Program's 'egg freezing' Expands Fertility Options
October 31, 2011
By Pohla Smith, Pittsburgh Post-Gazette
On July 25, Laura Ziros underwent outpatient surgery at Magee-Womens Hospital of UPMC for retrieval of six of her diminishing supply of egg cells, which had divided into the stage called oocytes. The oocytes were then frozen, a condition in which they should remain viable for at least several years.
Ms. Ziros became the first woman to have the procedure known as egg freezing but properly called oocyte cryopreservation done as part of the Fertility Preservation Program in Pittsburghand the Center for Fertility and Reproductive Endocrinology at Magee. The preservation program is a joint effort of Magee, Children’s Hospital of Pittsburgh of UPMC, the University of Pittsburgh School of Medicine and the Magee-Womens Research Institute.
Her reason was simple: The 26-year-old nurse from the Cleveland suburb of Rocky River, Ohio, is uncertain she’ll be carrying any fertile egg cells by the time she marries or decides she’s ready to be a mother.
When she was in the fifth grade, Ms. Ziros sustained an ovarian torsion, or twist, in her right ovary, which was removed. About 10 years later, in 2004, she developed a large cyst on her remaining ovary, and subsequent surgery to remove it left her with about two-thirds of her only egg-producing organ.
After the second surgery, she discussed the possibility of freezing some of her eggs with her reproductive and fertility specialist, Robert Collins. But the research was still in early stages and, he said, he didn’t think it was necessary at that time.
But science progresses and conditions change.
This past June, during Ms. Ziros’ general checkup, a laboratory test used to try to gauge fertility showed the level of the hormone checked had dropped almost 50 percent in a year.
“That’s when we started to discuss my options,” she said. “The options I had were to either freeze my eggs because the new process has come about, or to choose an anonymous sperm donor and have frozen embryos, or kind of do a half and half — half frozen embryos, half frozen eggs — or to just kind of wait and see what happens.”
The success rate of frozen embryos is on a par with the success rate of fresh embryo transfer and directly related to the age of the woman, according to Joseph Sanfilippo, director of the fertility center as well as the division of reproductive endocrinology and fertility at Magee. “Overall, in our hands, ongoing pregnancy rates in women less than 40 years of age is in the 42-45 percent range,” said Dr. Sanfilippo, who also is a professor of obstetrics, gynecology and reproductive sciences.
Ms. Ziros opted for freezing some eggs.
She explained why: “Because I felt I didn’t know what was going to happen within the next six months to a year, but I want to be able to have the opportunity to try and have my own children [and] I didn’t know if my hormone level was going to drop even further and as fast as it did.”
Her decision gives her what she calls a “backup plan.”
“I’m still carrying some eggs in my ovary that I’m going to try first,” she said. “… If my own eggs I have left aren’t viable and [don’t] produce an embryo or a baby and I have a husband, I’ll obviously use him [for the frozen eggs]. If it comes to I’m going to be single and want to have a child then I’d probably use an anonymous donor.”
Dr. Collins works at both the UPMC Center for Fertility and Reproductive Endocrinology-North in Hermitage, Mercer County, and at Magee, but he was not on call at Magee the day of Ms. Ziros’ egg retrieval. Instead the surgery was done by Dr. Sanfilippo.
Four more women have undergone egg freezing at the center since Ms. Ziros did. Two women did so because they were about to undergo treatment for cancer, which Dr. Sanfilippo said usually destroys eggs; one who is heading toward premature ovarian failure and one who froze eggs because of sperm issues with her partner.
Because the program is so new, Dr. Sanfilippo said, it has not had any resulting pregnancies.
Egg freezing is the newest of a number of options for males and females — adults and adolescents — with specific fertility problems that are offered by the Fertility Preservation Program, which he said is several years old.
The adolescent part of the preservation program, in which only ovary cryopreservation and oocyte cryopreservation are offered, is also relatively new.
Besides the earlier reasons given for why women have undergone egg freezing, other circumstances include women diagnosed with a debilitating disease that is not cancer but requires egg-destroying treatment, such as sickle cell anemia.
Two national physician groups, the American Society for Reproductive Medicine and American Society of Clinical Oncologists, have provided guidelines that address the options available to both men and women with newly diagnosed cancer.
Besides egg freezing, Dr. Sanfilippo said, women and girl adolescents’ choices include freezing of an entire ovary before treatment; “ovarian transposition,” which is the moving of the ovaries out of the field of radiation, and a procedure called “simultaneous ovarian suppression,” which is the creation of a medical menopause at the same time as chemotherapy is administered.
Men about to undergo cancer treatment can choose testicular tissue freezing or sperm banking, he said.
The procedures all are designed “to significantly increase the probability” that the patients needing medical therapy adversely affecting egg or sperm survival now have “a number of new and exciting options to have their own genetic child,” Dr. Sanfilippo said.
Egg freezing was years in development. The first birth following oococyte cryopreservation was in 1986, eight years after the first baby was born from in vitro fertilization, but the technique needed work, he said.
“I would say prior to 2007 the problem has been that the human egg is a very large cell and contains a lot of water, which results in ice crystal formation. Therefore freezing, or cryopreservation, would destroy the egg,” Dr. Sanfilippo said.
The development of cryoprotectants, a kind of “antifreeze that avoid a chilling injury to the oocyte … [means] the frozen ovum can stay for many years,” he added.
Another technical hurdle had to be overcome to permit fertilization after an egg is thawed: A way for the sperm to penetrate the ovum through a surrounding ring called the zona pellucida that is hardened by freezing. The answer was a sperm injection process called ICSI, or intracytoplastic sperm injection, Dr. Sanfilippo explained.
“So in other words the technology has advanced so fast and so far that all we need is one sperm and one egg, and this can result in a genetic, live-born baby.”
Prior to her egg retrieval, a woman has to inject herself with hormones for nine to 10 days to develop a number of oocytes, which are retrieved under the light anesthesia known as twilight sleep. After they’re retrieved, the eggs undergo special processing and are placed in liquid nitrogen.
“I didn’t experience any pain pre-procedure,” Ms. Ziros said. “Post-procedure there was just some mild cramping. Everybody was clear with what was going on. They were very supportive and told me exactly what I would expect.”
Parts of the procedure were covered by insurance, but there were still out-of-pocket costs — a “little over $6,000” for the procedure itself and over $1,000 for medication, she said.
Bloodwork and ultrasound that are very indicative of that egg’s ability to become fertilized are done before the procedure, but there’s no way to tell or guarantee if fertilization actually will take place, Dr. Sanfilippo said.
Other fertility clinics, however, have reported live births from oocyte cryopreservation.
Ms. Ziros said she feels “blessed and privileged to be able to have this opportunity and be in this time of medical advancement. …
“I definitely feel more secure knowing that if something were to happen to the rest of my ovary, I have six little eggs waiting for me and six potential opportunities to still have children using my own eggs.”
Being the first to do the procedure locally was icing on the cake.
“It was kind of cool, actually,” she said. “It was kind of like being able to lead the way for other women who might need this, to have that experience and be able to share that experience [with] other women.”