Q&A: Fertility Preservation for Oncology Patients

Medical Contribution by Gilbert L. Mottla, M.D.

Studies have shown that chemotherapy, especially those using alkaline agents, can severely diminish a woman’s ovarian reserve. With some chemotherapies of longer duration, the sensitive egg cells will not survive, rendering the patient infertile and unable to conceive in the future. Woman now have the ability, though, to freeze their eggs prior to beginning chemotherapy, due to recent advancements in freezing technology. This option allow patients to safeguard their fertility for the future.

Q: What is Egg Freezing? eggs

A: Egg freezing is a process in which the ovaries are stimulated to produce several mature eggs. These eggs are then retrieved; frozen using vitrification technology; and stored for future use. Since frozen eggs are suspended in time, their quality remains unchanged from the point of freezing.

Q: Who Should Consider Egg Freezing for Fertility Preservation?

A: Women with a recent cancer diagnosis who are planning to have children in the future should consider egg freezing at the time of diagnosis. The best outcome relative to both egg thaw survival rate and future pregnancy is achieved in women under the age of 40.

Q: What does the Process Entail? 

A: When a patient with a recent cancer diagnosis is referred to Shady Grove Fertility, a specially-trained team guides them through the entire treatment process. This team helps to navigate patients through each step, from finding ways to afford treatment to the actual medical procedure. Due to the time-sensitive nature of treatment, oncology patients can expect an expedited treatment plan and to see a physician for consultation as soon as possible.

Once a patient decides to move forward with treatment, it generally takes 2-3 weeks to complete stimulation of the ovaries. During this time patients will take injectible medications administered subcutaneously (under the skin.) Egg development is monitored 4-5 times during the 10-12 days of stimulation. Monitoring appointments consist of a transvaginal ultrasound and bloodwork, both used to monitor egg development. These appointments help your physician to adjust medications as needed and identify the ideal time for the egg retrieval. Once the follicles reach 20mm in size, an egg retrieval is scheduled in one of our ambulatory surgery centers in either Rockville or Towson, MD or Chesterbrook, PA. The retrieval is performed under light sedation, with normal activity resuming the next day.

Q: What are my Future Options?  

blastocysts-1A: Once eggs are frozen, they are available for when the patient has completed their cancer treatment and been cleared to move forward with attempting pregnancy. A back-up plan is now in place should a patient need to use their eggs in the future. Use of these eggs in the future involves thawing, inseminating with sperm, and transferring a healthy embryo into the uterus. Once eggs are frozen, a woman’s success at achieving pregnancy is related to her age at the time of freeze – not at the time when she plans to use her eggs to achieve pregnancy. At Shady Grove Fertility, eggs may be used to achieve pregnancy before a patient’s 51st birthday. Beyond this age, other medical conditions impact safe pregnancy and delivery.

Q: How Long Can My Eggs Remain Frozen?

A: While long-term data on egg freezing is not available, our experience and research leads us to believe frozen eggs can remain viable indefinitely. Since the start of elective egg freezing using vitrification over 200 babies have been born as a result.

We hope this summary is helpful as you consider egg freezing as a possibility for protecting your fertility. Most importantly, we recommend discussing your particular situation with your medical team, so that we can individualize your care and coordinate with your oncology team.

If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.

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Folate for PCOS

by Nicole Holovach, RD – Dietitian at Pulling Down the Moon

Nicole Holovach, RD

Nicole Holovach, RD

For the majority of the population, folic acid and folate are the same thing – a nutrient found in food and prenatal vitamins that helps prevent neural tube defects in babies. While the terms are often used interchangeably, there is an important distinction between the two. Folate is a B vitamin found in foods like dark leafy greens, lentils, beans, eggs, sunflower seeds, and liver. Folic acid is the synthetic form of folate. It is only found in fortified foods and supplements and must be converted to the active form within the cell. Humans are unable to make their own folate, so we have to get it from food or supplements.

Most prenatal vitamins contain folic acid because it’s less expensive, more stable, and more of it is absorbed than folate. But there are several factors that affect conversion of folic acid to the active form. Under normal dietary conditions, absorbed folic acid is converted into an active form used by the body. Age, environmental factors, a defect in the converted gene, and certain drugs can all play a part in how effectively folic acid is converted.

