More Hope for Future Fertility

Reproductive researchers are reporting an important first-time event: an embryo created as the result of cryopreserved (frozen) ovarian tissue.

While semen cryopreservation is standard practice and has been oft- utilized by male cancer patients prior to starting chemotherapy, no such standard has existed for female patients because the reproductive technology needed has not been available. In short, the freezing of eggs has thus far shown to be limited in its capacity to result in successful pregnancy. So researchers have also been working on cryopreserving actual tissue from the ovary itself, not the eggs, and this latest result is the farthest reaching development.

A 30 year old woman had samples of her ovarian tissue cryopreserved and, six years later, had tiny pieces of the thawed tissue transplanted subcutaneously (that is, just under the skin) in her abdominal area. After administration of fertility drugs, the tissue began ovulating, about 20 eggs were extracted, some were combined with semen for in vitro fertilization, and one resulting embryo eventually developed to a 4-cell embryo. The embryo was transferred back to the woman, but it did not implant.

Of Special Significance

The value of this advance is especially important to people with cancer. Imagine being diagnosed with cancer and told that the treatment, the therapy that will likely save your life, will also likely render you infertile.

That's what Lindsay Nohr heard a few years ago when, at the age of 24, she was diagnosed for a second time with cancer. Her first bout of tongue cancer two years earlier had been treated successfully with radiation therapy, a form of treatment not generally harmful to fertility unless it is performed specifically on the reproductive organs. The recurrence of Lindsay's cancer involved her lymph system, so the prescribed treatment this time included surgery, radiation, and chemotherapy. She was informed of chemo's typical risk: permanent sterility.

My first response,” she recently said in a forum for interested researchers and clinicians, “was what doctors fear and often hear: I said 'no way' and backed away from treatment.”

Fortunately, Lindsay changed her mind. “All my surgeon had to say was, 'That's not really rational...' and explained that even though I have goals to be a parent, not treating my cancer would surely result in death.”

So, the confident young woman, who had already helped develop a multi- million dollar healthcare Internet company, told her doctor that she would need assistance to preserve her future fertility. Without a male partner to help her create embryos to cryopreserve for future use, Lindsay spent hours investigating the available options and, many phone calls later, turned up only oocyte (egg) freezing. It wasn't until after her cancer therapy that she learned about ovarian tissue freezing as a possibility.

Six months after her treatment, Lindsay founded Fertile Hope, a non-profit program that is enthusiastically spreading the message that cancer patients have new reasons to be optimistic. The educational, support and advocacy program has been cited and featured in a wide array of national media venues. Their message of hope and empowerment is being heard.

The forum at which Lindsay spoke most recently was another first: a multidisciplinary gathering of physicians, researchers, embryologists, and psychologists discussing every angle of the issues relating cancer and fertility. It was at this gathering that researchers presented their exciting new findings about ovarian tissue preservation. The title of the conference, “Parenthood After Cancer,” illustrated the new, more positive light being shed on options for cancer survivors.

Freezing Ovaries Vs Eggs

The American Society for Reproductive Medicine has issued comments applauding the latest results of ovarian tissue freezing, along with the reminder that patients should be clear on the current experimental nature of both this and egg freezing.

Dr. John Schnorr with Southeastern Fertility Center in South Carolina is one of a few reproductive endocrinologists who has explored the clinical uses of frozen ovarian tissue to preserve fertility. He concurs with the ASRM on their recommendation that interested patients seek only programs that are approved by an investigative revue board (IRB).

Thus far, frozen eggs have resulted in only a few babies. Italian researchers, because of that country's rigid restrictions on embryo freezing, have become the foremost in helping patients become pregnant with cryopreserved eggs – and their success rate is generally only in the 10 to 15 percent range, as compared to a pregnancy rate with frozen embryos (the current standard of cryopreserved ART) of 30 to 40 percent. Schnorr explains that the cryopreservation process itself is more damaging to individual egg cells than to embryos. He expects that ovarian tissue freezing will eventually provide a good option for successful pregnancy.

Schnorr details the apparent advantages of cryopreserving ovarian tissue as opposed to eggs:

Retrieval of ovarian tissue can occur virtually immediately, resulting in no delay of cancer therapy. On the other hand, egg retrieval requires several days of fertility drug administration (and all the discomforts that may result), thereby delaying cancer treatment for as much as three weeks or more.

Retrieving an ovary involves no change in the woman's hormonal milieu, unlike ovulation induction by medication, which can increase a woman's normal estrogen level as much as ten times. “There are some cancers,” says Schnorr, “where you simply don't want to increase your estrogen levels like that.”

By saving the entire ovary, the potential exists for the woman to utilize the tissue later to produce thousands of eggs, rather than only being able to attempt fertilization with the 30 or 20 or fewer that resulted from her ovulation induction.

The question after freezing the ovary now remains -- what are we going to do with the frozen tissue,” says Schnorr, who has been directing a protocol similar to the recent news-breaking study, in which women are having their tissue transplanted back subcutaneously in hopes of ovulation and in vitro fertilization.

The risk of ovary removal is a standard one to two percent operative risk, the same baseline risk assigned to any surgical procedure.

Schnorr anticipates that once more is learned about the processes involved in going from cryopreserved tissue to ovulation to an implanted embryo, the procedure will work best for women who are younger than 35 at the time of their cancer diagnosis, with regular menstrual cycles, and who are being treated for cancer which is not ovarian-specific and has not spread to the ovary.

Tissue frozen today can likely be 'rescued' by tomorrow's technology, and it gives people some hope.” Schnorr reasons, “We can't promise people it's going to be available in 10 years, but with what we've seen happen in IVF technology in the past 10 years, there's a good chance it could happen.”

For more information on this ground-breaking work, see:

Southeastern Fertility Center

Fertile Hope