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RE of the Month Mitchell P. Rosen, M.D.

November 2009

Mitchell P. Rosen, M.D.

Adjunct Professor, Reproductive Endocrinology and Infertility, UCSF Center for Reproductive Health
Director, The Fertility Preservation Program
San Francisco, California

    “The unfulfilled desire for childbearing can be devastating. My goal is to better predict ovarian age and optimize care for cancer patients so that achieving a pregnancy becomes a reality.”

Dr. Mitchell Rosen specializes in understanding the biological clock and ways to predict menopause and the end of reproductive capacity through state-of-the-art tests. This is good news for two types of patients: women who are suffering from cancer and those who have decided to delay child bearing for various social and economic choices and experiences. It’s also why we’ve chosen Dr. Rosen as our RE of the Month.

As Assistant Professor in the Division of Obstetrics and Reproductive Science at University of California, San Francisco, and Director of The Fertility Preservation Program at UCSF Center for Reproductive Health, Dr. Rosenhelps his patients – cancer patients, or women who want to preserve their fertility -- decide whether to have eggs or ovarian tissue frozen.

Ovarian Aging

Age is one of the factors this decision depends upon. As we age the number of follicles that release eggs decline along with egg quality. A patient can have her “ovarian age” assessed through an antral follicle ultrasound. By placing a wand-like device inside the vagina, doctors can look at a woman's ovaries on a screen and actually count the number of antral follicles (resting follicles) she has. Depending on the results of the test and the number of follicles found, a patient can decide whether to freeze her eggs at their current age or possibly gamble by waiting.

Ovarian aging is a vital aspect of a cancer diagnosis since most chemotherapy treatments can damage a woman's fertility; some treatments can even render a woman totally infertile. “A patient needs to get treated with chemotherapy and all of a sudden her number of eggs have dropped,” Dr. Rosen explains. “So the question becomes where is she on the reproductive aging spectrum? Does this woman have an egg quality in which she will be able to get pregnant or will she need to freeze her eggs?”

Navigating a Cancer Diagnosis and Fertility Preservation

One of the strongest motivations for beating cancer is the desire to have a genetic family. According to the National Institutes of Health (NIH), in 2000, approximately 2.5 million adults of childbearing age survived cancer.

“What if you’re 25 and you’ve just been diagnosed with cancer and you’ve been told that you’re going to become infertile from chemotherapy?” says Dr. Rosen. Or maybe you’re 37 and you receive a breast cancer diagnosis. “There is some suggestion that quality and quantity [of eggs] are related. As the egg count declines with age, the presence of abnormal eggs increases with age. It may be that your ovarian age is proportional to the amount of healthy eggs that you have.”

It’s scenarios like these that led Dr. Rosen to spearhead The Fertility Preservation Program at the UCSF Center for Reproductive Health in 2007. The Program's main goal is to help patients diagnosed with cancer navigate the rocky waters of fertility preservation.

Dr. Rosen, along with his team, has developed a multi-disciplinary team approach to push the envelope of this field of clinical care and medical research. Each patient is assigned a “Patient Navigator” who looks at their individual situation and biology, helps them make critical decisions, and then directs them to the best support among the team of reproductive endocrinologists, urologists, psychologists, genetic counselors and clinical embryologists and experts in gamete biology.

We like this kind of support. Keep studying Dr. Rosen!

Click on the page numbers below to find out about other REs that have wowed us!