Research Proposal: Qualitative Analysis of Fertility Preservation

This report presents a research proposal for a qualitative analysis of fertility preservation. It begins with an introduction to the topic, highlighting its growing importance due to lifestyle changes and medical advancements. The research background explores cryopreservation and vitrification techniques, emphasizing the increasing need for fertility preservation, especially for cancer patients and those undergoing treatments that may affect fertility. The rationale underscores the need for advanced research and development in this field, particularly for young cancer patients and those delaying childbearing. The report poses key research questions, including the definition of fertility preservation, its methods, and the societal sections that benefit from it. Research aims and objectives are clearly defined, including studying the technologies and challenges in this field. The theoretical framework discusses assisted reproductive technology and the growing need for awareness. The report also covers ethical issues, a research schedule, and limitations. The conclusion emphasizes the significance of fertility preservation, and the references provide supporting literature.

A Research Proposal For Qualitative Analysis of Fertility Preservation
[DATE]
Hewlett-Packard
[Company address]

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Contents
Introduction.................................................................................................................. 2
Research background..................................................................................................... 3
Research rationale..........................................................................................................4
Research questions.........................................................................................................5
Primary question........................................................................................................5
Secondary questions...................................................................................................5
Research aims and objectives..........................................................................................6
Theoretical framework...................................................................................................7
Research design...........................................................................................................12
Ethical issues.............................................................................................................. 13
Research schedule........................................................................................................14
Limitations..................................................................................................................15
Conclusion..................................................................................................................16
References.................................................................................................................. 17
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Introduction
Fertility preservation is a branch of reproductive medical science that is evolving rapidly.
With the changes in the lifestyle of people, and the decision to defer childbearing for medical
or social reasons, fertility preservation and its importance is ever increasing in the present
day, and so are the possibilities in this field. This is the technique with which, the eggs or the
sperms (human gametes) are frozen and stored for future use in the fertility treatment of a
person. There are a number of techniques that have been developed for the storage of these
gametes, and these practices are well established in the medical science (Faries, 2010). There
is a lot of progress that has been made in this field of science over the years, and continuous
study is being performed to improve it further. Fertility preservation, sometimes also referred
to as Assisted Reproductive Technology (ART) is done by following various methods and
technologies. Fertility preservation is practiced by freezing, protecting or saving the eggs,
sperms or even the reproductive tissues of a person, in order to use them later on to help them
in having biological children. A number of people worldwide have benefited from fertility
preservation as this practice gains popularity. The people for whom fertility preservation has
come as a boon usually belong to one of the categories given below (Agarwal & Allamaneni,
2007). The people detected with cancer and who are about to begin the treatment for the
same, people suffering from autoimmune disorders, people detected with genetic diseases
that have the ability affect the fertility of the patient in future, people exposed to toxins or
toxic chemicals because of the kind of job that they do or during military duty, people having
endometriosis or those suffering from uterine fibroids. This report is written with an intent to
make the reader understand fertility preservation by giving an overview of this topic along
with developing a proposal for carrying out a detailed research on this subject (Edwards,
2010).
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Research background
Preserving the fertility of a person involves freezing the eggs, sperms, reproductive tissues or
the embryos in order to have biological children and family in future. This preservation is
achieved by practicing cryopreservation. Cryopreservation can be explained as the process
through which the cells and tissues are cooled down to sub zero temperature to cease any
biological activity from happening in them. The temperature generally used for storing the
cells of mammals is -196 degree Celsius. Cryopreservation is generally achieved by slowly
freezing the eggs, sperms, embryos or reproductive tissues of humans (Foote, 2002). Another
way of storage and preservation of these cells and tissues involves ultra rapid cooling which
is done in the presence of cryoprecipitants in high concentrations which helps in the
solidification of the cells and tissues into a state that make them glass like. This process is
known as vitrification. Vitrification, unlike cryopreservation ensures that no ice crystals are
formed and prevents any injury that maybe caused to the cells and tissues during the chilling
process. There is a widespread increase in the number of people who survive cancer for more
than 5 years and the advancement in the treatment of life threatening diseases has further
strengthened and empowered the research on fertility preservation (Mei-Ami, 2005). The
increase in the life expectancy of humans and general delay in procreation and having
children due to changes in the lifestyle of the people has made it necessary to research more
and develop advanced fertility preservation techniques and technologies that give better
results that have a higher chance of success. Certain types of cancer treatments which include
the most commonly followed chemotherapy or radiotherapy involve the usage of some drugs
which when taken in high doses can cause infertility to the patients. This makes the people
going for these treatments consider fertility preservation. The people going for armed forces
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deployment also opt to preserve their sperms, eggs or embryos before they get deployed to
remote areas so that their fertility is preserved in case of an injury (Holland & Herzog, 2010).
This provides them with the relief that there is still a possibility of reproducing biologically in
future. People are counselled and suggested health plans before going for fertility
preservation as this practice requires the person undergoing the process to be medically fit
and sound.
