October is Breast Cancer Awareness month. What does breast cancer have to do with fertility? Breast cancer treatment often involves exposure to chemotherapy and/or radiation. Chemotherapy and radiation can dramatically increase your risk for infertility. Both of these treatments can destroy eggs — so much so that many women may become prematurely menopausal after cancer treatment. Women who do not undergo premature menopause may still suffer from significantly compromised ovarian function after cancer treatment. The rate of infertility for cancer survivors is significantly higher than the rate in the general population.
The good news is that many women are surviving cancer. Cancer treatments have become so successful, it now makes sense to talk with many patients about life after cancer. For young cancer survivors, that often means talking about fertility preservation so cancer survivors can have a family in the future.
Although sperm freezing has been widely available and highly successful since the 1950s, egg freezing has not. Until very recently, embryo freezing was a reasonable option with good pregnancy rates, but egg freezing was a long shot. This made it very difficult for women without stable partners to preserve their fertility. A single woman could freeze her eggs and not really know if she had a reasonable chance of pregnancy from those eggs, or she could consider embryo freezing with a much more predictable pregnancy rate but the downside of having to commit to using donor sperm to create the embryos. Neither was really a desirable option. Today, thanks to dramatically increased pregnancy rates in the last few years, egg freezing is a realistic option for preserving your fertility, one that has success rates that are approaching success rates for frozen embryos. So cancer patients — and patients who are just concerned about their aging eggs — can freeze eggs knowing that there are predictable and reasonable survival rates after thawing, excellent fertilization rates and very reasonable pregnancy rates.
Why is it so hard to freeze eggs? It is because eggs are some of the largest cells in the body, containing relatively large amounts of water. Water crystallizes upon freezing, and it is those crystals that can do irreparable damage to the delicate and essential structures of the eggs. New freezing solutions and a super-rapid method of freezing called VITRIFICATION, eliminate crystal formation, allowing preservation of the delicate, microscopic structures of the egg.
Although the first frozen egg baby was born in the 1980s, only a handful were born in the 1990s and, as recently as last year, it was thought that only about 1,000 babies had been born from frozen eggs. More than a million babies have been born from IVF since the first IVF baby in 1978, so you can see how new egg freezing technology really is.
Why is VITRIFICATION such a revolutionary advancement? Vitrification literally stops the molecules in their tracks by plunging your eggs from body temperature – around 37 degrees Centigrade or 98.6 degrees Farenheit to negative (that is below zero) 196 degrees Centigrade or negative 321 degrees Farenheit – a drop of 233 degrees Centigrade and over 419 degrees Farenheit! The molecules literally cannot move at these low temperatures. What does that mean for your eggs? No freezer burn! Eggs frozen via this method, once thawed, have the same pregnancy potential as fresh eggs. We can literally stop time – at least for your eggs.
In 2012 ASRM (The American Society for Reproductive Medicine) and in 2013 the ASCO (the American Society for Clinical Oncologists) were so impressed by the vitrification data that they declared that egg freezing should no longer be considered experimental and that ALL women diagnosed with cancer who might consider conceiving in the future should have counseling regarding egg freezing.
What is the message? The message is that cancer patients have more options now. But since successful egg freezing is so new, many cancer doctors, busy saving their patients lives, may not have this conversation with their patients.
Get the word out. Egg freezing is a viable option for cancer patients and for any woman who wants to preserve her fertility. Have that conversation with your doctor and with a reproductive endocrinologist. You may decide that freezing eggs is for you. You may decide that it is not for you. But it is important to know your options, so the choice is yours.
Copyright Serena H Chen, MD 2016
