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Egg Banking: Preserving Fertility in Female Cancer Patients

by Dr. Geoffrey Sher on March 5, 2017

It is only through propagation of our biological offspring that we as humans can leave a lasting legacy of our existence. Perhaps this explains why the desire to have children is a basic human instincts and why an inability to achieve this goal (infertility) often leads to considerable psychological and social difficulties. Infertility evokes a strong sense of failure, loss and helplessness leading to one of life’s most distressing crises.

Seven out of ten children and young adults with cancer can be cured. Accordingly by the end of this decade, an estimated one in two hundred and fifty adults will be survivors of childhood cancer.[i] Unfortunately for many of them, one of the long-term sequelae of treatment is infertility.

Many cancer chemotherapy and/or radiation regimens that are directed at the reproductive organs will render the patients infertile. It is argued by some that cancer survivors should be so grateful as to ignore the “inconvenience” of having been rendered infertile by the treatment they underwent, that the burden of post-treatment infertility pales in significance when compared to the long term and often life-endangering complications associated with radiation and chemotherapy. Moreover, those who make this argument often take the position that such patients could always have a baby through using donated eggs or sperm. But this dispassionate attitude ignores the fact that most people crave having their own biological children.

In the last decade, patients to have their sperm or eggs collected and cryopreserved (frozen) for post-recovery dispensation. For males, the cryopreservation of masturbation specimens is quite uncomplicated and efficient, while for  females gaining access to eggs for cryopreservation (freezing and banking)  is significantly more involved and costly, requiring the prior administration of fertility hormones for more than a week followed by a surgical procedure (egg retrieval), that is performed under local or general anesthesia.

An existing, troublesome problem is the fact that conventional egg banking has until recently been much of a hit-and-miss proposition. The baby rate per frozen egg has hovered around 5-7%, which is hardly sufficient to give a woman confidence that that her banked eggs will ultimately produce a baby for her. This low yield per frozen eggs is the reason that most egg banks advise women that in order to provide reasonable level of confidence that banked eggs will ultimately produce a baby, the woman should freeze a large numbers of eggs (15-20) in advance of undergoing cancer therapy. Sadly, ignorance of this reality has led many women to freeze eggs with only a false sense of expectation that by doing so, they will ultimately be able to be mothers.

In 2007, I and my associate, Levent Keskintepe PhD, first reported on the ability, using preimplantation genetic screening (PGS) with metaphase, comparative genomic hybridization (CGH) which identifies those mature MII eggs that have all 23 chromosomes (haploid) intact, thereby suggesting that they are the ones that are most likely, upon fertilization and transfer of resulting embryos to the uterus, to be capable of propagate live births. We demonstrated that the baby rate per selectively frozen, CGH-normal egg would yield a baby rate of almost 30% which is five-fold higher than previously attainable. More than 20 babies have been born through the selective transfer of such genetically selected eggs. Against this background, the selective banking of only 4-6 such “competent” eggs should potentially provide a far greater level of confidence and offer particular promise for young female cancer victims scheduled to undergo chemotherapy and/or radiotherapy. Although promising, this method of egg selection is, as of yet, not commercially available.

There is also the issue of the financial impact of fertility preservation; insurance companies and government payers rarely cover the costs. While the freezing and storage of eggs is not that much more expensive than the analogous service for sperm, the costs associated with the ovarian stimulation, egg retrieval, and anesthesia can be considerable and in the current economic environment must be totally borne by the patient and/or her family.

Technology is indeed available to help cancer patients preserve the option of having biological children. Since we do have the know how to preserve human gametes, then as a society it should not, in my opinion, be reserved for the “haves.” The preservation of fertility for cancer patients should become a standard service, but major challenges remain to make this a reality.

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  • MN - March 9, 2017 reply

    Thank you very much Dr for the reply,

    In our case as they are early blasts on day 6 and are frozen [5 of them], do you see any risk for implantation to result in viable pregnancy as we got only 7 embryos from 3 cycles.

    thank you

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 9, 2017 reply

    It all depends on the integrity (“competency”) of the blastocysts. And whether they were PGS tested

    Geoff Sher

  • MN - March 8, 2017 reply

    Hi Dr,

    We had 7 embryos pooled from 3 cycles, about 4 were good grades and 3 were fair ones as per embryologist
    As we wanted to get PGS testing done our embryologist and the RE suggested to grow them to blastocyst to perform biopsy as it gives better results than doing biopsy on day3.

    During the blastocyst culture 5 embryos survived till day 6 but they are early blasts than fully developed blastocyst hence embryologist was not confident to do biopsy and we had to abandon the plan for PGS testing without any option and decided to freeze them at day 6 for transfer after the ERA test.

    could you please let us know would you still recommend to get the PGS test done?

    Please note we went to ivf due to severe male factor[OAT], and i am 34years and my wife is 32 years and she never conceived yet

    Thank you

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 8, 2017 reply

    I would agree with your RE that there is really no point in biopsying poor qualty early day-6 blastocysts.

    It sounds as if aside from MF, you might also have diminished ovarian reserve. If I am on the mark then please read further….

    In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
    Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.

    While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy

    Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.

    • Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
    • IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
    • The Fundamental Requirements For Achieving Optimal IVF Success
    • Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
    • Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
    • The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
    • A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
    • Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
    • Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
    • Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
    • The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
    • Blastocyst Embryo Transfers should be the Standard of Care in IVF
    • Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
    • Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
    • Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
    • Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
    • Preimplantation Genetic Testing (PGS) in IVF: It should be Used Selectively and NOT be Routine.
    • Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
    • PGS in IVF: Are Some Chromosomally Abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
    • PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
    • Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
    • Traveling for IVF from Out of State/Country–
    • A personalized, stepwise approach to IVF
    • How Many Embryos should be transferred: A Critical Decision in IVF.
    • The Role of Nutritional Supplements in Preparing for IVF
    • Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
    • IVF Egg Donation: A Comprehensive Overview

    I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
    Email: Julied@sherivf.com
    Phone: 702-533-2691
    I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

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