Posted by Brigham and Women's Hospital September 25, 2013
Today’s post is written by Dr. Elizabeth Ginsburg, a physician at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital. She discusses fertility preservation options for patients who may need to put parenthood on hold while they undergo treatment for cancer.
Recently, I saw a young woman who was diagnosed with non-Hodgkin’s lymphoma. After undergoing tests and meeting with her oncologist, it was determined she would need chemotherapy. However, the chemotherapy was expected to put her at risk for infertility. Though this woman is not married, she has always wanted children. Her oncologist referred her to me for a consultation.
Cancer is a frightening diagnosis, and although cure rates have improved dramatically, many treatments increase the risk of infertility or may cause sterility in both men women. Studies have shown that for some young men and women facing cancer treatment, the loss of fertility can be as devastating as the cancer diagnosis itself. Fortunately, there are methods which can help cancer patients preserve their fertility.
For men, sperm can be banked (or frozen) for future use as part of in vitro fertilization (IVF). IVF is very effective and the likelihood of having a healthy baby using this technique is excellent.
For women, several fertility preservation options are available. One option is to freeze eggs. The first step involves taking injections of fertility medications for about two weeks to stimulate egg production (ovarian stimulation). Once tests indicate that eggs have developed in the ovaries, the eggs are removed by a fertility specialist using a small ultrasound guided needle. Pregnancy and live birth rates using frozen eggs are excellent. As a result, last year, the American Society of Reproductive Medicine removed the experimental label for the procedure. A woman’s eggs also can be fertilized with sperm (from the male partner or donor), using IVF, and frozen for future use, a process is known as embryo cryopreservation.
For women who have a rapidly progressing cancer or don’t have time to undergo ovarian stimulation, ovarian tissue can be removed and replaced in the abdomen after cancer treatment ends. This treatment will reverse menopause that may occur as a result of cancer therapy. The replaced ovarian tissue produces eggs for three to eight years. Women have become pregnant naturally after ovarian tissue replacement or using IVF treatment. Ovarian tissue replacement is also an option for girls who have not yet reached puberty, but who are at high risk of being sterilized by cancer treatments. After puberty, some girls and women choose to do both ovarian stimulation with egg freezing and ovarian tissue freezing.
Some insurance companies have begun to cover fertility treatments as a part of cancer care. For patients whose plans do not offer coverage, organizations such as Fertile Hope’s Sharing Hope Program may be able to help. Fertile Hope works with providers such as BWH to arrange for discounted fertility preservation services for eligible female cancer patients.
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