In the US, 1.8 million people are diagnosed with cancer yearly. Some of these are young pre-pubertal girls. Others are women of reproductive age who may or may not have begun to think about the possibility of having children yet. While each cancer is different, early detection and current medical treatments have allowed more and more patients to be cured. These are reassuring statistics. However, chemotherapy drugs may render some patients unable to have options that include having biological children. As the intent of these medications is to “kill” cancer cells, they also will “kill” oocytes, or eggs. Since women are born with a predetermined number or eggs, there is no replenishing of their egg supply, also known as ovarian reserve. Certain chemotherapy drugs cause ovarian germ cells, or eggs, to be permanently lost.
In the 1980’s, scientists began working on techniques that would allow for freezing of eggs. Over the past decades, the technique of egg freezing has improved dramatically. Prior to 2012, the only available option for a woman to preserve her fertility was to undergo ovarian hyperstimulation, egg retrieval, and in vitro fertilization of her eggs using anonymous donor sperm. The sperm would be purchased from a sperm bank and the eggs injected with sperm in order to create an embryo. All embryos that appear to be healthy would have been frozen. While embryo freezing is a viable option for fertility preservation in patients with a partner, it is not an optimal choice for patients without a partner. In 1986, the first baby from a frozen egg was born. Egg freezing has evolved as new techniques such as vitrification has been perfected. Today, we are able to have excellent rates of egg survival, conception, and live births from previously cryopreserved oocytes, also known as “frozen” eggs. Moreover, children born from frozen eggs do not appear to have adverse outcomes.
The process of egg freezing can be overwhelming, particularly when someone is facing a cancer diagnosis, but with the survival rates thankfully high, most young women don’t want to surrender their chance of having a biological child in the future. There’s options and one owes it to oneself to at least meet with an RE specialist first. We make the process as turnkey as possible so there is no delay in cancer treatment. You are supported by a whole team of experts – from medical to counseling support. As soon as the patient has a consultation, medications are ordered. The patient will give herself injectable medications daily. Progression of ovarian response and “growth” of the eggs will be followed daily until the patient is ready for egg harvest. This is done with the aid of hormonal levels and a transvaginal ultrasound. The process of egg harvest is performed under ultrasound guidance and requires sedation. Once the embryologist examines the eggs, only the mature eggs will be frozen.
From this point on, the patient would be able to proceed with any necessary treatment, be it surgery, chemotherapy, or radiation.
While it is difficult to have the conversation of fertility preservation with patients facing a difficult diagnosis, it is a topic that must be discussed. As physicians, we look to provide the best outcomes for our patients. When cancer strikes, it is imperative to have a conversation and discuss the option of fertility preservation with all patients of reproductive age.
Dr. Jessica Salas Mann Dr. Jessica Salas Mann is an affiliate physician to IRMS at Saint Barnabas. As medical director of JSM Fertility, Dr. Mann works in concert with IRMS physicians to give exemplary care and service to patients throughout Central and Southern New Jersey. She is an experienced reproductive surgeon, having served the patients of Monmouth and Ocean counties since 2011. Her areas of clinical interest and expertise are pregnancy loss, ovulation induction, in vitro fertilization, polycystic ovarian syndrome, and third party reproduction.