Folate for PCOS Patients

In certain clients, I may have them switch to a prenatal with folate, or add a folate supplement, depending on their health issues. For my clients with polycystic ovary syndrome (PCOS), I now have a reason to potentially add a folate supplement.

A recent study showed that folate, the active form, has beneficial effects on metabolic profiles in women with PCOS. The study was a randomized controlled trial, considered the “gold standard” of research. In the study, 5 mg of folate supplementation, compared with 1 mg and a placebo, resulted in better glucose metabolism and better cholesterol lab values in women with PCOS.

The average prenatal vitamin has between 600-1000mcg (1 mg) of folic acid or folate, so to reach 5 mg another supplement may be needed. While folate is more difficult to find over-the-counter than folic acid, high-end vitamin stores and health food stores may sell folate supplements.

While there is little risk associated with folate supplementation, it is recommended to speak with your physician before taking folate for PCOS or any other supplement.

References:
http://www.ncbi.nlm.nih.gov/pubmed/24828019

Learn more about nutrition, call 888-604-7525 or schedule an appointment online.

If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.

This article was submitted as a guest writer. The opinions expressed in the article do not necessarily represent the opinions of Shady Grove Fertility Center.

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Huffington Post: “Would You Donate Your Eggs to a Couple Who Couldn’t Conceive?”

In vitro fertilization (IVF) has helped tens of thousands of couples conceive for over 35 years. For many women though, using their own eggs for treatment is not possible. When this diagnosis occurs, egg donation is the most effective treatment option: it allows a woman to carry her child and offers the highest pregnancy rates of any fertility treatment.

Recently, the Huffington Post article “Would You Donate Your Eggs to a Couple Who Couldn’t Conceive?” explored the various reasons why couples use donated eggs. We wanted to provide a deeper clinical background for the five key reasons from the original article:

  1. Advanced maternal age.
    Female fertility naturally begins declining in the early 20s, but conception rates remain high into the 30s. By a woman’s mid-30s, the decline accelerates, reaching minimal pregnancy potential by the age of 45. In addition, women over 35 have an increased risk of miscarriage and/or genetic abnormalities in their children as a result of age-dependent changes in egg quality. While it is possible for women to conceive naturally using their own eggs after the age of 42, it is the exception, not the rule. Generally, women ages 44+ use donor eggs for fertility treatment.
  2. Women who have premature ovarian failure or menopause.
    Premature ovarian failure (early menopause) is a condition in which menopause occurs before the age of 40. Women who develop early menopause usually have run out of eggs in their ovaries. The cause of premature ovarian failure is generally unknown. However, there are a few reasons why the ovaries may stop producing eggs at an early age. Exposure to certain chemicals or medical treatments can damage or destroy the ovaries. These may include chemotherapy and radiation therapy. Autoimmune diseases such as rheumatoid arthritis are sometimes also associated with early menopause, because the immune system forms antibodies that attack and damage the ovaries. Heredity can also play a role: some genetic disorders lead to early menopause.
  3. Women who have poor egg reserves.
    Decreased ovarian reserve occurs when a woman is producing eggs of a lower quality. These women tend to have a poor egg yield and generally poor fertility treatment outcomes when using their own eggs.
  4. “Gay male couples who require both an egg donor and a gestational carrier to have a child.”
    Egg donation has provided gay male couples with the ability to have a child (born by gestational carrier) that will have genetic material from one or both members of the couple.
  5. Unknown.

    If a couple is undergoing fertility treatment and is unsuccessful after a few rounds of IVF, the next recommendation is for the couple to use donor egg treatment.

Egg donors afford couples the opportunity to have a family, regardless of diagnosis or situation. Often, by the time a couple undergoes donor egg treatment, they have already attempted several unsuccessful cycles using their own eggs. Women who donate their eggs offer a piece of hope for those who may feel hopeless.

If you are considering egg donation but have questions about the process, please contact Abby.Estwick@integramed.com. If you would like to apply to become an egg donor, please complete the initial application

 

Posted in Donor Egg, IVF, LGBT, TTC, Unexplained Infertility | Tagged , , , , | 2 Comments