Research rationale
Fertility preservation over the last decade has emerged as the topic that has grabbed the
attention of the medical scientists all over the world. Specifically, young cancer patients have
requested advanced research and development in this subject to provide them with the hope
of biological reproduction later in life. A number of medical societies worldwide have given
instructions to the physicians to take action in this regard, on behalf of their patients, to
preserve their future fertility. The emergence of fertility preservation has aroused a new hope
to these patients and also to the people who delay childbearing willingly or due to social
stigmas or various other reasons. The greatest benefit of fertility preservation has been
received by the cancer patients worldwide and the field of oncofertility has further addressed
the needs of the patients and empowered these practices by carrying out detailed researches in
recent past. The oncofertility community worldwide still has to face certain challenges that
need to be addressed in future. This should be done in order to reduce the disparity that the
patients face due to the challenges in the form of access to this treatment and its affordability.
The financial and geo political constraints limit these facilities to a certain set of people only.
However, the oncofertility research community is working towards developing ways to make
these processes accessible to all and more affordable in the coming future. This research is
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being carried out to get a better understanding on the subject of fertility preservation and its
scope in future. The recent advancement in the technology of fertility preservation has
empowered the healthcare technologies. This research addresses the concerns related to these
procedures and the latest advancements made in this field. It also summarizes of the available
options for getting these services and compiles the information that is presently available on
this topic (Denton, 2017).
Research questions
Fertility preservation is the technique with which, the eggs or the sperms are frozen and
stored for future use in the fertility treatment of a person. There are a number of techniques
that have been developed for the storage of these gametes, and these practices are well
established in the medical science. There is a lot of progress that has been made in this field
of science over the years, and continuous study is being performed to improve it further. This
research is being conducted on the topic of fertility preservation in order to get a better
understanding of this subject as a medical practice. Apart from getting the basic
understanding of the subject, there are a number of questions that this research aims to
answer for its readers. This section lists all the questions that will be answered by carrying
out this study and answers for which will be compiled in the form of this research report. The
research questions that this report aims to address are listed below.
Primary question
 What is fertility preservation?
Secondary questions
 Why was fertility preservation invented?
 Why is this branch of reproductive science being developed?
 What are the available methods and options for fertility preservation?
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 What are the latest developments in this field?
 Which section of the society can benefit from these methods and medical
technologies?
 What are the enablers and constrains in practicing fertility preservation?
Research aims and objectives
Fertility preservation involves freezing the eggs, sperms, reproductive tissues or the embryos
in order to have biological children and family in future. This report is being compiled to
make the readers understand fertility preservation by giving an overview of this topic along
with developing a proposal for carrying out a detailed research on this subject. The process of
defining the core objectives of a research report is at the heart of the conduction of study for
the chosen topic. It is necessary to objectively define the aims of a research and to list them
down with clarity and precision. Research objectives list the areas of knowledge on which the
project report aims to advance and build on. The objectives that are defined for the
conduction of this research report on fertility preservation are listed in this section. This
report aims to investigate the topic of fertility preservation in depth. The objectives of this
research report are:
 To study the topic of fertility preservation.
 To understand the reason for development of this procedure.
 To analyze the various technologies and methods available for practicing fertility
preservation.
 To find out the people who can benefit from fertility preservation.
 To find out the challenges that the medical practitioners are facing in this field.
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Theoretical framework
A rapid increase in the survival rates of the people suffering from life threatening diseases,
combined with the shift of the society towards delayed childbearing has made fertility
preservation an important area of investigation. The latest advancement in medical
technologies and reproductive medical science indicates a promising future for fertility
preservation. A number of clinical trials as well as meta analysis of these procedures is
continuously being carried out to further advance this technology and improve the level of its
accuracy in order to generate better results from these procedures. The first scientifically
recorded instance of Assisted Reproductive Technology (ART) was carried out by John
Hunter in London. He did this by inseminating a woman artificially by collecting a sample of
semen produced by her husband who was suffering from hypospadias. The present
day Assisted Reproductive Technology primarily comprises of fertility preservation and
'assisted conception' as practiced by John Hunter does not fall strictly within the dimensions
of these. The medical technology has made enough progress to store the embryos, sperms and
eggs. Further progress is being made to develop technologies for successful storage of
testicular and ovarian tissues to make the preservation process and the results from them
more effective. There is a dearth of a consistent approach for increasing the awareness about
fertility preservation among the masses (Elder & Dale, 2000). An exponential increase in the
number of people surviving cancer has encouraged a lot of fertility specialists and oncologists
to take steps to preserve the fertility of the patients who might suffer from irreversible
consequence of infertility due to chemotherapy and radiotherapy. These therapies and
treatments make the patients sterile and fertility preservation can prove to be a boon for these
patients who want to procreate after reviving from these treatments. Apart from cancer
patients, there are a number of oncological or non-oncological conditions which need to be
treated with the help of toxic agents which also lead to ovarian or testicular failure. Some
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other situations in which a woman may benefit from preservation of fertility are medical
conditions like, autoimmune disorder, endometriosis or even delayed conception until they
reach later reproductive years. Some gynaecological situations are also observed in clinical
practices which could not be treated prior to the development of these techniques of fertility
preservation, but can now be solved. Vitrification of oocytes and embryos is performed by
the medical practitioners to transfer the embryos to a stimulated cycle (Rani & Paliwal,
2014). Vitrification can also be considered for the conditions when the sperm is absent on the
specific day when the ovum gets picked up, there is bleeding right before the transfer of
embryo, the low responding patients who want to accumulate oocytes or embryos or want to
go through pre implantation genetic screening (PGS) can also take help of fertility
preservation. The present day technologies that are used in assisted reproduction are:
 In vitro fertilization (IVF)
 Intracytoplasmic sperm injection (ICSI)
 Gamete intrafallopian transfer (GIFT) (rarely practiced presently)
 Zygote intrafallopian transfer (ZIFT) (rarely practiced presently)
 Oocyte and embryo donation
 Cryopreservation of sperm
 Oocytes and embryos
 Gestational surrogacy
 In vitro maturation of oocytes
 Pre-implantation genetic diagnosis
Future fertility is found to be an area of significant concern for patients that are undergoing
treatment for life threatening diseases and also for the people who plan a delayed pregnancy.
