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Semin Reprod Med 2019; 37(05/06): 232-238
DOI: 10.1055/s-0040-1701633
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fertility Preservation Before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty Military

Anne E. Martini
1   Department of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Joseph O. Doyle
2   Shady Grove Fertility, Rockville, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
10 February 2020 (online)

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Abstract

Active duty military service and deployment has the potential to compromise fertility through combat-related genitourinary injury, gonadotoxic exposures, and physical separation from a partner. Despite a growing interest among the military community as well as promising efficacy and safety data, fertility preservation remains an uncovered benefit for active duty soldiers. In 2016, the Pentagon proposed a program that would cover oocyte and sperm cryopreservation for any member of the active duty military desiring its use. Regrettably, that funding was not secured and predeployment fertility preservation remains an out-of-pocket expense. Today, advocacy groups, non-for-profit organizations, and physicians remain vigilant in their attempts to drive another government initiative through Congress. While activism continues, it is important to stress the value of fertility preservation counseling in soldiers' predeployment preparation and military family planning.

Keywords

fertility preservation - military - deployment
 

  • References

  • 1 Martinez F. ; International Society for Fertility Preservation–ESHRE–ASRM Expert Working Group. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives. Fertil Steril 2017; 108 (03) 407-415.e11
    CrossrefPubMedGoogle Scholar
  • 2 Doyle JO, Richter KS, Lim J, Stillman RJ, Graham JR, Tucker MJ. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril 2016; 105 (02) 459-66.e2
    CrossrefPubMedGoogle Scholar
  • 3 Cobo A, García-Velasco JA, Coello A, Domingo J, Pellicer A, Remohí J. Oocyte vitrification as an efficient option for elective fertility preservation. Fertil Steril 2016; 105 (03) 755-764.e8
    CrossrefPubMedGoogle Scholar
  • 4 García A, Herrero MB, Holzer H, Tulandi T, Chan P. Assisted reproductive outcomes of male cancer survivors. J Cancer Surviv 2015; 9 (02) 208-214
    CrossrefPubMedGoogle Scholar
  • 5 Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org. Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion. Fertil Steril 2018; 110 (03) 380-386
    CrossrefPubMedGoogle Scholar
  • 6 Lee SJ, Schover LR, Partridge AH. , et al; American Society of Clinical Oncology. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006; 24 (18) 2917-2931
    CrossrefPubMedGoogle Scholar
  • 7 Yang H, Ramstein J, Smith J. Non-oncologic indications for male fertility preservation. Curr Urol Rep 2019; 20 (09) 51
    CrossrefPubMedGoogle Scholar
  • 8 Healy MW, Yauger BJ, James AN, Jezior JR, Parker P, Dean RC. Seminal vesicle sperm aspiration from wounded warriors. Fertil Steril 2016; 106 (03) 579-583
    CrossrefPubMedGoogle Scholar
  • 9 Lucas PA, Page PR, Phillip RD, Bennett AN. The impact of genital trauma on wounded servicemen: qualitative study. Injury 2014; 45 (05) 825-829
    CrossrefPubMedGoogle Scholar
  • 10 VHA Directive. 1332 Infertility Evaluation and Treatment. 2017 . Available at: https://webcache.googleusercontent.com/search?q=cache:9JTbctfGprUJ:https://www.va.gov/vhapublications/ViewPublication.asp%3Fpub_ID%3D5431+&cd=1&hl=en&ct=clnk&gl=us&client=safari . Accessed October 31, 2019
    PubMedGoogle Scholar
  • 11 American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Age-related fertility decline. Obstet Gynecol 2008; 112 (2, Pt 1): 409-411
    CrossrefPubMedGoogle Scholar
