Decision Making Aids

Decision Making Aids

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

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

Fertility Preservation in Pittsburgh is an affiliate of the Oncofertility Consortium