Egg Banking Offers Hope to Women
The phones began ringing nonstop in the Atlanta offices of Reproductive Biology Associates on Oct. 17, less than 24 hours after doctors there announced that they had achieved a pregnancy--and twin babies--using eggs that had been frozen before being thawed and fertilized.
The medical advance, also duplicated by a team of Italian researchers, has sent infertility researchers nationwide scurrying to address questions from consumers who are anxious to partake of egg, or oocyte, cryopreservation.
“We’ve had a big response in patient inquiries,” says Ron Davidson, administrator of the Atlanta group. “But when something like this breaks, it ripples through the industry. Other clinics are fielding these calls, too.”
Many clinics are already setting up protocols to begin studying egg freezing in a small number of patients. Others have been studying the technology for some time.
“The method that was used in Atlanta is the same--to our knowledge--as we are all using. So it’s well within the capability [of everyone] because the methodology is the same,” says Dr. Geoffrey Sher, director of the Los Angeles branch of Pacific Fertility Centers.
Advancements in the field of assisted reproductive technologies tend to move rapidly through the field, adds Nancy Reame, an infertility specialist at the University of Michigan.
“I don’t think anyone is going to have to fly to Atlanta [to have their eggs frozen]. Good infertility practices, especially those affiliated with a university, are likely to have a program up and going within the next few months,” she says.
But experts caution that the technology is still experimental. The Atlanta researchers have established only one additional pregnancy from frozen, thawed eggs against many failures, and the Italian researchers have four more pregnancies. It is still much too early to fully understand who will benefit and what problems may ensue from egg freezing.
“Egg freezing has wonderful possibilities. But there are consequences that we can’t foresee,” says Elaine Gordon, a Santa Monica-based clinical psychologist with expertise in reproductive technologies. “In the reproductive world, there are lots and lots of pitfalls. And we have no experience with this.”
Infertility clinics must quickly embrace new developments to maintain their competitive edge, warns Reame.
“We often see only small success rates [for a particular procedure], but people go with it and advertise that they do this,” she says. “Frequently, clinics don’t distinguish between what is mainstream care and what is innovative therapy. There is a rush to market these unproven techniques.”
While a clearer picture of the benefits and drawbacks of egg freezing is sure to emerge within the next few years, an informal polling of several leading infertility clinics shows that many are looking at the benefits of the technology in terms of three classes of patients: cancer patients; young, fertile women; and women who are nearing the end of their reproductive years.
Cancer patients
Young women undergoing cancer treatment represent the group most likely to gain immediate access to egg freezing, according to experts. Several types of cancer treatments can destroy fertility, but freezing eggs might preserve the option of future parenthood.
“Our first priority is to help the patients with a medical necessity--the cancer patients,” acknowledges Davidson, of Reproductive Biology Associates. “We’ve had numerous calls from newly diagnosed cancer patients. And we’re working with those patients now.”
Young men diagnosed with cancer are routinely encouraged to bank their sperm before undergoing treatment. But “there really has not been much we could offer to a woman oncology patient until now,” says Mary Lou Cullen, a nurse practitioner with the Institute for Reproductive Health and Infertility in Rochester, N.Y., who has studied infertility services for cancer patients.
However, Cullen says she has several concerns, including a fear that oncologists won’t refer young women or girls to infertility clinics for egg freezing because the technology is so new. Another problem is that the patient still has no guarantee that she will become pregnant with the frozen, thawed eggs at a later date, she says.
(So far only an estimated 10% to 20% of frozen eggs survive the freezing process and even fewer are successfully fertilized, according to recent data.)
Finally, says Cullen, research is needed on the question of whether eggs or ovarian tissue removed from a cancer patient and frozen could trigger a recurrence of the cancer after it is returned to the body. Studies are also needed to determine whether the drugs used to stimulate egg development are dangerous for cancer patients.
“I think we have to be very careful,” Cullen says.
Nevertheless, oncologists should immediately begin referring young female cancer patients to infertility specialists, she says.