  • 12 Practice Committees of American Society for Reproductive Medicine; Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril 2013; 99 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 13 Goldman KN. The evolution of oocyte cryopreservation (OC): longitudinal trends at a single center. Fertil Steril 2014; 102: e164-e165
    CrossrefPubMedGoogle Scholar
  • 14 Mucowski S. Current utilization status of cryopreserved oocytes in the United States. Fertil Steril 2014; 101: e31-e32
    CrossrefPubMedGoogle Scholar
  • 15 ACOG. ACOG: Committee Opinion No. 584: oocyte cryopreservation. Obstet Gynecol 2014; 123 (01) 221-222
    CrossrefPubMedGoogle Scholar
  • 16 Del Mastro L, Ceppi M, Poggio F. , et al. Gonadotropin-releasing hormone analogues for the prevention of chemotherapy-induced premature ovarian failure in cancer women: systematic review and meta-analysis of randomized trials. Cancer Treat Rev 2014; 40 (05) 675-683
    CrossrefPubMedGoogle Scholar
  • 17 Chian RC, Wang Y, Li YR. Oocyte vitrification: advances, progress and future goals. J Assist Reprod Genet 2014; 31 (04) 411-420
    CrossrefPubMedGoogle Scholar
  • 18 Parmegiani L, Bertocci F, Garello C, Salvarani MC, Tambuscio G, Fabbri R. Efficiency of human oocyte slow freezing: results from five assisted reproduction centres. Reprod Biomed Online 2009; 18 (03) 352-359
    CrossrefPubMedGoogle Scholar
  • 19 Oktay K, Cil AP, Bang H. Efficiency of oocyte cryopreservation: a meta-analysis. Fertil Steril 2006; 86 (01) 70-80
    CrossrefPubMedGoogle Scholar
  • 20 Smith GD, Serafini PC, Fioravanti J. , et al. Prospective randomized comparison of human oocyte cryopreservation with slow-rate freezing or vitrification. Fertil Steril 2010; 94 (06) 2088-2095
    CrossrefPubMedGoogle Scholar
  • 21 Gook DA, Edgar DH. Human oocyte cryopreservation. Hum Reprod Update 2007; 13 (06) 591-605
    CrossrefPubMedGoogle Scholar
  • 22 Rienzi L, Gracia C, Maggiulli R. , et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update 2017; 23 (02) 139-155
    PubMedGoogle Scholar
  • 23 Cobo A, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2011; 96 (02) 277-285
    CrossrefPubMedGoogle Scholar
  • 24 Cobo A, Meseguer M, Remohí J, Pellicer A. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod 2010; 25 (09) 2239-2246
    CrossrefPubMedGoogle Scholar
  • 25 Lewis EI, Missmer SA, Farland LV, Ginsburg ES. Public support in the United States for elective oocyte cryopreservation. Fertil Steril 2016; 106 (05) 1183-1189
    CrossrefPubMedGoogle Scholar
  • 26 Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?. Fertil Steril 2013; 100 (05) 1343-1349
    CrossrefPubMedGoogle Scholar
  • 27 Devine K, Mumford SL, Goldman KN. , et al. Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth. Fertil Steril 2015; 103 (06) 1446-53.e1 , 2
    CrossrefPubMedGoogle Scholar
  • 28 Milman LW, Senapati S, Sammel MD, Cameron KD, Gracia C. Assessing reproductive choices of women and the likelihood of oocyte cryopreservation in the era of elective oocyte freezing. Fertil Steril 2017; 107 (05) 1214-1222.e3
    CrossrefPubMedGoogle Scholar
  • 29 ASRM. New York Becomes Tenth State to Require Coverage of IVF and Sixth State to Require Coverage for Fertility Preservation for Certain Patients. 2019 ;22. Available at: https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/new-york-becomes-tenth-state-to-require-coverage-of-ivf-and-sixth-state-to-require-coverage-for-fertility-preservation-for-certain-patients/ . Accessed October 4, 2019
    PubMedGoogle Scholar
  • 30 Abram McBride J, Lipshultz LI. Male fertility preservation. Curr Urol Rep 2018; 19 (07) 49
    CrossrefPubMedGoogle Scholar
  • 31 Shin DH, Turek PJ. Sperm retrieval techniques. Nat Rev Urol 2013; 10 (12) 723-730
    CrossrefPubMedGoogle Scholar
  • 32 Picton HM, Wyns C, Anderson RA. , et al; ESHRE Task Force On Fertility Preservation In Severe Diseases. A European perspective on testicular tissue cryopreservation for fertility preservation in prepubertal and adolescent boys. Hum Reprod 2015; 30 (11) 2463-2475
