Cancer treatment includes fertility planning

A young woman raised her hand at the end of a seminar for young cancer survivors. It was last spring, during an I[2]Y (or "I'm Too Young for This!") meeting, and the seminar was on post-cancer family planning. She said she received radiation to her abdomen during treatment for cancer in her teens and, as a result, was being told that her eggs were most likely not viable, though she is well within child-bearing age. She was upset that fertility issues were not discussed with her and her family at the time of her treatment. Until recently, standard cancer treatments have not included female fertility preservation as a joint concern. If cancer was discovered, regardless of the patient's age, it was treated as quickly and as aggressively as deemed necessary (chemotherapy, surgery, and radiation being the primary tools), and that was that; fertility was not generally a part of the conversation. But as awareness grows about the potential effects of treatments on female fertility, and as fertility-preservation techniques become more sophisticated, these discussions are changing. Several programs now help girls and women who are facing cancer treatments to retain their fertility options for the future. One of them, the "Fertility Rescue" program of the Sher Institute for Reproductive Medicine (with locations in Illinois, Texas, Nevada, Pennsylvania, New Jersey, New York, and California), offers free egg-retrieval cycles for women of childbearing age who are facing treatments that might compromise their fertility. The eggs are then frozen and stored, to be thawed at the time that a pregnancy is desired. This is an important resource given that each egg-retrieval effort can cost $10,000 and few insurers offer coverage. "The main costs are our fees, which we waive," says Sher's Dr. Drew Tortoriello. "The medications are being donated by the pharmaceutical companies. We also do not charge for storage for the first two years." New Focus The Sher program's focus on egg freezing, as opposed to the creation and preservation of embryos, is relatively new. Embryo creation, first practiced in the 1980s, was the norm because eggs stood less of a chance of surviving the required preservation processes. "The big barrier to egg-freezing technology was the poor survival rate upon thawing the egg," Tortoriello explains. "We now use a technique called vitrification that allows 98 percent of the eggs we thaw to survive." Eggs contain a great deal of water, which can make freezing processes complicated. When eggs are frozen, ice crystals can form within them and destroy the cell's structure. Vitrification freezes the egg so quickly that ice crystals don't have time to form. Live-birth statistics with this method are promising, says Tortoriello: "The once large disparity between the success of embryo and egg freezing has narrowed, and they are similar in their outcomes. For every chromosomally normal egg we freeze, the chance of the woman later having a baby with this egg is over 35 percent." This is an important development for women who don't yet have a partner with whom they are planning a family (or for same-sex couples who have not made arrangements with a sperm donor). But even women in long-term heterosexual partnerships have reason to consider freezing eggs rather than embryos. Anna, whose name has been changed here to protect her privacy, was diagnosed with early-stage breast cancer at age 34. She offers an invaluable perspective on this issue. "When I was diagnosed in 2006," she says, "I was on the brink of attempting to have a second child; literally days away from starting to try to get pregnant. Although the diagnosis was startling, I was very confident I would survive the cancer but quite devastated that I might not be able to have more children. My husband and I decided to pursue fertility treatments, and we successfully froze 15 embryos. I understood the risks of freezing eggs, and with complete security in my marriage of 11 years, I had no reservations about freezing embryos."