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Fertility Preservation: GenZ and innovative solutions

Written by Alessia Squinteri and edited by the Cambridge Femtech Society.


Times change, and so do the approaches individuals take towards significant life moments, including family planning. The decision to have children involves several factors, such as having a stable job and being financially and economically prepared [1]. Whether someone opts for single parenthood or not, establishing a supportive environment is crucial, and nowadays, it may require additional time.






According to the Council of Europe European Committee on Organ Transplantation (CD-P-TO), fertility preservation encompasses safeguarding a person’s oocytes (also known as ‘eggs’), sperm, reproductive (ovarian/testicular) tissue, and/or embryos for potential use in conceiving biological children later in life. It is worth noticing that unlike sperm, which are continuously produced in the testicles from puberty onwards, all oocytes are generated before birth during fetal development and stored in the ovaries in small pockets called follicles. This pool of oocytes,  known as the “ovarian reserve”, can be affected by a number of factors [2]. Oocyte cryopreservation to ensure the preservation of fertility is therefore strongly recommended in the face of medical treatments or conditions that may impact ovarian function. This includes cancer patients prior to oncologic treatment, individuals with conditions affecting ovarian reserve or who require medical treatment that can result in infertility (such as endometriosis, ovarian masses requiring surgery, BRCA I or II mutations, genetic disorders associated with premature ovarian insufficiency, or autoimmune/haematologic/metabolic diseases requiring gonadotoxic therapies or bone/stem cell transplant), and transgender individuals anticipating gender-affirming surgery or hormone therapy [1]. Additionally, an increasing number of women are opting for oocyte or ovarian tissue cryopreservation to mitigate age-related fertility issues. In such non-medical cases, this is referred to as Social Eggs Freezing (SEF) or Elective Eggs Freezing (EEF) [3]. For optimal results, it is advised to undergo the process before the age of 35. However, lifestyle factors such as smoking, alcohol abuse, and diet, can significantly influence ovarian reserve. Moreover, delaying pregnancy  increases the risk of encountering accidents, diseases, or conditions that impact fertility [3]. 


Whether for medical or non-medical reasons, consulting with your gynecologist is crucial when freezing your eggs. They would recommend exams to assess your ovarian reserve, considering factors such as medical history, age, and lifestyle. Blood tests measuring Follicle-stimulating hormone (FSH) and Anti-Müllerian hormone (AMH), along with imaging tests such as transvaginal ultrasonography, are also typically prescribed. These tests provide valuable information on your antral follicle count and ovarian volume [4]. Evaluating these aspects before starting ovarian stimulation and regularly throughout the process is essential. 


Moreover, since ovarian stimulation is necessary to ensure the optimal number of oocytes, a personalized treatment plan should be recommended by the clinic of reference based on your medical results. Ultrasound scans should be conducted to monitor follicle development during hormonal stimulation, determining the ideal time for egg collection.  Egg collection is a relatively straightforward procedure lasting up to 30 minutes and carried out under light sedation. It is performed by a highly skilled doctor who uses ultrasound guidance to extract the eggs from the ovarian follicles. Finally, embryologists use vitrification to carefully freeze the eggs, storing them in liquid nitrogen until the individual decides to use them [5]. 


While SEF appears as a promising option to safeguard fertility and allow young people the flexibility to postpone important decisions like family planning, this procedure is not yet widely adopted. It is crucial to raise awareness among the younger generation about SEF and normalize discussions around it in contexts such as university, work, and social events. 

Several solutions available in the market have a positive impact on knowledge, like Flo Health [6], aiding women in understanding their bodies better and gaining more control over their fertility. However, awareness is not the sole challenge: the affordability of fertility treatments, including egg freezing, remains a barrier for many. The cost of a procedure such as SEF is quite high, leading many young individuals to feel discouraged and  opting to delay or avoid egg freezing altogether. 


In a recent study,  Berlin based fertility benefit company Apryl [7] reported that 48% of people aged 16–24 are worried about their future fertility. Apryl’s CEO Jenny Saft highlighted the absence of fertility education in schools, contributing to anxiety among young people about family planning timing. It is crucial to encourage early consideration of fertility without unnecessary worry, providing resources to understand one's body and fertility, thereby enabling informed decisions at the right time. Data released by Apryl just last month found that over a fifth of Gen Z workers are interested in accessing fertility and family-forming support through their workplaces, indicating increased awareness among young people regarding available fertility support [8]. In a separate survey, two-thirds of adults aged 18–34 said they would consider freezing their eggs, sperm, or embryos to preserve their fertility if they could afford it [9]. 


Addressing the cost of egg freezing, an intriguing solution comes from the US-based startup Cofertility [10], founded by three women who have grappled with fertility issues. Cofertility proposes a unique approach: donating half of one’s eggs to a couple in need, thereby reducing the cost of egg freezing for young women. This innovative idea aligns with the efforts of  a London based biobank [11]  that introduces a “freeze and share program” to help individuals freeze their eggs while assisting another family in having a baby. 

Despite the challenges, the positive aspect is that numerous creative solutions are emerging to facilitate access to fertility treatments and promote open discussions about fertility. What are your thoughts on this? 


Alessia is currently working with  Flami [12] to develop new ways to assist people in their fertility journey, and they have designed an anonymous questionnaire for you to share your opinion on the matter.  If you would like to contribute to their research, here is the link to the questionnaire: https://tally.so/r/wkNxr1


References


Druckenmiller Cascante, S., Berkeley, A. S., Licciardi, F., McCaffrey, C., & Grifo, J. A. (2023). Planned oocyte cryopreservation: the state of the ART. Reproductive BioMedicine Online, 47(6), 103367. https://doi.org/10.1016/j.rbmo.2023.103367


Council of Europe European Committee on Organ Transplantation (CD-P-TO). (2021). Fertility Preservation: A Guide for People Facing an Illness or Life Events that May Affect Their Fertility. Retrieved from https://go.edqm.eu/transplantation.


Varlas, V. N., Bors, R. G., Albu, D., Penes, O. N., Nasui, B. A., Mehedintu, C., & Pop, A. L. (2021). Social Freezing: Pressing Pause on Fertility. International Journal of Environmental Research and Public Health, 18(8088). https://doi.org/10.3390/ijerph18158088





Soutar, L. (2023, May 24). 'New age of flexibility' | Gen Z workers are flipping the script on inclusive workplace benefits


Bello, C. (2023, March 01). Money is putting off under-35s in the UK from having kids. How do child benefits compare in Europe?




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