A diagnosis of cancer is life-altering, and one fear it may bring for women of childbearing age is that treatment could leave them unable to have children. Indeed, chemotherapy sometimes has that result. But pre-treatment oocyte cryopreservation— egg freezing—can often preserve a woman’s eggs for later use in in vitro fertilization (IVF). And this technology, until recently considered experimental, is now the standard of care.
That’s great news, says Serena H. Chen, M.D., director of reproductive medicine at Saint Barnabas Medical Center, but unfortunately too many women—and even some doctors—still don’t know it. “This is a really big step in fertility care,” she says, “but awareness of it hasn’t caught up, so we’re trying to spread the word.”
Dr. Chen and her colleagues want people to know that in 2012, the American Society for Reproductive Medicine (ASRM) declared that egg freezing was no longer experimental. This year the American Society of Clinical Oncology (ASCO) not only updated its guidelines to recommend oocyte cryopreservation as standard practice, but also stressed the need for all health providers, not just oncologists, to alert their patients to this advance in fertility preservation. The new ASCO guidelines encourage providers to “advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation.”
It’s easier for potential dads to protect the option of parenthood than for would-be moms, because freezing sperm is relatively simple and has been a viable option since the 1950s. Egg freezing is more challenging, Dr. Chen explains: “We struggled with it for 30 years.” Unlike sperm cells, egg cells are very large and contain a lot of water. “Freezing makes ice crystals that can damage the structures in the cell,” she says. “Once a cell is frozen, something changes in its outer shell so that it doesn’t let sperm in easily.”
The techniques that allow for the sperm to be injected into the cell were not perfected until the mid- 1990s, she says. It took a while longer for researchers, predominantly in Italy, to find a way to freeze and thaw the egg cells without internal damage. Why Italy? In that country, because of religious objections, the doctor says, “embryo freezing was illegal.” As a result, researchers there worked tirelessly on egg freezing as an alternative. “Many of the advances were discovered there, although research was also done in Atlanta and here at the Institute for Reproductive Medicine and Science (IRMS) at Saint Barnabas Medical Center.” The process takes the eggs down to a temperature of –140 degrees Celsius (–220 degrees Fahrenheit).
“It’s kind of miraculous that we can freeze, thaw and fertilize these eggs and make it possible for a baby to develop,” she says.
That’s a miracle many female cancer patients are looking for. Chemotherapy can destroy the reproductive cells, and until recently “women had few choices to preserve their fertility,” Dr. Chen says. “They could donate an egg, fertilize it and freeze the embryo, but some women may not have a partner and for some, embryo freezing is a less appealing option for religious reasons.”
Fertility preservation is critically important here in the Garden State, she says, “Because we know there is a lot of cancer here. But we also have some of the best oncologists in the world here—including right here at Saint Barnabas—and we are also the center of the IVF world. Some of the biggest, oldest and most famous IVF programs are in the New York metropolitan area, and IRMS at Saint Barnabas is one of them.”
Because cost can be a major concern for some women, IRMS often can help cancer patients get discounts through pharmaceutical or foundation grants.
So why has this news about egg freezing been slow to spread? “Unfortunately, there have been gaps in communication between reproductive endocrinologists and oncologists,” says Dr. Chen. “Our two medical fields have tended not to talk with each other enough. We need to come together better over this.”
She says that she is reaching out to ask oncologists to refer women diagnosed with cancer to her staff. “Our offices are just two floors above theirs here at Saint Barnabas Medical Center, and our staff knows that if we get a call for a new cancer patient, we mobilize right away,” Dr. Chen says. “We talk to her on the phone, get her in to see us that day or the next day and get all her other physicians involved as quickly as possible. This is a very difficult time, and these women have to juggle 100 balls once they get a diagnosis. We try to make it as easy as possible to get fertility information to them in a supportive and loving way.”
Dr. Chen and her colleagues let women newly diagnosed with cancer know that they can improve their odds of having a baby later on. “Despite what they have to go through with a diagnosis, most women feel empowered and have a more positive outlook after hearing about fertility preservation and knowing that this option is available,” says the doctor.
Egg freezing isn’t for everyone
When the American Society for Reproductive Medicine (ASRM) removed the “experimental” label from oocyte cryopreservation— egg freezing—it also issued a couple of caveats.
For one thing, said the ASRM, the woman’s age is a key factor. “Success rates with oocyte cryopreservation appear to decline with maternal age consistent with the clinical experience with fresh oocytes,” it says, and the procedure may not be suitable for older women.
In addition, although “egg freezing is a valid technique for young women for whom it is medically indicated, we cannot at this time endorse its widespread elective use to delay childbearing,” the group says.