Fertility Preservation for Cancer Patients
Cancer is a life-changing diagnosis. It is a struggle just to survive. Treatments may include surgery, chemotherapy and radiation, all of which can impact fertility. It is imperative that a newly diagnosed cancer patient consult with a physician as soon as possible to discuss fertility issues and the options for fertility preservation.
For many years, men undergoing cancer treatment have been able to store sperm for long periods with great success. Since the 1980s, embryo freezing has been available to women with a life partner or sperm donor and pregnancy rates following transfer of these frozen embryos has steadily improved. Only recently, however, has egg freezing become a real option for women, thanks in particular to a new technology known as vitrification, or flash freezing.
Frozen eggs can be stored for many years. Once thawed, the eggs can be fertilized using a procedure called intracytoplasmic sperm injection, or ICSI (“ick-SEE”), in which an embryologist microscopically inserts a sperm cell into the egg. If fertilization is successful, the embryo can be grown in culture for several days before being transferred to the woman. This technology is still new, and the number of babies born from frozen eggs still ranges between 1500 – 2000. Survival of thawed eggs ranges from 35-90%, depending on the study. Fertilization of thawed eggs ranges from 70-90%, but pregnancy rates range in different studies from 5%-50%. This technology continues to improve.
Just like in a regular IVF cycle, an egg or embryo freezing patient must take medications that stimulate egg growth for up to two weeks, and then undergo an outpatient procedure for egg retrieval. Under ultrasound guidance, we visualize the ovaries and insert a needle into the follicles to extract the eggs. Any mature eggs can be frozen to be fertilized at a later date. Alternatively, we can fertilize the eggs with sperm in the lab (in vitro) and the resulting embryos can be frozen and used at a later date.
If a patient’s period stops (amenorrhea) during chemotherapy, egg and embryo freezing will be impossible until menses return. In some cases, amenorrhea may be a temporary phenomenon that resolves spontaneously after chemotherapy is finished. But, especially in older woman and/or those taking more toxic medications, amenorrhea may be permanent. And even if menses do return after cancer treatment, fertility may still be compromised at a much younger age than expected. It is recommended that young survivors maintain an awareness of their fertility status after cancer treatments.
Some patients prefer alternatives to egg and embryo freezing. One option involves taking Lupron simultaneously with chemotherapy. Lupron causes the brain to stop stimulating the ovaries, putting the eggs in a quiescent state that some have theorized may make them more resistant to the harmful effects of chemotherapy. The literature is mixed on the success of this treatment, but it may provide some benefits.
Elective Fertility Preservation
You are born with all the eggs you are ever going to have. Unlike sperm which are constantly regenerating, the number of eggs in a woman’s ovaries decreases over time, from approximately 1-2 million eggs at birth, to 300,000 – 500,000 eggs at puberty to approximately 25,000 eggs at age 37. This is why fertility decreases with age, and why young women get pregnant with greater ease. Despite this fact, many women today are postponing childbearing in order to pursue educational or career goals, for other personal reasons or simply because they haven’t met “the one.” Oocyte cryopreservation, or egg freezing, is revolutionary technology for these women, allowing them to preserve their fertility and save their eggs now for use at a later date.
Egg freezing involves going through most of the same steps as a regular IVF cycle including ovarian stimulation, monitoring with ultrasounds and bloodwork and egg retrieval. Following the retrieval, the eggs are then frozen for use at a later date.
The use of oocyte cryopreservation for elective and medical reasons has become quite widespread. In addition, published data show that pregnancy rates from frozen eggs seem to approximate pregnancy rates in fresh IVF cycles, at least for eggs frozen from women 37 years old and younger.
For women who have a male partner and are not in a position to have children yet, or for women who would rather use a more proven technology, embryo cryopreservation is also available for elective fertility preservation. In these cases, eggs are fertilized following retrieval and are the resulting embryos are then frozen approximately 3-5 days later.
If you think that egg freezing might be a good option for you, please contact us for a consultation with one of our specialists.
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