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What Are the Alternatives to Egg Freezing?

Egg freezing has become a hot topic in recent years, but it's important to keep in mind other solutions. Dr. Gleicher describes some other potentially more successful alternatives to egg-freezing and fertility preservation.

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We have quite the number of times in recent months and years addressed the issue of egg freezing, both here in video format and in our newsletter. It's an important issue because egg freezing has become quite popular and indeed a whole industry, one can say, has arisen around the concept of freezing eggs in young women so that they can prolong their reproductive lives later on. In that evolution of egg freezing, we sometimes forget that besides freezing eggs there are other possibilities as well available which may help to prolong a woman's fertility or even a couple's ability to have a child and it is important that patients remember those alternatives. And probably the most widely used alternative, though often forgotten when patients are counseled about what alternatives there are, is the freezing of embryos. An embryo is obviously the product of an egg and sperm and therefore it is not a necessarily good way of preserving fertility for a single woman. Single women obviously don't want to commit to a sperm donor, for example, but freezing embryos may be a wonderful solution for a stable couple. A couple that for whatever reasons does not want to have children right now, but is thinking about having children down the road in five or 10 years. They may be very well advised to freeze embryos. Indeed, freezing embryos is in many ways better than freezing eggs because it is much more predictable in its pregnancy chances. In other words if we have X number of embryos, our predictive abilities (what those embryos represent in pregnancy chance) are much higher than having X number of eggs. So if you are a couple and you're thinking about preserving your options for later in life together as a couple, give it a thought-- consider the possibility of freezing embryos while you're still young. Aside from embryo freezing and egg freezing, there is another option which has been practiced now for a good number of years and in cancer patients is no longer considered experimental. And that is the freezing of ovarian tissue. Why am I stressing the fact that this technique of fertility preservation is only considered non experimental in cancer patients? The answer is simple. In cancer patients, there is really no alternative. If a young woman is diagnosed with cancer or for that matter with other diseases that require medical treatments which will wipe out that woman's ovarian function, and moreover, the medical situation is an emergency (in other words, there is not much time left to freeze eggs), the only thing that can be done is to freeze ovarian tissue. When we are talking about freezing ovarian tissue, we're specifically talking about freezing pieces of the cortex-- the the outer membrane of the ovaries-- because that's where all the immature (the very immature so called primordial) follicles and their eggs are sitting. So by getting just a piece of an ovary or even a whole ovary and removing the cortex and cutting that cortex into tiny little slices and freezing those slices, we are freezing much larger egg numbers than we can ever freeze by freezing eggs in the traditional way. And this technique has been used, as I said before, for a good number of years in young cancer victims (primarily in young cancer victims), but also sometimes in young women without autoimmune diseases who need to get a cytotoxic therapy to put them into remission. So in these patients the treatment would otherwise wipe out the ovaries, but once we have a few of those pieces of ovaries frozen away, once that patient is stable, those pieces can be re implanted, and they very quickly are invaded by blood vessels and they become kind of little mini ovaries and a good number of pregnancies have been established--some indeed through spontaneous ovulation, others requiring IVF. So in those specific patients this technique has been used for quite a while, but more recently and also very recently even in the lay press, voices have raised the possibility to expand the concept of ovarian tissue freezing to a broader candidate population and the logic is very much the same than I explained before. You can take a little piece of ovary and in that little piece alone there will be hundreds--maybe even thousands-- of eggs. That is never possible to obtain through repeated cycles of egg retrieval and freezing of those eggs. And therefore, tissue freezing in certain ways is more efficient and also even though it does involve an ambulatory surgical procedure, it is also not necessarily more expensive--very much to the contrary indeed. Plus, ovarian tissue freezing has one more potential. This is a potential. We are not there yet, but we are getting very close. You may remember that just a few weeks ago, the media reported quite widely that colleagues in Scotland had for the first time, taking those primordial (very immature follicles that I just was talking about) and maturing them in vitro in the laboratory and getting mature eggs that could be fertilized. Now, think about it. Assuming we could really develop this technique further and make it more efficient than it is currently still (our colleagues really had to culture lots of follicles to get just a few to maturity), but it is very likely that over the next few years, maybe five years-- certainly not much longer, we will learn how to mature those primordial follicles to maturity in the lab. We have been working on this here at CHR also for quite some time. Indeed, our director of laboratories, Dr. Albertini, was a co-author with our Scottish colleagues on that paper. So, five years from now, it will very likely be possible not only to take those little strips of ovarian tissue that are currently surgically re implanted into patient, but we will be able to take one of those little strips, separate the eggs (those very premature follicles and and their eggs) out of the tissue and grow them in the laboratory. And think about it-- instead of getting five eggs here or maybe ten eggs or fifteen eggs in a single egg retrieval, you will have available hundreds to thousands of eggs. In other words, through tissue preservation, a woman could really prolong her reproductive life forever and ever because she would never run out of eggs. Thank you for listening.

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