Female fertility preservation for family planning: a position statement of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)

Abstract

Purpose: This position statement by the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) aims to establish an optimal framework for fertility preservation outside the standard before oncological therapies. Key topics include the role of fertility units in comprehensive fertility assessment, factors impacting ovarian potential, available preservation methods, and appropriate criteria for offering such interventions.

Methods: The SIFES-MR writing group comprises Italian reproductive physicians, embryologists, and scientists. The consensus emerged after a six-month period of meetings, including extensive literature review, dialogue among authors and input from society members. Final approval was granted by the SIFES-MR governing council.

Results: Fertility counselling transitions from urgent to long-term care, emphasizing family planning. Age, along with ovarian reserve markers, is the primary predictor of female fertility. Various factors, including gynecological conditions, autoimmune disorders, and prior gonadotoxic therapies, may impact ovarian reserve. Oocyte cryopreservation should be the preferred method. Women 30-34 years old and 35-39 years old, without known pathologies impacting the ovarian reserve, should cryopreserve at least 12-13 and 15-20 oocytes to achieve the same chance of a spontaneous live birth they would have if they tried to conceive at the age of cryopreservation (63% and 52%, respectively in the two age groups).

Conclusions: Optimal fertility counselling necessitates a long-term approach, that nurtures an understanding of fertility, facilitates timely evaluation of factors that may affect fertility, and explores fertility preservation choices at opportune intervals.

Keywords: Family planning; Fertility preservation; Oocytes cryopreservation; Ovarian reserve.

Fig. 1

Factors that may influence biological age, reducing the ovarian reserve

Fig. 2

Key question: how many oocytes should we vitrify to provide the woman at least with the same chance of live birth as if she would try to conceive spontaneously at the time of the procedure? The figure reports the number of vitrified oocytes required in women 30–34 years old or 35–39 years old to achieve the same chance of a spontaneous live birth (green line) at the moment of cryopreservation. Data adapted from Hendershot and Mosher, 1982 for spontaneous conception; Doyle et al., 2015 (light blue column) and Cobo et al., 2021 (blue column) for oocyte cryopreservation