Freezing Eggs, Embryos Prior to Cancer Treatment Works for Most Women

A long-term study measuring the success of strategies to preserve fertility in women diagnosed with cancer found a live birth rate of 71 percent. The study was presented July 6 at the virtual annual meeting of the European Society of Human Reproduction and Embryology (ESHRE). It adds to a growing body of literature suggesting that women of childbearing age newly diagnosed with cancer should be offered fertility preservation measures.

Some cancer treatments, such as chemotherapy and radiation, are known to damage eggs and diminish ovarian function. Freezing eggs and embryos before beginning therapy preserves healthy eggs before treatment begins.

Increasingly, many newly diagnosed women have pursued these options, but they are not necessarily routinely offered them, nor were experts sure that success rates would be the same as in healthy women.

“There was a time when the idea was that these [cancer] patients would have worse outcomes because of underlying disease at the time we collected the eggs,” said Mitchell Rosen, MD, director of the fertility preservation program and reproductive laboratories at the University of California in San Francisco, who was not involved in the study.

The current results, he says, suggests that patients who undergo fertility preservation have roughly the same odds of a later live birth as healthy women who freeze eggs or embryos.

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Motherhood After Cancer — How Many Want the Option?

The study featured 879 reproductive-age women with cancer who were treated between 2000 and 2019. The patients represented a range of cancer types, including breast cancer and lymphoma. About two-thirds of the patients had breast cancer. The average age of the patients was about 33.

All the women enrolled in the study had sought counseling on fertility preservation prior to beginning cancer treatment. The study’s authors found that, following counseling, 42 percent of the patients chose to undergo fertility preservation. About one-half chose egg freezing, 41 percent chose embryo freezing, and 5 percent did both.

One percent of the women chose a newer technique in which part of the ovary is removed and frozen, called ovarian tissue cryopreservation. In this procedure, the ovary or piece of it is reimplanted later to produce eggs. It is sometimes used for prepubertal cancer patients or when cancer treatment must begin immediately and there isn’t enough time to go through the process of stimulating and retrieving eggs.

The study is ongoing, but so far, 16 percent of the patients have returned to use their frozen eggs or embryos through in vitro fertilization (IVF). Among those 61 women, 41 (71 percent) have achieved a live birth. Nine percent of the women who gave birth had twins.

“It’s not so much the 71 percent that’s important,” said Dr. Rosen. “What is critical is that it works. It’s worth it to offer fertility preservation because half of these couples will probably have trouble getting pregnant if they don’t have fertility preservation.”

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Few Women With Cancer Offered Fertility Preservation

Reproductive-age cancer patients should be presented with all their fertility preservation options, Rosen said. But many simply are not. “I would say 10 to 20 percent of U.S. women diagnosed with cancer are having the opportunity to preserve fertility. That’s the max,” he said.

Oncologists sometimes fail to present the option to their patients, he said, because they assume the patient can’t afford fertility preservation or already has a child. In other cases, the oncologist may wish to begin cancer treatment immediately.

Fertility preservation can delay cancer treatment by a few weeks to stimulate the ovaries and retrieve eggs for freezing. But other studies show the short delay does not worsen cancer outcomes.

“The reality is there is no difference in disease-free survival if they do fertility preservation,” said Rosen. “There is this perceived sense of urgency. But the couple of weeks that it takes is not very long.”

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Insurance reimbursement for fertility preservation, even for cancer patients, is also lacking in many states, Rosen said. Nine States have fertility preservation statutes governing insurance reimbursement, according to the according to the American Society or Reproductive Medicine (ASRM). And women in underserved or remote areas may simply not have access to fertility centers who can provide the care.

“I think the awareness has gone up,” Rosen said. “More and more people are understanding these cancer treatments are damaging to reproduction. I think we are getting better with cost because more states are finding ways to mandate preservation coverage. I think the climate is changing,” says Rosen. “But the climate is challenging.”

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