Every year approximately 800,000 reproductive age men and women are diagnosed with cancer. A cancer diagnosis is devastating, but due to the advances made in the fields of oncology, diagnoses are made much earlier and treatments are becoming more successful leading to increased survival rates. Many cancers are now successfully treated allowing people to live long lives after their diagnosis. Unfortunately, a major complication of these increasingly effective cancer therapies is reproductive failure resulting in temporary and permanent infertility or sterility in both women and men.Cancer treatments such as chemotherapy, radiation therapy, radical surgery or bone marrow transplantation can affect future fertility by reducing the number of eggs/sperm, altering the blood supply to the reproductive organs or by removing necessary organs.
Cancer survivors often want to have families but their cancer treatment may have caused significant deterioration, or complete loss of fertility. The deleterious effects depend on multiple factors such as the patient’s age, dose and the type of the chemotherapy agent or radiation used, as well as the individual susceptibility to treatment. It is vital to consider fertility as an important factor for patients who have been diagnosed with cancer and other serious chronic conditions and diseases. Planning Fertility Preservation in advance can preserve sperm, eggs or embryos for future use. Arizona Associates for Reproductive Health is prepared to help you move through the process quickly so you can begin your cancer treatment and recovery.
Arizona Associate for Reproductive Health’s Fertility Preservation Program is designed to provide state-of-the-art options for reproductive-aged men or women who are about to begin treatments that may threaten their future fertility. We understand the time constraints and emotional stress of patients facing cancer treatment, as well as the concern over the potential negative impact on future fertility. We offer expedited, compassionate care at a discounted rate for egg or embryo freezing prior to cancer treatment. We partner with LIVESTRONG (Fertile Hope) to offer cancer patients help through the Sharing Hope Program. As a participating center in the Sharing Hope financial assistance program, AzARH works with LIVESTRONG to increase access to Fertility Preservation services for cancer patients by providing Fertility Preservation treatments and medications at a discount for qualifying patients. LIVESTRONG is a national, nonprofit organization dedicated to providing reproductive information and financial support to cancer patients and survivors whose medical treatments present the risk of infertility.
If you're a woman of child bearing age or a man who is concerned about his future ability to become a father, our services will allow you to approach and recover from your illness with the satisfaction that you have addressed this important aspect of your life, and will help you to realize your fertility goals following your treatments. Simply call Arizona Associates for Reproductive Health at 480-946-9900 and express your interest in Fertility Preservation to schedule an expedited appointment with one of our specialists. Most visits can be arranged within 24 to 72 hours of your call. You will have a thorough consultation with one of our reproductive endocrinologists and a customized plan of care will be created in conjunction with your oncologist.
Elective Fertility Preservation for purposes other than medical reasons has been an option for men for many years. Fortunately, due to exciting developments in the field of Assisted Reproductive Technology (ART), elective Fertility Preservation is now a realistic option for women who elect to delay child bearing for medical, professional or personal reasons.
Fertility Preservation for Women
Fertility Preservation may be used by women who elect to delay child bearing for medical, professional or personal reasons. The primary indications for Fertility Preservation include:
Technologies for Fertility Preservation in women include:
Egg freezing, also known as oocyte cryopreservation, is now a reality in the specialty of reproductive endocrinology and infertility. It has opened new treatment options for assisting infertile patients and also has new applications for women wishing to preserve their fertility for medical indications or personal reasons.
Cryopreservation is not something new in the world of Assisted Reproductive Technologies (ART). Medical clinics have been freezing sperm since the 1950s and embryos since the 1980s. While sperm and embryo cryopreservation have become routine, egg freezing has presented greater challenges and is a relatively new technology. The first baby born from frozen eggs occurred in 1986.
Freezing of eggs can trigger premature hardening of the zona pellucida which surrounds the egg. Normally zona hardening occurs after the sperm penetrates the egg, thus protecting it from being penetrated by other sperm. Fortunately, hardening of the zona can be overcome with the use of Intracytoplasmic Sperm Injection (ICSI), a routine procedure already proven successful for many years in treating male infertility.
The high water content of eggs has also presented challenges since it increases the risk of cellular damage during the freeze-thaw process. Additionally, eggs are at a sensitive stage of the meiotic cell division cycle. The egg chromosomes are aligned within a fragile structure known as the spindle apparatus. These inherent difficulties have limited the success of egg freezing in the past. Recent studies over the last 5 years have reported improved results with adjustments in freezing protocols. In particular, extremely rapid cooling rates with a technique known as vitrification appear to minimize chromosomal damage and the formation of intracellular ice. Many fertility programs throughout the world have recently demonstrated good success with freezing and thawing of eggs with live births using egg vitrification technology. There have now been approximately 1600 babies born worldwide from frozen eggs.
