Egg Freezing, Breast Cancer & Fertility
Cryopreservation of oocytes is available to women who cannot get pregnant now but who wish to preserve their future fertility. Freezing arrests the aging of eggs which is a major obstacle to successful birth of a healthy child. The graph below portrays the decline in live births with advancing age in all women undergoing fresh embryo transfers after IVF using their own eggs in the United States in year 2005 as reported by the CDC. With IVF the relentless decline in live births per cycle begins at the age of 33 years. Most women who freeze eggs do so between the ages of 33 and 38 years.
While the first live birth from frozen-thawed unfertilized egg was reported in 1986, this early success could not be consistently duplicated for decades. The low success rate of egg freezing was attributed to the delicate protein structures (called spindles) that suspend the chromosomes in a mature egg. During the freezing process, ice crystals can easily damage the spindles. The safety and success rates for egg freezing improved only with the development of vitrification – a rapid cooling technique that minimizes formation of ice crystals, leaving the eggs suspended in a glass-like state.
As of October 2012, egg freezing was no longer considered experimental by the American Society of Reproductive Medicine (ASRM). However, it is important for patients to realize that the live birth rates with frozen eggs have not yet been firmly established for different age groups but are likely to be 20-25% lower than cumulative live birth rates with IVF in the same age groups. Current studies indicate that conceptions resulting from egg freezing are safe with no reported increase in congenital/chromosomal anomalies.
Egg freezing is a complex and expensive treatment, although its cost is less than cost of IVF. One of the major advantages of freezing eggs over freezing embryos is that the woman retains complete custody over the fate of her eggs as opposed to joint custody with her partner in the case of frozen embryos. The development of safe and efficient egg freezing is an important option for women seeking preservation of fertility for future family building. We encourage interested women to make an appointment to discuss whether this technology is appropriate for them.
Cancer, Breast Cancer & Fertility
Significant advances in the diagnosis and treatment of different types of cancer and other chronic diseases have rendered fertility preservation of acute interest to increasing number of men and women.
In some cases the disease itself may impair future fertility while in others it is the treatment, such as chemotherapy, which may impact the ability to have children in the future. While each patient and each condition requires a highly individualized approach, a few general rules apply to many situations.
It is important to rapidly assess your current reproductive potential as well as the ability to carry a pregnancy and raise children after treatment. The value placed upon preserving a genetic link to the offspring is key to determining the available alternatives and their optimal timing. The many available options include IVF with embryo banking, unfertilized egg freezing, freezing of ovarian tissue, semen freezing, ovarian suppression during chemotherapy and use of egg donor eggs or sperm as well as surrogacy. Psychological support and close cooperation with the doctors taking care of your primary disease are essential.
Advances in the diagnosis of breast cancer have led to earlier detection while combined therapy has rendered many smaller tumors potentially curable in a high percentage of cases. Since 15% of new breast cancer cases occur before the age of 45, a large number of women receive the diagnosis before they have completed or even begun building their families. Hence, preservation of fertility ranks high on their list of priorities. However, their reproductive options are extremely complex and fraught with potential risks. Multiple medical, social, psychological and financial factors need to be taken into account in selecting the best course of action for each patient.
Optimal management requires close cooperation of the breast surgeon, radiation and medical oncologists and the reproductive endocrinologist. We give special attention to the psychological needs of patients who face the combined stress of a life-threatening disease and the life-long consequences of irreversible reproductive choices. Furthermore, new treatment options are emerging rapidly and current practices are based on a limited number of studies, which have yet to be reproduced in most fertility clinic settings.
Clearly, immediate conception is not safe while delaying pregnancy until after completion of treatment is likely to require an egg donor. Most treatment protocols, in addition to surgery and regional radiation, include either chemotherapy or prolonged hormonal therapy (tamoxifen), which markedly reduce the chance of conception with the woman’s own eggs. Chemotherapy is toxic to ovaries. Consequently, many women in their late 30s and early 40s whose ovarian reserve is fragile to begin with either lose the ability to produce multiple eggs after chemotherapy, or stop ovulating altogether and enter menopause early. While tamoxifen treatment does not damage the ovaries directly, this therapy is usually given over a prolonged period of time, such as five years, which itself markedly reduces the number of healthy eggs and makes the chance of successful pregnancy unlikely.
Fortunately, the continuing progress in assisted reproductive technologies has led to a wide range of options available for preservation of fertility in women with breast cancer.
Our egg freezing, breast cancer and fertility patients come to us from San Francisco, the Bay Area, Berkeley, Oakland, Sacramento and surrounding areas.