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Preservation and Postponement of Fertility
by Dr. Jason Bromer, Shady Grove Fertility Center, Aug. 4, 2010
Some of Reproductive Medicine’s most exciting advances have come in the area of preservation of female fertility. It is an area of utmost importance to women of reproductive age who have developed a cancer or disease that threatens their ability to have children in the future.
Preserving Fertility Important to Many Cancer Patients
These advances in preserving fertility in patients preparing for toxic chemotherapy or radiation therapy couldn’t have come at a more important time. It has been estimated that one in 250 adults will be a cancer survivor. In recent surveys, 75 percent of patients with cancer have stated that they want children in the future, 80 percent feel that their cancer experience would make them better parents, and 67 percent would want a child even if they were to die young.
Nonetheless, there remains a sharp divide between patient interest in fertility preservation and health providers’ education on the topic.
Only 60 percent of survivors diagnosed with cancer in young adulthood recall discussing cancer-related infertility. And, in a survey of 697 women diagnosed with breast cancer before the age of 40, 72 percent of respondents stated that they had discussed infertility with their physician, but only 55 percent were satisfied that their concerns about childbearing were addressed.
There are other reasons women choose to postpone or preserve their fertility. Women in western countries have increasingly delayed the birth of the first child to a later age.
With the growing popularity of assisted reproductive technology, many women have been given the impression that female fertility may be successfully influenced at any point prior to menopause. Unfortunately, the assumption that fertility can simply be resumed at a later time is erroneous. On the other hand, the uterus does not seem to play a significant role in age-related fertility until much later, a phenomenon that makes preservation of the egg — egg freezing — particularly attractive.
Egg Freezing Becomes an Attractive Option
Traditionally, fertility preservation has been limited to cryopreservation, the freezing of embryos. But embryo cryopreservation in the context of fertility preservation has a few critical pitfalls.
- First, it requires that the female patient has a male partner or uses donor sperm to fertilize retrieved eggs.
- Second, ovarian stimulation must precede oocyte retrieval for in vitro fertilization. This characteristic necessitates a delay that may be unacceptable in the case of a cancer patient requiring rapid initiation of chemo- or radiotherapy.
- Third, the high estrogen levels associated with ovarian stimulation may be contraindicated in women with estrogen-sensitive malignancies such as breast cancer.
Newer techniques have recently been developed that can overcome these limitations. Many fertility centers now have the ability to freeze oocytes, or eggs, a process that eliminates both the need for sperm and the ethical quandaries that sometimes arise with freezing embryos.
While egg freezing is still considered a new technology, more than 1,000 babies have been born to date from frozen and thawed eggs. In cases in which the time needed for ovarian stimulation is not available, ovarian tissue with intact eggs can be surgically removed and frozen. This tissue can later be thawed and re-transplanted, allowing women to resume menstruation and become pregnant.
In the near future, it may even be feasible to freeze, thaw, and re-transplant an entire ovary. Several fertility centers in the United States, Europe, and Israel are currently working on this technology, and early results are very promising.
Reproductive-age women have a right to fight for their fertility – whether it is threatened by disease, chemotherapy or just the passage of time. Similarly, caregivers have a responsibility to inform their patients that there are options available to them when a threat to their future fertility ensues. The first step is to become educated about available treatments and to find reproductive physicians who can provide them. Here are some websites that may be of help:
- Fertile Hope – Part of the LiveStrong Organization
- >The American Society of Reproductive Medicine — Fertility Preservation
- The International Society for Fertility Preservation
- The OncoFertility Consortium
Jason Bromer, MD, FACOG, is a specialist in Reproductive Endocrinology and Infertility at Shady Grove Fertility Center, formerly of the Reproductive Science Center of New Jersey. After receiving a medical degree from the George Washington University School of Medicine and a residency in Obstetrics and Gynecology at Georgetown University, he completed a three-year fellowship in reproductive endocrinology and infertility at Yale University and was involved in cutting edge research in fertility preservation for cancer patients., pregnancy implantation and methods of embryo selective for IVF. During his time at RSC NJ, Dr. Bromer held teaching positions at Monmouth Medical Center and Jersey Shore University Medical Center, an Affiliate of the Robert Wood Johnson Medical Center. He now sees fertility patients in the Frederick, Maryland office of Shady Grove.