Becoming Parents Later in Life Through Fertility Preservation

Prospective parents undergoing in vitro fertilization (IVF) often generate more than one viable embryo in the process of building their families. Once sperm and ova (also known as eggs) are brought together under laboratory conditions, the process of fertilization occurs. Viable embryos can then be implanted in the womb of either the patient or a gestational carrier, or kept preserved at extremely cold temperatures for use in future pregnancies that might take place years or even decades later. This technology not only helps couples – including queer families – fulfill their family-building dreams today, but can serve as a means of fertility preservation for the future.

Freezing embryos is only one of a couple of options for fertility preservation. One of the lesser-known aspects of fertility care is the freezing of sperm or eggs before the creation of an embryo. This might be done for any number of reasons, but the overall purpose is typically to give the patient a luxury of time that they may not otherwise have. Patients who produce sperm can continue to do so with little appreciable loss of quality into their 50s or later, but for patients with ovaries the situation is a little less forgiving: Born with all the eggs they will ever have, patients with ovaries experience a loss each month in the number, as well as a decline the quality, of their ova – especially after age 35, Dr. Sarah Cascante, a Clinical Assistant Professor at New York University's Langone Fertility Center, tells EDGE.

"Oocyte cryopreservation, is the medical term for egg freezing," Dr. Cascante explains. "It's really a way that patients with ovaries can preserve their fertility for the future," including those who come to NYULFC "who either don't currently have a partner, or who do have a partner, but they'd like to have more flexibility for the future."

Other families coming to the clinic – which is part of The Prelude Network, North America's largest and fastest-growing network of reproductive health centers, with more than 90 locations in the U.S. and Canada – include "same sex couples who use donor sperm or donor eggs to make and freeze embryos for future use," which is "another form of fertility preservation," Dr. Cascante adds. "So, both of those technologies can be used to try to increase the odds of having a biological child later in life."

A primary driver for fertility preservation that fertility specialists like Dr. Cascante are seeing is a growing number of women deciding to focus on education, career, and/or financial stability in their 20s and 30s – the ideal time for those pursuits, but also prime childbearing years. Freezing eggs (or embryos) allows women more agency over their bodies, their reproductive planning, and their professional lives.

As Dr. Cascante puts it, "People with ovaries are postponing childbearing, often, now, into their late 30s or early 40s, but we know that fertility significantly declines after the age of 35. Without taking precautions to try to preserve their fertility before that point, there is an increased risk of people with ovaries being unable to have children after the age of 35."

Dr. Isabelle Ryan of the Pacific Fertility Center in San Francisco – also a part of The Prelude Network – agrees, noting that "There are lots of things that cause infertility for us as women, which we will uncover once we start doing an evaluation. For example, your age: That's the number one most important predictor of egg health. If you come to me at age 40, whether you're heterosexual or lesbian, you know, your eggs will have declined, so that's going to be a component right off the bat."

"Most of these patients are between 30 and 35," Dr. Cascante details of those who come to her clinic seeking fertility preservation via egg freezing. "However, there are some patients who come in in their 20s, and then there are some patients who come in in their late 30s or early 40s, as well. The idea is that they're doing this so they can delay childbearing."

Apart from the health of the ova, though, there's something else to consider: The age of the person carrying the embryo as a factor in a healthy and successful pregnancy.

"We know pregnancy complications increase with age, and that's true for both mom and baby," Dr. Cascante explains. "For mom, we see higher risks of things like preeclampsia (high blood pressure of pregnancy) or diabetes of pregnancy. For babies, we see higher risks of things like stillbirth, growth restriction, or preterm birth with advancing maternal age.

"Generally, I recommend that patients try to carry a pregnancy before the age of 45, if possible, to try to decrease those risks," Dr. Cascante continues. "We certainly do have patients who have come back and used their frozen eggs at later ages and have beautiful babies from that process. But I do counsel them that it's associated with a higher risk. And I usually have any patient who comes to see me over the age of 45 meet with a high-risk obstetrician before doing fertility treatment, so that they can better understand what those risks are and get clearance" to go ahead with a pregnancy.

The process of egg freezing is similar to that of a standard IVF course of treatment, with the ovaries being stimulated to mature multiple eggs and the eggs collected. With IVF, multiple ova are fertilized; with egg freezing, the ova are preserved before fertilization. In either case, Dr. Cascante notes, "You're actually losing the same number of eggs from an egg freezing cycle as from a normal period, it's just that we're taking them out of your body and freezing them as opposed to letting them die naturally."

That revelation touches on a relatively little-known fact: That ovaries do not typically lose only one egg per menstrual cycle, but bring forth numerous eggs, usually somewhere between 15 - 20 in your twenties and early thirties. "Your ovary recruits a certain number of eggs to its surface each month," Dr. Cascante details, "and one of them becomes dominant and is released for fertilization. The other ones all die off."

And you may have thought jousting and jostling among sperm was the extent of competition among gametes leading up to conception!

Speaking of sperm, "I occasionally have patients, for example, if they're egg freezing and they're partnered, who will say, 'What about my partner freezing sperm? Is there value to that?'" Dr. Ryan mentions. "I always say, 'Sure. Why not?' Because, again, you never know if there may be any medical risks that the partner with sperm may encounter down the line."

Patients of any gender might face medical situations that diminish their fertility and their prospects for parenthood. Disease could strike; accidents could happen. But there's another, far happier, reason why some patients who come to reproductive health specialists might be interested in fertility preservations, Dr. Cascante points out, specifying "fertility preservation for transgender persons.

"Prior to gender-affirming care," Dr. Cascante continues, "it is recommended that all transgender persons be counseled about the effects of gender-affirming care (both hormonal and surgical) on their fertility, and options for fertility preservation and future childbearing.

"Egg, sperm, embryo, ovarian tissue, and testicular tissue cryopreservation are all ways that fertility can be preserved before gender-affirming care," Dr. Cascante adds. "These treatments can help transgender people build families after they transition."

The Prelude Network provides respectful, inclusive assistance to families of all configurations of gender and sexuality when it comes to making their dreams of parenthood come true. "I think it's important for everybody to be able to build the families that they want to build, and on the timelines that they want to build them," Dr. Cascante stresses. "That's something that may not have be discussed with queer couples previously, so I think it's something that's important for us to focus on and ask them about: If they'd like to have children, on what timeline, how many children – and how they would like to build those families, so that we can best assist them and talk about whether that includes preserving fertility for the future so that they can leave their options open."