“Even having the option to store their eggs can give them a psychological boost. They might have more faith in their recovery and that there is something to live for.”
Young, fertile women
Should egg-freezing success rates improve substantially, many experts see great potential in egg banking for women in their 20s who want to delay childbearing to later in life. Beginning in her 30s, a woman’s chances of becoming pregnant decline.
“Putting your eggs on hold is very appealing,” says Gordon. “I’m hearing this from younger women who are looking at this as giving them some control over their lives. It’s the long-term planning that is appealing. I think people fear they may be infertile down the line.”
Egg cryopreservation may also become a routine back-up plan for women in their 20s who undergo sterilization.
“If you want to have tubal ligation at a young age, go ahead and freeze some eggs first,” says Sher. “These kinds of opportunities have immediate application.”
Women Nearing Menopause
Egg cryopreservation, at present, has the least to offer women who are approaching 40 or are in their 40s and who see their chances of becoming pregnant declining with age. Banking eggs in the “eleventh hour” of one’s fertility is an attractive idea for women who aren’t married or aren’t ready to become pregnant just yet. But these women shouldn’t get their hopes up, several experts caution.
“As we sit here today, this technology is not applicable to that type of patient,” Davidson says. “When you are 39 or 40 those eggs are already past their prime.”
Sher agrees that egg freezing is most likely to be successful with younger eggs. Older women may be better off trying in vitro fertilization with donor sperm and freezing the resulting embryos. Older women could also wait until they want to become pregnant and use donor eggs if their own eggs fail.
However, there is another advance on the horizon for older women who wish to become pregnant using their own eggs. Researchers from New York University Medical Center announced last month that they have succeeded in removing the cell nucleus--containing the genetic material--from the egg of an older woman and inserting it into the “denucleated” egg of a younger woman. A denucleated egg contains the cytoplasm, or outer part of the cell, but the genetic material has been removed. Four of seven “reconstructed” eggs in this study matured and displayed the normal number of chromosomes, the researchers reported.
Researchers propose that it may not be the genetic material of an older woman that causes fertility problems but other elements of the egg--elements that could be replaced with the use of younger donor eggs, adds Sher, who says Pacific Fertility Centers will soon begin a small pilot study of this technology.
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Scores of other questions and controversies loom as egg cryopreservation becomes a part of the medical landscape.
For example, do frozen-thawed eggs produce a higher risk of genetic abnormality? According to researchers from South Korea writing in this month’s issue of the journal Fertility and Sterility, eggs that were frozen at an early stage of development and then thawed showed an increased incidence of chromosomal abnormalities compared to eggs that were not frozen.
And there are many economic and ethical questions, as well, says Cullen. Such as: Who will make decisions regarding the fate of frozen eggs? Earlier this month, New York state authorities held hearings to debate the fate of thousands of frozen embryos that are unclaimed. Egg freezing could add to this significant issue.
“There are many, many moral and ethical dilemmas around all this. Who owns the tissue if something happens to the patient?” Cullen says.
It also remains unclear who will take the lead in establishing the first commercial egg banks: infertility clinics, sperm banks or another industry?
And who will set the rules? In general, the infertility field is self-monitored, with clinics abiding by voluntary guidelines, Reame notes. Egg banking may prove reason enough for limited government oversight, she adds.
“I think the banking of reproductive tissue is going to haunt us more than any other issue,” Reame says. “One of the things we’ll have to grapple with soon is the issue of licensing and developing adequate, minimum standards for oocyte banking. We are just now figuring out what the practice guidelines should be for semen banking: how to store semen, record-keeping, handling, processing and documentation.”
The lack of regulations in semen banking, she notes, has resulted in 12 documented cases of HIV transmission as well as concern that too many children are being born from the same donors.
“We know that mistakes, errors, negligence and misconduct can happen with semen banking. And we know from [the alleged misappropriation of eggs and embryos at] the University of California, Irvine, that embryo preservation has had problems, too. Oocyte banking could produce the biggest issues yet,” she says.
