Starting a Family When You Are Truly Ready

In the 21st century, many people are exploring the option to delay parenthood in favour of first overcoming an illness or even laying a foundation of financial stability and emotional maturity.

Dr. Mmaselemo Tsuari is a fertility specialist at St Philip's Private Hospital. She says fertility preservation is a practice that saves healthy eggs, sperm or reproductive tissue from people who might experience a decline in fertility if they wait for a stage that is more suitable to them.

Typically, patients undergoing intensive medical treatments undertake fertility preservation. She fertility preservation in cancer patients was once the most common application of the procedure but, patients with non-oncological illnesses have also been turning to preservation as their body heals from treatment.

“Autoimmune conditions like lupus, Duchenne [muscular dystrophy], rheumatoid arthritis, and also hemoglobinopathies like sickle cell disease and thalassaemia put patients at risk of sterility with treatments. Fertility preservations is thus an important route to explore in these cases.” Says Dr. Tsuari, “With women who have thalassaemia or sickle cell disease, there is a risk of ovarian failure of up to 85%. In men with these conditions, testicular failure rises to about 90%.”

In oncological cases, particularly those involving blood cancers, she says extensive testing must be undertaken to preserve non-cancerous tissue. “In the case of blood cancers, care must be taken to ensure that cancer cells are not reintroduced into the body through the persevered tissue that was extracted prior to chemo or radiation.”

Dr. Tsuari said fertility preservation is an important option for patients at risk of premature ovarian insufficiency which is a genetic condition that causes ovarian failure. Typically, it is diagnosed in women under the age of 40. “We can start the process of preservation from the age of 15, right up to 30 years old, in woman at risk of POI” she says.

Fertility preservation for endometriosis, inflammatory bowel disease, pelvic infections that also spread to the tubes and ovaries and benign tumours in the reproductive organs could also present solutions to overcome possible obstacles to parenthood. Dr. Tsuari explains that when benign ovarian tumours are removed, for example, the operation could also “leave the ovary deplete of healthy follicles.” Fertility preservation in benign ovarian tumours thus helps store healthy eggs and possibly tissue for a later stage.

Dr. Tsuari says many people also pursue fertility preservation for the purposes of delayed procreation. She says with the pursuit of academic qualifications and career progression, people are recognising that they can be better equipped parents in the future than they can be at present.

“Fertility preservation is thus a wise choice in that it buys people the time they need. Maybe you want to travel, or wait for the right partner. Both are valid reasons to delay procreation.”

She says delayed child bearing is common place in today’s society. In days gone by, people used to conceive and have complete families in their early to mid-20s. Lately, child bearing happens in the early 30s. “Now, the problem with that is in women, fertility starts declining gradually from the age of 32. After 37, it declines sharply. This means that by age 37, your ability to conceive ranges around 5-10%.” Fertility preservation for women considering delayed child bearing would thus freeze their reproductive tissue at its most viable stage, for use later on. “It used to be called ‘social egg freezing’, but I think over time it has become known as elective egg freezing for women who are prioritising themselves and choosing to start families at a time that they decide is right for them.”

Dr. Tsuari says it is important that men are included in conversations around fertility preservation because sperm quality is also impacted by age. Body mass index and age affects the morphology, motility and the count of sperm.

“Men should consider freezing sperm before 40 because sperm counts start declining after the age of 41.” To put it into clearer perspective, she says 45-year-old men take five times longer to achieve a pregnancy than men in their mid-20s.

In essence, fertility preservation is a consideration for both men and women. “In the past we used to warn that older women carry a risk of chromosomal abnormalities in their pregnancies. What we’ve learned is that men also face that risk. So, risk is equally spread between men and women and this is why we’re seeing both sides pursuing fertility preservation.”