February 2012 eNews
GIVF establishes The Fertility Preservation Center for Cancer Patients
Building on its record of being the first clinic in the Washington, DC area to provide elective oocyte preservation - Personal Egg Banking™ - GIVF is pleased to announce the establishment of a Center to provide fertility treatment for both female and male cancer patients that is fully-integrated with the treatment provided by the patient's oncologist.
GIVF is uniquely positioned to provide these services:
- First outpatient fertility clinic in the US
- First fertility clinic in the Washington, DC area to offer elective oocyte freezing
- First and one of the largest sperm banks in the US with years of experience working with male cancer patients
- National leader in egg, embryo, and sperm storage
The Fertility Preservation Center for Cancer Patients provides patients with the ability to schedule a rapid consultation with a fertility specialist who will work seamlessly with the oncologist to provide treatment.
Fertility Options after the Diagnosis of Cancer
by Stephen R. Lincoln, MD, REI, FACOG
Hearing the words, "I am sorry, but you have cancer" is a devastating, emotional, everything changes moment that no one can really be prepared for. So many decisions have to be made in a short amount of time that it can be overwhelming. For the 140,000 Americans diagnosed with cancer each year under the age of 45, one unfortunately overlooked issue is future fertility.
The 77% survival rate in cancer patients is very heartening, and now we need to address the long term consequences of cancer treatments on reproductive abilities in the future after cancer treatments are completed. Unfortunately, cancer treatments such as chemotherapy, radiation and surgery can all be very effective in treating cancers, but have profound effects on future fertility. Abdominal or pelvic radiation as well as chemotherapy regimens including alkylating agents such as cyclophophamide have very high risks of inducing amenorrhea and premature ovarian failure with permanent sterility. More recently we have learned in those women treated for cancer and who still maintained normal menstrual cycles, their fertility potential nonetheless can still be impaired.
There is hope for cancer patients who want to build a family in the future. The most productive step is to have an immediate consultation with a fertility specialist to discuss and begin fertility treatments before the cancer treatment is even started. The most successful techniques include obtaining and preserving the gametes (eggs or sperm) or creating embryos for couples, all for future use after the cancer treatments are completed.
Sperm banking is one the most successful, least expensive options for men diagnosed with fertility associated cancer such as testicular cancer. Even with very low sperm counts, men can have samples frozen for long periods of time followed by successful outcomes in family building. The Fairfax Cryobank at GIVF has been a world leader in sperm storage for male cancer patients and has the resources to immediately help those with the sudden need to freeze sperm or testicular tissue.
For female cancer patients, several options are available now. The most successful option is for the patient to undergo a stimulated IVF cycle and create embryos for cryopreservation and future use. This requires the use of donor sperm or if the cancer patient has a partner, the use of the male partner's sperm. Embryos can be frozen for many years until after the cancer treatment and risk of remission stage have passed. Once the oncologist physician gives the okay, the patient can then proceed with a frozen embryo transfer cycle.
There are exciting new options for patients who do not want to create embryos, but want to preserve their fertility options before cancer treatments begin. The most promising option is the egg freezing or vitrification process. The patient begins a stimulated IVF cycle and the eggs are harvested as usual, but then frozen for later use rather than fertilized with sperm from a donor or current partner. There are many investigational studies that are showing egg vitrification is a safe effective treatment (including at GIVF). Other investigational options being developed include ovarian tissue freezing, which requires removing part or the entire ovary prior to cancer treatment with later re-implantation. Ovarian tissue freezing currently is not as successful as egg freezing.
Pregnancy after cancer treatment can still be a reality. Patients may no longer be limited to donor egg IVF because of harmful side effects of the cancer treatments, but instead may still be able to have their own biological child with the use of their own eggs. Although the data now is limited, there seems to be no increased risk of cancer recurrence, even in breast cancer in those that become pregnant. There also appears to be no increased risk of miscarriage, birth defects or pregnancy complication. In patients that have a genetically linked cancer, there could be potential risks of inheritance, and an even more exciting future therapy may be the use of preimplantation genetic diagnosis to test embryos for the genetically linked cancers before transfer in an IVF cycle. The most important concern for any newly diagnosed cancer patient is to quickly consult with a fertility specialist to see what options may work for their unique circumstances.
There are 140,000 patients under age 45 diagnosed with cancer in the US every year. With improved cancer treatment, the 77% survival rate is very heartening. Now, more than ever, cancer survivors are looking to their future and the ability to have or extend their family. Unfortunately, many cancer treatments can have devastating effects on patients' reproductive potential.
