A cancer diagnosis or inopportune timing don’t have to prevent a person from having children. Through egg freezing, UC Health’s reproductive endocrinology and infertility specialists can help preserve fertility and patients’ dreams of a family with kids.
A woman bringing her children to a gynecologic appointment wouldn’t seem out of the ordinary in most settings.
For Amanda Jackson, M.D., it’s the picture of success.
“My favorite stories are when we see our younger patients at a follow-up appointment and they bring their baby with them,” says Dr. Jackson, an associate professor of obstetrics and gynecology at the University of Cincinnati College of Medicine and division director of the Gynecologic Oncology Center at UC Health. “We see that they can live their lives normally after cancer, which includes having a family.”
For an oncofertility patient to have birthed a child, it means she overcame both a cancer diagnosis and potential infertility resulting from her treatment, thanks to a comprehensive care plan that included measures like egg freezing to help preserve her ability to bear children. At UC Health’s Center for Reproductive Health — the only comprehensive patient care and research center focused on fertility in the Greater Cincinnati area — physicians provide
reproductive, endocrine and infertility care using an approach tailored to each patient’s unique issues and needs.
“The most common reason that patients freeze their eggs is a diagnosis of cancer or a potentially life-threatening medical condition that requires medications that may compromise their future fertility,” says Michael Thomas, M.D., chief of the Division of Reproductive Endocrinology and Infertility at the UC College of Medicine. “The second reason is because the patient is in her 20s or 30s and doesn’t want a child at this time.”
Egg freezing for the latter reason has gained more attention in recent years, moving beyond being the province of physicians and specialists to becoming part of a larger conversation about the state of 21st century relationships. But it’s a discussion rooted in social realities — the age of a woman giving birth for the first time in the United States reached 26 in 2018, up from 21 in 1972. U.S. Census data in 2018 reported 28 as the median age for women’s first marriages.
As more women also pursue advanced education, training and career advancement, more are considering how they can have children in the future when their fertility rates begin to decline.
Dr. Thomas says that freezing eggs at younger ages gives women the best opportunity to have children in the future, as those eggs have a lower risk of miscarriage or age-related genetic problems. Some patients, however, have frozen eggs in their early 40s, he notes.
Women experiencing intermittent ovarian failure or going through premature menopause — defined as losing all female hormonal function before the age of 40 — can also attempt to become pregnant through reproductive technology. In these cases, Dr. Thomas suggests women use an egg from a donor between the ages of 20-32 with good hormonal and egg function.
The egg freezing process starts with patients taking medications to stimulate the ovaries, leading to the production of multiple eggs available for removal. The patient then undergoes a minor procedure under anesthesia to remove the eggs.
The eggs can then be frozen or fertilized by donor sperm or their partner’s sperm to be frozen as embryos. Specialists aim to freeze a minimum of 10 eggs for one cycle. Embryos have a more successful thaw than the eggs alone, Dr. Thomas says, making some patients more interested in choosing that option.
Eggs and embryos are stored in a cryogenic chamber until the patient is ready to use them, at which point they are thawed and then implanted into the uterus through in vitro fertilization.
Extending Life, Creating New Life
In the immediate period following a cancer diagnosis, having children might not be the first thought of a patient who is worried about survival, or she might not know the best way to introduce the topic with her doctor.
An oncofertility specialist can bridge that gap.
“The partnership between the oncologist and the reproductive endocrinologist is imperative to the option of fertility preservation,” says Caroline Billingsley, M.D., assistant professor of obstetrics and gynecology at the UC College of Medicine, fellowship-trained in gynecologic oncology. “For many years, this was largely unaddressed. Oncologists were concerned with getting their lifesaving surgeries and treatments underway, and there were limited options and available specialists who were comfortable with even considering fertility-conserving options.”
Dr. Jackson, who also completed a fellowship in gynecologic oncology and treats ovarian, uterine, cervical and vulvar cancer patients, asks patients under 45 about their goals for future fertility. For those who haven’t had children and want them in the future, or for those who want more children, she can offer a referral to a reproductive endocrinologist.
From there, the patient is “fast-tracked” so she can undergo the stimulation and egg-retrieval process immediately instead of waiting for a particular point in the menstrual cycle like a typical patient. The entire process takes about two to three weeks — the usual waiting period between diagnosis and the start of treatments for all patients — meaning that lifesaving oncology procedures aren’t put on hold.
Other procedures to preserve fertility during cancer treatment involve shifting the ovaries so they avoid radiation during cancer treatment and the freezing of ovarian tissue for future use.
According to Dr. Jackson, the team waits about two years after the initial cancer diagnosis before performing any fertility treatments with the frozen eggs, embryos or tissue, as the highest risk of cancer recurrence takes place within that two-year window. After that point, patients can move forward at any time with their fertility goals as long as they remain in remission.
“Our message is about empowering young reproductive-age women (and men) that future fertility is often still an option after cancer care,” Dr. Billingsley says. “These patients should feel comfortable asking their oncologists about these options early, even at their first visit.”