June 15, 2008
More Couples Freezing Sperm and Eggs
WHEN HE HEARD THE DIAGNOSIS -- prostate cancer, surgery needed -- Neal Rosenblum was crushed that the treatment would destroy his ability to have more children.
Now a year later, the self-employed Hollywood engineer and inventor lives cancer-free, and he and his wife last week tried for a baby through in-vitro fertilization using his sperm frozen before the surgery left him sterile.Rosenblum, 41, is one of a growing number of young cancer patients freezing sperm and eggs in case surgery, chemotherapy and radiation end their reproductive futures. For men, it's a fairly successful process.
But for women, egg freezing is still experimental, with high hopes but uncertain success. What's more, some fertility doctors are upsetting their colleagues by marketing egg freezing as a mainstream technique for healthy women who want to bank young eggs so they can delay pregnancy.
"It's not responsible. We do not know this is safe yet," said Dr. Moshe Peress, medical director of Boca Fertility, who does not freeze eggs and does not recommend it unless a woman has no other choice.
Rosenblum and his wife, Jennifer, spent about $5,000 plus $75 per quarter in storage fees -- health insurance covers little -- to put his sperm on ice. In the weeks before cancer surgery last August, he made five visits to IVF Florida fertility clinic in Pembroke Pines to make deposits.
"We wanted our son Alex to grow up with a sibling," Rosenblum said. "I thought freezing would be my only shot at having another baby."
In-vitro procedures involve extracting eggs from the woman and sperm from the man, then either mixing them in a petri dish or injecting sperm directly into eggs. The resulting embryo is then implanted in the womb.
The Rosenblums now have at least 15 chances at pregnancy. The first embryo made from frozen sperm did not survive implantation. The process is not cheap. Their in-vitro bill stands at about $30,000 after their second IVF try.
New approach boosts success
Babies have been conceived with frozen sperm since the 1950s, but the odds have risen as a result of a relatively new technique called intracytoplasmic sperm injection, in which a single good sperm is inserted into an egg.
Even so, only about one-third of young cancer patients bank sperm and only a few percent use it, recent studies show. That's partly because many cancer doctors do not discuss the options for patients who may lose fertility during treatment, said Dr. Kenneth Gelman, a Cooper City reproductive specialist.
"It tends to get missed. Oncologists have more serious issues to be dealing with," Gelman said. "But the patients should be made aware of their future fertility concerns, so they can decide if they want to freeze their sperm before the treatment begins."
Dr. Mark Soloway, Rosenblum's cancer doctor and chairman of urology at the University of Miami medical school, said sperm freezing is becoming more common because male cancer patients in their 20s and 30s are on the rise. Higher awareness of cancer means more and younger men get tested, diagnosed and treated, he said.
Female cancer patients in South Florida have fewer choices because egg freezing has only been done here for about a year, and only a handful of clinics do it as part of research studies. The procedures are not yet approved for wide use by the U.S. Food and Drug Administration.
The first baby was born from a frozen egg in 1986, but compared to sperm or embryos, eggs do not freeze well. The outer shells harden. If ice crystals form on the inside, the egg dies. The thawing process claims some. Those that survive are not as likely to fertilize, and in the womb, they are not as robust as fresh eggs, fertility doctors said.
In 2005, Italian researchers unveiled a new quick-freeze method using liquid nitrogen that may solve the icing problem. In certain overseas labs, success with frozen eggs reached 30 percent, exciting fertility specialists such as Dr. Harold F. Rodriguez at the Center for Assisted Reproductive Embryology.
The practice in Plantation now offers egg freezing to women as part of a study by a California company seeking FDA approval for a freezing system, Rodriguez said. Couples in the study pay about half of the normal $12,000 cost of in-vitro. Of the eggs collected so far, he said, most sit in storage. Five have been thawed, fertilized and implanted. Two resulted in pregnancy, but neither survived beyond eight weeks.
"We view egg freezing as something that's going to be revolutionary," Rodriguez said. "Women will be able to freeze their eggs, then go through their careers and then get pregnant when they are later in their careers, in their 40s and 50s."
But such statements distress some fertility doctors, who warn against hyping the highly profitable procedure to over-40 women.
The odds of a woman getting pregnant erode after age 35, from a peak of 30 percent down to 10 percent at age 40 and 5 percent at 42. Some of the decline is due to lower-quality eggs that could be replaced by frozen young eggs, but experts said older women have other biological barriers to conception.
Plus, egg freezing lags other reproductive methods. Michigan researchers reported in October that about 5 percent of frozen eggs led to a pregnancy, compared to 34 percent of IVF procedures using fresh eggs resulting in babies and 28 percent of IVF using frozen embryos.
With only about 200 babies born from frozen eggs, the FDA wants more data to be sure the process does not cause genetic damage to the babies. While there's no evidence it does, there's not enough of a track record to rule it out.
"There is no good data yet. I think it will remain an experimental therapy for a while longer," said Dr. Steven Ory, a partner at IVF Florida in Margate, Pembroke Pines, Wellington and Palm Beach Gardens. The practice offers egg freezing only to women with cancer or who can't get pregnant otherwise.
The professional group American Society for Reproductive Medicine urges fertility doctors to use the procedure only under experimental conditions.
"It works, and it's going to get better," said Dr. Karine Chung, founder of a fertility program at the University of Southern California. "The way it's being marketing, it's not being entirely truthful to the potential clientele that's it still early in the game."