. (2014) The cyclophosphamide equivalent dose as an approach for quantifying alkylating agent exposure: a report from the Childhood Cancer Survivor Study. Pediatric Blood & Cancer 61(1):53-67.
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Ocofertility logo onlyFertility Preservation in Pittsburgh is an affiliate of the Oncofertility Consortium

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