    CrossrefPubMedGoogle Scholar
  • 33 van Casteren NJ, van Santbrink EJ, van Inzen W, Romijn JC, Dohle GR. Use rate and assisted reproduction technologies outcome of cryopreserved semen from 629 cancer patients. Fertil Steril 2008; 90 (06) 2245-2250
    CrossrefPubMedGoogle Scholar
  • 34 Habermann H, Seo R, Cieslak J, Niederberger C, Prins GS, Ross L. In vitro fertilization outcomes after intracytoplasmic sperm injection with fresh or frozen-thawed testicular spermatozoa. Fertil Steril 2000; 73 (05) 955-960
    CrossrefPubMedGoogle Scholar
  • 35 Levron J, Madgar I, Shefi S. , et al. IVF outcome with cryopreserved testicular sperm. Andrologia 2011; 43 (01) 48-51
    CrossrefPubMedGoogle Scholar
  • 36 Huang C, Lei L, Wu HL. , et al. Long-term cryostorage of semen in a human sperm bank does not affect clinical outcomes. Fertil Steril 2019; 112 (04) 663-669.e1
    CrossrefPubMedGoogle Scholar
  • 37 Feldschuh J, Brassel J, Durso N, Levine A. Successful sperm storage for 28 years. Fertil Steril 2005; 84 (04) 1017
    CrossrefPubMedGoogle Scholar
  • 38 Szell AZ, Bierbaum RC, Hazelrigg WB, Chetkowski RJ. Live births from frozen human semen stored for 40 years. J Assist Reprod Genet 2013; 30 (06) 743-744
    CrossrefPubMedGoogle Scholar
  • 39 Johnson MD, Cooper AR, Jungheim ES, Lanzendorf SE, Odem RR, Ratts VS. Sperm banking for fertility preservation: a 20-year experience. Eur J Obstet Gynecol Reprod Biol 2013; 170 (01) 177-182
    CrossrefPubMedGoogle Scholar
  • 40 Saito K, Suzuki K, Iwasaki A, Yumura Y, Kubota Y. Sperm cryopreservation before cancer chemotherapy helps in the emotional battle against cancer. Cancer 2005; 104 (03) 521-524
    CrossrefPubMedGoogle Scholar
  • 41 Edge B, Holmes D, Makin G. Sperm banking in adolescent cancer patients. Arch Dis Child 2006; 91 (02) 149-152
    CrossrefPubMedGoogle Scholar
  • 42 Dean WK, Caplan AL, Parent B. Military genitourinary trauma: policies, implications, and ethics. Hastings Cent Rep 2016; 46 (06) 10-13
    CrossrefPubMedGoogle Scholar
  • 43 Sonnenburg DW, Brames MJ, Case-Eads S, Einhorn LH. Utilization of sperm banking and barriers to its use in testicular cancer patients. Support Care Cancer 2015; 23 (09) 2763-2768
    CrossrefPubMedGoogle Scholar
  • 44 Grover NS, Deal AM, Wood WA, Mersereau JE. Young men with cancer experience low referral rates for fertility counseling and sperm banking. J Oncol Pract 2016; 12 (05) 465-471
    CrossrefPubMedGoogle Scholar
  • 45 Nahata L, Cohen LE, Yu RN. Barriers to fertility preservation in male adolescents with cancer: it's time for a multidisciplinary approach that includes urologists. Urology 2012; 79 (06) 1206-1209
    CrossrefPubMedGoogle Scholar
  • 46 Ben-Rafael Z. The dilemma of social oocyte freezing: usage rate is too low to make it cost-effective. Reprod Biomed Online 2018; 37 (04) 443-448
    CrossrefPubMedGoogle Scholar
  • 47 Machen GL, Harris SE, Bird ET. , et al. Utilization of cryopreserved sperm cells based on the indication for storage. Investig Clin Urol 2018; 59 (03) 177-181
    CrossrefPubMedGoogle Scholar
  • 48 Hammarberg K, Kirkman M, Pritchard N. , et al. Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Hum Reprod 2017; 32 (03) 575-581
    PubMedGoogle Scholar
  • 49 Krulewitch CJ. Reproductive health of active duty women in medically austere environments. Mil Med 2016; 181 (09) 1166
    CrossrefPubMedGoogle Scholar
  • 50 Zephyrin LC. Reproductive health management for the care of women Veterans. Obstet Gynecol 2016; 127 (02) 383-392
    CrossrefPubMedGoogle Scholar
  • 51 2017 Demographics Profile of the Military Community. 2017 . Available at: https://www.militaryonesource.mil/reports-and-surveys/demographic-profiles . Accessed August 31, 2019
    PubMedGoogle Scholar
  • 52 Returning home from Iraq and Afghanistan: assessment of readjustment needs of veterans, service members, and their families. Mil Med 2014; 179 (10) 1053-1055
