Fertility preservation provision in the NHS in Scotland: guidance

Treatment to be offered

Egg/embryo storage: one cycle of ovarian stimulation will be offered. When it is considered that the ovarian stimulation regimen did not result in an optimal response for that patient, a second stimulation may be considered. The number of eggs stored is not the basis for whether a second cycle is offered.

Sperm storage: generally, one ejaculate will be stored, however the storage of sperm from more than one ejaculate may be appropriate where the initial sample is not of good quality, and there is sufficient time.

Ovarian tissue storage: this is available through SNBTS and managed as a research project, rather than through fertility services. Following surgical (laparoscopic) removal, tissue is stored under license from the Human Tissue Authority (HTA), not the HFEA: an important distinction is that this allows consent to be given by the parent/legal guardian where appropriate. Although recognised as a valid option for adult women, it is less commonly performed due to the increased availability and success of oocyte vitrification, and it is largely undertaken in prepubertal girls and younger adolescents. While the same access criteria apply in relation to risk of loss of fertility, the upper age limit is before 36th birthday (both for ethical approval and as per international guideline).

The challenges for successful treatment following ovarian tissue replacement after cryostorage are recognised. While many babies born following this procedure have been through natural conception, assisted reproduction will be appropriate for some. As the ovarian response to stimulation will inevitably be low, they will be offered up to three cycles of ovarian stimulation, but only two if no oocytes are obtained in the first two cycles. It is anticipated that in most instances the intention will be to perform a fresh embryo transfer, but in some cases ‘embryo banking’ or ‘double stimulation’ protocols may be clinically appropriate.^[10]