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December 9, 2010 | 12:00 a.m. CST
Dr. Sherman Silber, superstar surgeon of the Infertility Center of St. Louis at St. Luke’s Hospital, is often in the news. Recently it’s for his work in preserving the eggs and ovarian tissue of busy career women who want to put off child rearing. The ethics of the procedure might be controversial, but surprisingly, it’s also the same method that can give cancer patients hope for children after their treatment.
The procedure, simply put, is freezing, but this isn’t the kind happening with your two-year-old box of pizza rolls. When a patient is diagnosed with cancer, there is a significant likelihood that the radiation and chemotherapy, not the disease itself, will render him or her partially or completely infertile. By freezing sperm, eggs, embryos and ovarian tissue beforehand, a patient can make a safety deposit on his or her future fertility and secure the chance to have biological children after the cancer is gone.
Men and women from all over, flock to Missouri to seek fertility help from Silber. He was the surgeon responsible for making Amy Tucker from Columbia, Ill., the first U.S. cancer survivor to have a child after transplanting her previously frozen ovaries back to her own body after she had gone into remission. Now Dr. Silber has broken the freezing barrier with vitrification, a Japanese process that can freeze a woman’s eggs by dropping the temperature 23,000 degrees Celsius per minute so ice crystals don’t form. Before vitrification, conventional slow freezing didn’t allow for refreezing of thawed material, and the chance for ice crystals damaging the functionality of the frozen tissue was much higher.
Although the latest advances in technology and surgery can give most cancer patients options to preserve their fertility, the knowledge about freezing isn’t universal.
Joyce Reinecke is a cancer and fertility advisor with the Livestrong foundation as well as a cancer survivor who froze her embryos. She thinks this is a subject not enough doctors have talked about with their patients.
“A lot of patients don’t know that this is a threat to them,” Reinecke says. “We have battled this for years. Doctors tell us they haven’t talked about this with their patients, but it’s become a mantra of ours that patients don’t know what they don’t know. Doctors are holding up a false expectation that your knowledge is the same as theirs.”
The list of reasons doctors don’t bring up the fertility risks of radiation and chemotherapy run the gamut. Sometimes it’s a missed connection when a doctor doesn’t think to tell their throat cancer patient that they could potentially have a problem downstairs, too. Other times it’s insurance concerns; health insurance rarely covers the cost of the procedures patients need to freeze their eggs and sperm.
One look at the price of freezing, and it’s understandable why some patients can’t afford it. Sperm freezing is the cheapest, depending on storage time. On average, it costs $1,500, including five years of storage, if the patient doesn’t require the more complicated testicular sperm extraction. This is a surgical procedure in which sperm is taken from testicular tissue if the patient does not have mature sperm or his ejaculate doesn’t contain sperm. If he does need this procedure, it can cost $6,000-16,000.
Egg freezing costs anywhere from $10,000-13,000 depending on additional medications, and freezing ovarian tissue or embryos typically costs $12,000. Fertile Hope, an organization that offers support and optimism to both patients and survivors of cancer, started The Sharing Hope Program in 2004 to give financial aid to patients faced with these staggering numbers. The money starts to pile up once storage fees are included. The price varies, but banks such as Fairfax Cryobank in Virginia, charge $40 a month to store sperm. But according to Dr. Silber, any material frozen through vitrification has virtually no expiration date, which gives younger patients more time to plan their parenthood.
Luckily, a doctor told Stephen Janssen, 20, from Plainfield, Ind., to consider freezing his sperm. Janssen was 18 years old when he was diagnosed with Hodgkin’s disease.
“What convinced me is the fact that after all of this was over, I could keep a way to have a normal life when I got older,” says Janssen, who has relapsed and undergone a stem cell transplant. “I was thinking long term in that way, I guess, to try to preserve that, but all I want is a normal life. That’s all I want.”
But as things often are in reproduction, men have it a little easier than women. “If a man needs to start treatment the next day, he can bank his sperm in an hour,” Reinecke says. “But with women it takes a lot longer. Sometimes women hear about the hormones, blood tests and collecting their eggs, and they say, ‘I can’t handle this right now,’’ However, some women find the procedure to be life-affirming and positive because they are able to focus on something other than their cancer.
Although sperm is the Helen Mirren of reproductive material, aging gracefully with little damage to its structural integrity, eggs and ovarian tissue are best collected earlier. Freezing literally suspends the age of a woman’s eggs or ovarian tissue. If a patient had her ovarian tissue frozen when she was 22 she will have a 22-year-old ovary with all the benefits and increased capability that come with younger reproductive organs, even if she’s 32 when it’s transplanted back into her body. Success rates are based on the individual, but Dr. Silber says the pregnancy rate from frozen material isn’t lower than normal and much more successful than conventional freezing. But the bottom line for women is still the same: the younger, the better.
Yvonne B., who asked to remain anonymous, 38, from Ann Arbor, Mich., decided to freeze both her embryos and eggs despite the difficult process so she would have options instead of regret after her treatment for breast cancer, which she is currently undergoing.
“It’s the one chance I have to have children,” she says. “There might be a small percentage (that the treatment won’t take effect), but you can’t just take that for sure. It’s like insurance to me.”
There’s no new technology or procedure that can erase the anxiety that comes with cancer. Being able to protect a part of themselves to pass on to the future is a comforting opportunity that Janssen and Yvonne both agree patients should take advantage of, especially if they have been fortunate enough to receive a forewarning.
“Do it,” says Janssen, “even if you have the slightest idea that you want to have a family.”