The table below lists all the available strategies for the preservation of the reproductive
tissues (Radon, 2015).
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Figure: Available strategies for the preservation of the reproductive tissues
As much as 77% of the people undergoing cancer treatment are reported to have stress of
clinically significant level related to the probable loss of their fertility. In fact, a lot of patients
going for oncology treatments opt for a dose of chemotherapy that is less toxic, in order to
preserve their fertility even if it may result in an increased risk of recurrence of cancer. In
order to address these concerns of the patients, treatments and health practices of fertility
preservation have been promoted by the oncologists and the doctors treating the patients for
diseases whose treatments have a possibility of making them sterile (Aurora Reproductive
Care, 2013). The idea of childbearing is of great importance to many people. A number of
people who are unable to bear their own offspring are found to have symptoms of
psychological distress and depression. The advancement in the field of fertility preservation
has helped in reducing this burden to a great extent. However, there is still a long way to go
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for these treatments to give out better results, and to guarantee future pregnancy. The
challenges due to the limitations that come in front of the healthcare providers in the form of
medicine and technology have been taken care of, and the results of the developments so far
look very promising. In addition to the technical challenges and obstacles that these
treatments and development may face going forward from here, there are a number of ethical
issues that surround these treatments that need to be addressed and encountered. There is a
significant financial investment involved in the process of fertility preservation, the benefit of
which is uncertain. Some of these treatments also subject women, who are otherwise healthy,
to go through some procedures that involve medical risks that could even jeopardize their
future fertility. Arguments have also been made against these procedures as some people state
that these advancements encourage women to potentially delay the child bearing process.
Another aspect of this progress that remains unexplored is the long term health of the people
undergoing these treatments, and their offspring (Owens, 1985). A lot of progress has been
made in the field of fertility preservation, but the experimental techniques being used in these
procedures are still in their infant stage, and there is a long way to go for them to gain the
popularity and momentum in the society at mass level. The importance of accurate and
contemporary information for patients undergoing treatment for cancer or a life-limiting
illness affecting their fertility, cannot be underestimated. Timely and honest conversations are
required at a very difficult time. It becomes crucial to offer specialist services and counselling
to the people who are contemplating fertility preservation. These treatments make the patients
go through physical as well as emotional stress (Center, 2015). Therefore, psychological
support and counselling services should be made available to any person thinking about
going for fertility preservation, in order to provide them with the additional support which
helps them throughout the process of the treatment. Some of the factors that must be specially
taken care of while providing fertility preservation services to the patients are that the patients
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should be properly informed of the diagnosis as well as the prognosis. The risk involved with
the procedures should also be communicated to the patients, as well as their family. There are
also certain possible health risks that the patients face while undergoing treatments for
fertility preservation. Some of these treatments can even cause temporary or permanent
infertility, and the most common effect of these treatments in women is early menopause.
Consent of the patient and their family is a must to begin fertility preservation process.
Taking consent of the patient is a dynamic process which is heavily based on contemporary
information which is understandable and accurate at the same time. Structured meetings
should be organised by involving a team of healthcare practitioners in order to provide a
holistic approach to help the patient in the decision making and to receive the consent in a
competent manner (Matthews, Hurst, Marshburn, & Papadakis, 2012). A voluntary and
informed decision of the patient is must in order to begin these treatments and procedures. In
case of creation of embryos artificially, it becomes important to get the consent of both the
partners involved in the process individually and independently. In such cases, the
implications of the treatment that is being planned should be communicated to both the
parties and both the patient and their partner should be made to understand the need of their
consent and knowledge about the process.
This research review is going to summarize all the treatment options that are available for
fertility preservation among people. it will also address the concerns that arise during these
treatments and the procedures and how these treatments impact the health of the people going
through them (Fertility Associates, 2014). The providers of the healthcare services in the
society should work towards increasing awareness among the people of these available
treatment options and also communicate the advantages and disadvantages of fertility
preservation to them. The risks involved in these treatments and health practices should also
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