    CrossrefPubMedGoogle Scholar
  • 53 Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. Committee Opinion No. 547: Health care for women in the military and women veterans. Obstet Gynecol 2012; 120 (06) 1538-1542
    CrossrefPubMedGoogle Scholar
  • 54 Balzano FL, Hudak SJ. Military genitourinary injuries: past, present, and future. Transl Androl Urol 2018; 7 (04) 646-652
    CrossrefPubMedGoogle Scholar
  • 55 Janak JC, Orman JA, Soderdahl DW, Hudak SJ. Epidemiology of genitourinary injuries among male U.S. service members deployed to Iraq and Afghanistan: early findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project. J Urol 2017; 197 (02) 414-419
    CrossrefPubMedGoogle Scholar
  • 56 Cannon JW, Hofmann LJ, Glasgow SC. , et al. Dismounted complex blast injuries: a comprehensive review of the modern combat experience. J Am Coll Surg 2016; 223 (04) 652-664.e8
    CrossrefPubMedGoogle Scholar
  • 57 Oh JS, Do NV, Clouser M. , et al. Effectiveness of the combat pelvic protection system in the prevention of genital and urinary tract injuries: an observational study. J Trauma Acute Care Surg 2015; 79 (04) (Suppl. 02) S193-S196
    CrossrefPubMedGoogle Scholar
  • 58 Katon J, Cypel Y, Raza M. , et al. Self-reported infertility among male and female veterans serving during Operation Enduring Freedom/Operation Iraqi Freedom. J Womens Health (Larchmt) 2014; 23 (02) 175-183
    CrossrefPubMedGoogle Scholar
  • 59 Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Voluntary and involuntary childlessness in female veterans: associations with sexual assault. Fertil Steril 2014; 102 (02) 539-547
    CrossrefPubMedGoogle Scholar
  • 60 Schrader SM, Langford RE, Turner TW. , et al. Reproductive function in relation to duty assignments among military personnel. Reprod Toxicol 1998; 12 (04) 465-468
    CrossrefPubMedGoogle Scholar
  • 61 Velez de la Calle JF, Rachou E, le Martelot MT, Ducot B, Multigner L, Thonneau PF. Male infertility risk factors in a French military population. Hum Reprod 2001; 16 (03) 481-486
    CrossrefPubMedGoogle Scholar
  • 62 Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Ethics Committee of the American Society for Reproductive Medicine. Posthumous retrieval and use of gametes or embryos: an Ethics Committee opinion. Fertil Steril 2018; 110 (01) 45-49
    CrossrefPubMedGoogle Scholar
  • 63 Pastuszak AW, Lai WS, Hsieh TC, Lipshultz LI. Posthumous sperm utilization in men presenting for sperm banking: an analysis of patient choice. Andrology 2013; 1 (02) 251-255
    CrossrefPubMedGoogle Scholar
  • 64 Kime P. Military's new fertility benefit will let troops freeze their sperm and eggs. Military Times. 2016 . Available at: https://www.militarytimes.com/pay-benefits/military-benefits/health-care/2016/01/29/military-s-new-fertility-benefit-will-let-troops-freeze-their-sperm-and-eggs/ . Accessed September 7, 2019
    PubMedGoogle Scholar
  • 65 R H. GOP objection kills Senate funding for military fertility program. McClatchy DC Bureau. Available at: https://www.mcclatchydc.com/news/politics-government/congress/article83811887.html . Accessed September 7, 2019
    PubMedGoogle Scholar
  • 66 Bob Woodruff Foundation. Intimacy after Injury Symposium. Available at: https://bobwoodrufffoundation.org/wp-content/uploads/2016/10/Intimacy-After-Injury-Report.pdf . Accessed September 7, 2019
    PubMedGoogle Scholar
  • 67 Callegari LS, Borrero S, Reiber GE. , et al. Reproductive life planning in primary care: a qualitative study of women Veterans' perceptions. Womens Health Issues 2015; 25 (05) 548-554
    CrossrefPubMedGoogle Scholar
  • 68 Mattocks KM, Nikolajski C, Haskell S. , et al. Women veterans' reproductive health preferences and experiences: a focus group analysis. Womens Health Issues 2011; 21 (02) 124-129
    CrossrefPubMedGoogle Scholar