What's New at GIVF
Free Donor Egg IVF Webinar
Want to get the straight scoop on donor egg IVF treatment options?
On Wednesday, February 29, 2012 at 8:00 pm, Sunita Kulshrestha, MD, REI, FACOG will present a free online webinar to review the latest in donor egg IVF treatment options. Dr. K will be joined by Phyllis Martin, LPC, a counselor specializing in helping donor egg patients, who is herself a donor egg mother. A previous egg donor will talk about what motivated her to donate as well as her feelings throughout the process.
A question and answer period will follow the presentations.
Meet Dr. K
||Sunita Kulshrestha, MD, FACOG holds a bachelor's degree in molecular biology from the Massachusetts Institute of Technology (MIT), a medical degree from the University of Pennsylvania School of Medicine, where in 1994 she graduated in the top of her class as a member of the Alpha Omega Alpha honor society. After finishing her residency in obstetrics and gynecology at the University of Virginia, she completed a three year fellowship in reproductive endocrinology at the University of Pennsylvania School of Medicine.
Dr. Kulshrestha is board certified in obstetrics and gynecology and subspecialty board certified in reproductive endocrinology and infertility.
Frozen Embryo Transfers: Fresh and Frozen Embryo Transfers Result in Ever Higher Success Rates
by Andrew Dorfmann, MS, ELD(ABB)
Embryology Laboratory Director
The embryology laboratory at the Genetics & IVF Institute has been freezing embryos successfully for over 25 years. But in the last four to five years a new and far more effective methodology has put this practice into the forefront of infertility treatment. The new method is called Vitrification. Coincident with this new technology, new media and techniques within the embryology lab also enabled culture of embryos through to the blastocyst stage (day 5). The combination of these two new methods has been very powerful. Over the last two years survival rates of vitrified embryos have soared to approximately 95%. Pregnancy rates have increased in parallel. Using vitrification with top quality blastocysts, we can achieve pregnancy rates similar to what we can achieve in our "fresh" IVF cycles. In fact, in certain patient groups we have observed pregnancy rates even higher than in the fresh cycle. Most importantly, the cumulative pregnancy rate from a single cycle of IVF, especially in good prognosis patients can rise quite high. This gives patients and clinicians many more options, including single embryo transfer and freezing all embryos from a cycle if the uterine lining is not progressing optimally.
In the past, Frozen Embryo Transfer (FET) was considered a secondary choice for treatment, but since 2009 our data has been so convincingly good that we now consider FET as a viable and nearly equal choice. FET can be an easier course of treatment, once embryos are cryopreserved and stored. Of course, we need to first do a fresh IVF cycle to get to that point. But in aggregate, given the high rates of pregnancy, our cumulative pregnancy rate for each patient cycle increases. This cumulative pregnancy rate, once overlooked by many clinicians and patients has an important impact on the patient experience. Once we have embryos frozen, if the patient did not achieve a pregnancy on the fresh cycle, the patient can go through less costly, and less difficult rounds of FET cycles. In addition, it gives us the flexibility to transfer fewer embryos during each treatment cycle. It is also a way to build a larger family without having to go through multiple retrieval cycles.
I was recently invited to lead a roundtable discussion at the American Society for Reproductive Medicine meeting in Orlando on the topic of a new and exciting addition to the methodology of embryo freezing that we have been helping to pioneer here at GIVF. A method first proposed by Professor Mukaida in Japan, called artificial shrinking of the blastocyst cavity (or blastocoel). Using the same laser technology that we use for Assisted Hatching of embryos and embryo biopsy, we use a single pulse of a laser to shrink the blasotceol which helps to reduce ice crystal damage at this sensitive developmental stage. Our data was first presented at the 2010 ESHRE (European Society of Human Reproduction and Embryology) in Rome and will soon be submitted for publication. We have been very pleased with the results of this new method and I was honored to have been invited to lead a discussion of it at the recent ASRM meeting.
Embryo freezing and frozen embryo transfer has been a standard technique in human assisted reproductive technology for many years. However, this newer method of vitrification is a special technique that requires very careful and precise execution in the laboratory. The recent advances in this technology have been a boon to IVF patients and practitioners and we are very proud to be at the forefront of these new and exciting techniques in the GIVF embryology lab.
The Genetics & IVF Institute (GIVF) regularly publishes an informative newsletter featuring the latest infertility news and developments. The newsletter is sent electronically via email. To subscribe, click here.