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Egg Freezing Protocol Considerations for Cancer Patients
March 12, 2013
For cancer patients looking to preserve their fertility via egg freezing or embryo freezing, there are several ways in which fertility doctors can quickly and cautiously stimulate the ovaries to produce a great number of eggs with few risks.
James Goldfarb, M.D., of University Hospitals of Cleveland, Ohio, states there are two major considerations when it comes to ovarian stimulation and egg freezing for cancer patients: minimizing exposure to estrogen where clinically indicated, and reducing cycle time for patients with a time-sensitive case. He advises: “There are adjustments to an IVF protocol that can be made for cancer patients. For one, if they have breast cancer or another estrogen-sensitive cancer, using Letrizole along with the fertility drugs cuts down the level of estrogen the breast is exposed to. For patients who need to start chemotherapy quickly, if they are on day 14 or 15 of their cycle, rather than wait two weeks for their period, we can begin a Down Regulation GnRH (Gonadotropin-Releasing Hormone) Antagonist protocol. This stops the pituitary gland from stimulating the ovaries very quickly and allows the use of fertility shots which override the down regulation.” For patients with a time-sensitive need for freezing their eggs or embryos, a Down Regulation Antagonist protocol is ideal because their natural hormones are rapidly suppressed and ovarian follicle stimulation can begin almost immediately.
Another consideration that is less likely to be problematic, but still a valid concern, is preventing Ovarian Hyperstimulation Syndrome (OHSS) in these patients who are already dealing with a highly sensitive medical issue. OHSS is worsened by a rise in hormones once pregnancy is achieved. Since cancer patients are freezing their eggs or embryos for future use, they are less likely to experience severe OHSS. However, if a high number of eggs are retrieved, the patient could suffer some of the effects including bloating, fluid in the lungs, and risk of blood clot. “If a patient is hypercoagulable, as is the case for a patient with hyperstimulation, there is a higher risk of pulmonary embolism and thrombosis, which are major concerns,” states Goldfarb. Chemotherapy will have to be delayed if a patient develops ovarian hyperstimulation and given the medical state of the patients, additional complications should be prevented at all costs. This can be done in conjunction with the Down Regulation GnRH Antagonist protocol by using Lupron, rather than hCG, to trigger ovulation. Lupron is a fast-acting medication that does not present the risk of continued ovarian stimulation in a patient at risk for overstimulation.
Perhaps the most important factor when it comes to fertility preservation is educating the patient on the options available to them, and the little amount of time required to preserve their fertility. “The biggest issue with fertility preservation is knowing that there are options available. We tell oncologists: ‘You don’t have to know about fertility preservation, just call us (fertility doctors).’ We call the patient that same day. The technology is there, it is just a matter of patients being aware,” Goldfarb says.
University Hospitals of Cleveland is one of several fertility clinics active in the oncofertility movement. Organizations like Fertile Hope partner with these fertility clinics and pharmaceutical companies across the country to provide cancer patients with free or reduced cost fertility preservation options.
Cancer patients should consult an egg and embryo freezing expert to determine the fertility preservation protocol that best meets their needs.
To find a fertility preservation expert near you, contact our Patient Care Coordinators at 1-855-955-BABY (2229) or fill out the Contact Fertility Doctors Near Me form.