TV reality star and E! News host Giuliana Rancic announced Monday that she and her husband Bill are expecting a baby later this summer born to a surrogate mother. After undergoing several failed attempts at in vitro fertilization (IVF) and subsequent treatment for breast cancer, the 37-year-old Rancic announced that one of the banked embryos she’d previously frozen was successful implanted in a woman who agreed to carry the fetus to term.
“This was our last stop,” Bill told the NBC Today show’s Ann Curry. “This was it. We had those two embryos that we had banked prior to learning about the breast cancer, and with the medicine she was on (which meant Giuliana will have to wait years before trying to personally get pregnant), this was our last effort. The prayers were answered.”
Fertility issues are very common among women and men undergoing cancer treatments in their reproductive years. Yet, all too frequently, doctors fail to fully counsel young patients on the possible loss of fertility that may result from radiation to the ovaries, prostate, or testicles or from potent chemotherapy drugs.
A survey of more than 1,000 female cancer patients under age 40 published in the March issue of the journal Cancer found that 61 percent of the survey respondents had treatments that could potentially destroy their fertility but that only 5 percent of the total respondents were counseled by fertility specialists and only 4 percent took action to preserve their fertility.
While, no doubt, many of the women surveyed may have been uninterested in having future children, the University of California San Francisco School of Medicine researchers found that the addition of counseling from a fertility specialist led to less regret concerning a decision not to take fertility measures than counseling provided just from an oncologist.
There are several steps young cancer patients can take to raise their odds of having a baby after treatment, said Dr. Elizabeth Ginsburg, medical director of the assisted reproductive technology program at Brigham and Women’s Hospital. For men, it’s fairly simple: Deposit and bank a sperm sample, which can remain viable for years. “It’s easy, inexpensive, and no risk,” said Ginsburg.
For women, the choices are more complicated. While Rancic was fortunate to have already had frozen embryos on hand, a newly diagnosed patient may decide to create several embryos for banking before her treatment—if she has a willing partner or opts for a sperm donor.
Women who prefer to wait until later to choose a partner can have their eggs harvested and frozen. “Egg freezing seems to be much better than it was a few years ago,” said Ginsburg. “But we don’t have good data on pregnancy rates, especially in women who freeze their eggs in their late 30s or early 40s,” a time when cancer diagnoses begin to increase and fertility begins to wane.
More data is available on pregnancy success rates using IVF with frozen embryos, but either procedure requires the act of harvesting mature eggs from the ovaries; this requires several weeks of hormone treatments and removal of the eggs using a transvaginal needle. For women who need to begin chemotherapy immediately after diagnosis, added Ginsburg, mature egg removal isn’t an option.
Such patients, however, might be able to have a piece of their ovarian tissue frozen and re-implanted after treatment. The method is still deemed experimental in the United States, which means the $12,000 cost isn’t covered by insurance. The Dana-Farber Brigham & Women’s Cancer Center offers it, but Ginsburg emphasized that little is known about pregnancy rates following re-implantation.
“Women with leukemia wouldn’t be good candidates because the re-implanted tissue might contain malignant cells,” she said. Tissue freezing might, however, be feasible for those with solid tumors not involving the ovary. “I suspect as the technology improves, the procedure will become more common in the next 10 years.”
Those looking to preserve their fertility following cancer treatment should certainly ask about their array of choices, as well as whether their treatment can be modified to lower their chances of becoming infertile. Perhaps a lower dose or different combination of chemotherapy drugs can be used; alkylating agents, like cyclophosphamide, tend to be the biggest destroyers of fertility since they destroy DNA in healthy reproductive tissues.
Here’s more on what to do if you’re worried about fertility issues.