Arizona Associates for Reproductive Health (AzARH) doctors and embryologists have been involved in research to develop successful techniques for freezing sperm and embryos for many years. More recent research with an egg freezing process known as vitrification has allowed AzARH to offer egg freezing under IRB oversight for patients who may be reluctant to freeze embryos. Egg freezing may be used by women who wish to delay childbearing for different reasons. Three groups of patients can benefit from egg freezing:
While fertility specialists share much optimism that egg freezing provides options for groups of women who might otherwise have few or none, many in the scientific community still consider egg freezing to be experimental and consequently the process should be carefully considered. The American Society for Reproductive Medicine (ASRM) advises clinics to perform egg freezing under Institutional Review Board (IRB) approval and ongoing oversight. ASRM will continue to consider egg freezing experimental until published studies regarding risks, benefits and overall safety and efficacy are sufficient to regard the procedures as established medical practice.
Most assisted reproductive technologies are no longer considered experimental. The American Society for Reproductive Medicine (ASRM*) considers the following procedures to be established medical care:
*Established in 1944, the ASRM comprises over 10,000 fertility specialists worldwide
Arizona Associates for Reproductive Health (AzARH) fully complies with the ASRM recommendation to provide egg freezing services under IRB review. AzARH only offers egg freezing after carefully reviewing IRB consents for egg freezing with each patient. The goal is for each patient to fully understand the possible risks, benefits and current success rates with egg freezing before deciding to pursue this treatment option. Providing egg freezing under the observant eye of an IRB helps ensure the freezing and storage of eggs is done using techniques that provide your best chance for success as well as long term safety of your eggs in storage. There are currently egg freezing programs that operate with no IRB approval or oversight. Ask any program you may be considering if they provide egg freezing under an ongoing, approved IRB certificate.
Three of the most important factors in determining your chances for potential success with egg freezing are your serum FSH, baseline follicle count of your ovaries and ovarian reserve testing. These studies are used to gain an understanding of the ability of your ovaries to produce healthy eggs that will allow for successful freezing, thawing, fertilization and embryo development. These are vital steps to establish a successful pregnancy. Due to the natural egg aging process, it is more ideal to freeze eggs in women who are younger than 38 years old. To date, there have been few ongoing pregnancies reported in women over 38 from frozen eggs. This is mostly due to lower age cutoffs in egg freezing studies. Pregnancies are routinely achieved in women up to age 43 using fresh embryos. We may find with further egg freezing research that we are able to mimic these fresh rates.
Please contact our office to schedule a pre-consultation evaluation of your Follicle Stimulating Hormone (FSH) and estradiol levels. These tests should be scheduled for the third day of your menstrual bleeding prior to your initial consultation with the doctor.At your consultation, your physician will review your medical history and will outline your evaluation and treatment. Based on your ovarian reserve, which is determined by your internal reproductive hormones, a stimulation protocol will be formulated by your physician.
Group 1 – Best Chances for Success
The process for egg freezing is similar to a traditional IVF cycle and typically takes 3 to 6 weeks. Egg freezing uses standard protocols to stimulate egg production and retrieve the eggs. A woman usually takes birth control pills followed by hormone medications to stimulate the ovaries to produce multiple eggs. The eggs are retrieved and the mature eggs are frozen that same day. The eggs are stored in liquid nitrogen at temperatures where there is no cellular activity and, therefore, are not impacted by length of storage. The number of eggs produced and the percentage of mature eggs recovered is variable from person to person.
Once a woman is ready to conceive, an AzARH physician will coordinate with your oncologist to ensure you are healthy, able to use fertility medications, and ready to carry a pregnancy. Some patients may be unable or advised not to carry a pregnancy following cancer treatment. AzARH offers treatment using a gestational carrier (a woman who will carry the pregnancy for you). With approval from your oncologist, AzARH will allow transfer of embryos to women up to the age of 50. Patients starting a treatment cycle will begin taking medicine to prepare the uterus for pregnancy. The eggs are thawed and fertilized and then cultured for 3 to 5 days before embryo transfer. Extra embryos can be stored at AzARH.
Fertility Preservation for Men
Men have long been able to preserve their fertility by freezing their sperm. Tour de France champion Lance Armstrong's three children were conceived with sperm he banked before chemotherapy.
Men with very low sperm counts or poor quality sperm may still successfully freeze sperm when used with assisted reproductive technologies such as IVF and ICSI.If there is complete absence of sperm there is still the possibility of cryopreserving sperm in some cases. As long as at least one testis has areas of sperm production, sperm can be retrieved surgically from the epididymis or the testicular tissue and frozen for future use with ICSI.