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 testing (PGT) 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.