Egg Freezing Before Chemotherapy: What You Need to Know

Many options are weighed when it comes to the treatment of cancer. Starting with the type of cancer, the health of the patient, the most effective treatment, the treatment window, and the odds of survival. Typically chemotherapy is used across many types of cancer, and while effective, it may render the patients unable to build families in the future. 

For women, chemotherapy can impact their egg production resulting in early menopause. In consideration of their family building goals, egg freezing before chemotherapy can be used to give them a chance to have children after treatment. So let us talk about the impact of chemotherapy on a person’s fertility and why egg freezing can be an important consideration prior to the start of treatment. 

How Chemotherapy Affects Egg Quality

The nature of chemotherapy is that it destroys cells that multiply quickly. Cancerous cells multiply rapidly therefore, chemotherapy has been found to be an effective treatment because it can target the cells and destroy them quickly, giving the body a chance to recover. 

The female reproductive system could be negatively impacted by chemotherapy because oocytes also undergo rapid growth during the follicular phase. Once a mature egg is fertilized the embryo also undergoes rapid cell multiplication, in a sense, behaving as a foreign body, like a parasite.  

Chemotherapy can be administered intravenously or in the form of oral medications depending on the type of cancer being treated. As well, based on how aggressive the treatment protocol is, it could impact a person’s ovarian reserve. When the ovarian reserve is diminished, it affects the production of estrogen that a woman can produce naturally. Additionally, the DNA within the oocytes could also be damaged during chemotherapy. 

When the ovarian reserve is diminished, it could result in challenges conceiving naturally, or menopause coming early, or prematurely. If the ovarian reserve was not badly damaged, fertility could be restored to a degree. Using eggs or embryos that were previously preserved, assisted reproductive technology (ART) can be used to help a person build their family.

Egg Freezing: How the Process Works

Egg freezing before chemotherapy is no different than egg freezing for in vitro fertilization.  There are several steps taken beginning with ovarian stimulation which facilitates the ovaries into developing more oocytes to maturity. In natural menstruation, several oocytes are released for development, and only one typically matures per cycle. Ovarian stimulation aims to mature as many of the follicles that are released in order to increase the chances of fertility treatment success.  

Ovarian stimulation is a closely monitored process, which involves monitoring the development of the oocytes as the person takes prescribed medications and hormonal injections. Monitoring is done using ultrasounds to monitor the physical growth of the oocytes, and blood work to monitor hormonal levels. Once the oocytes develop to the desired size a final hormonal injection is administered to assist as many oocytes to mature. 

Thereafter, the eggs can be retrieved in a brief outpatient procedure that is conducted under sedation.  The eggs are counted and examined for health markers such as maturity and anomalies. Those that can be used for fertilization are then cryopreserved until they are required. Cryopreservation is more effective than previous freezing methods because it takes out water content from the cells, replacing it with preservation fluid and rapidly cooled to prevent the formation of ice crystals. 

Cryopreservation has also been found to be more effective than freezing because the ice crystals that would form in previous preservation methods would result in the damage of eggs and sperm when thawed. Thawing in cryopreservation has proven to result in less damage to the preserved cells giving people better chances at family building thereafter. 

Success Rates of Pregnancy After Egg Freezing

As we have already noted, the effects of chemotherapy vary from one case to another. Some people are able to recover their fertility with the restoration of their menstrual cycle, while others become infertile. Now, while menstruation is a good sign post chemotherapy, it is not necessarily indicative of fertility or the ability to conceive naturally. Typically, after treatment, a person’s fertility will have to be examined in order to get a better understanding of the effects that chemotherapy has had on their reproductive system, and what can be done about it. 

One of the fertility examinations done for women is referred to as ovarian testing which is done using a blood sample. The antral follicles produce two hormones, the first is anti-mullerian hormone (AMH) which is a direct indicator of the number of oocytes. The presence of oocytes in the ovaries is also what produces estrogen in the body. Children and younger women in their teens and early twenties tend to have much higher ovarian reserves at that stage of life, and therefore are more likely to recover their fertility. If radiation therapy around their pelvic region was part of treatment, this may contribute to the impact that chemotherapy has had on their ovarian reserves. 

Cryopreservation is a more effective method of egg freezing compared to earlier methods. Further, fertilization by injecting sperm directly into the egg’s cytoplasm increases the chances of fertilization success. As a result, more people can become pregnant after egg freezing. In fact, if during egg retrieval, a person was able to have more than 15 eggs retrieved per cycle,  about 82 percent of the eggs survive the thaw, with 67 percent being able to be fertilized. The birth rate for this is up to about 48 percent, and is particularly successful if the patient is about 38 years or less during the time of embryo transfer. 

How Long Can Eggs be Frozen?

While the duration of actual cryopreservation varies from one case to another, eggs can be frozen even for decades. While no particular study has been done on this, there are cases where embryos that had been frozen for more than 10 years were used and resulted in live births. This implies that it could be possible to freeze eggs for a similar period and they would still be viable. A comparative study on the long term effects of cryopreservation for fertility would help to give a clearer picture on how cryopreservation affects fertility.  

Cost and Insurance Coverage

The cost of fertility preservation is based on blood work, ultrasounds, medication, egg retrieval procedures, the actual preservation and storage fees. Many states have legislation regarding fertility preservation, but these laws vary in the details. However, most require that insurers cover cancer patients for fertility preservation. That said, each insurance policy gives cover based on a person’s plan, therefore consultation with the fertility clinic’s finance representative will help you know the exact costs you will incur for fertility preservation. This information would be used to discuss insurance matters, how much you would have to pay out of pocket, and what alternative finance options are available to assist with these costs. 

FAQs

Is egg freezing painful?

Not particularly, however, the process leading to the egg retrieval may cause some discomfort, such as bloating, while some cramping may be experienced afterward. 

How much does egg freezing cost for cancer patients?

The overall costs depend on the location and clinic where the egg freezing is being done. Ovarian stimulation costs would average $3,000 to $5,000, egg retrieval plus freezing could average $5,000 to $7,000, while annual storage could average $300 to $600. There are options for financial aid, grants, and even discounted programs for cancer patients through organizations such as Fertility Within Reach and Livestrong Fertility. As well, some insurers will cover medically necessary fertility preservation. 

How soon should I freeze my eggs before chemo?

If you want to build a family, you should consider egg freezing before chemotherapy treatments. You will require about two to four weeks per egg retrieval cycle, which will be discussed between your oncologist and fertility specialist. There are some clinics offering fertility preservation for cancer patients on a fast-track to ensure it can be done before treatments begin.