July 7, 2008
Geeta Shah no longer has her left breast. She will have chemotherapy for the next four months, which could lead to early menopause for the 30-year-old, who does not have children but wants to be a mother.
But she and her mother, Madhuri, often smile and laugh as they talk about Shah’s breast cancer. That’s because they believe Shah will survive — and that she could eventually have a baby. In May, in what doctors say is a first in Utah, she had 18 of her eggs frozen.
Putting eggs on ice is considered experimental, with a slim but growing chance of success. Freezing embryos is more common and successful, but fertilizing eggs before freezing them isn’t an option for single women who don’t want to use donor sperm.
Utah has been slow to offer egg freezing, perhaps because women here get married and have babies earlier than in most other states. Nationwide, as cancer survival rates improve and more women delay childbearing, fertility clinics have reached out to any woman who can pay the average $12,000 cost plus annual storage fees.
But the Utah Center for Reproductive Medicine, the only Utah clinic to offer the service so far, is emphasizing the service for cancer patients.
For Shah, the process of protecting her fertility was a welcome respite from thinking about cancer.
She found comic relief in picking out sperm — she had enough eggs to also freeze embryos. She giggles about the time her mother gave her a parking-lot hormone injection to boost her egg production — and what passers-by may have thought.
Seeing Shah’s overflowing ovaries on an ultrasound screen during a doctor’s visit, her mother called them her “grand-ovum” and posted the grainy picture on the fridge.
“In all of the sadness, this is a happy thing,” Madhuri said.
Male cancer patients have long been able to preserve their fertility by freezing their sperm. Tour de France champion Lance Armstrong’s three children were conceived with sperm he banked before chemotherapy.
Options for women have developed more slowly. The first baby from a frozen egg was born in 1986, and there have since been more than 550 such babies worldwide. The first American baby conceived using frozen sperm and a frozen egg was born last year.
Freezing eggs is more complicated than freezing sperm or embryos: The water inside the egg can form ice crystals, which can damage the egg and its chromosomes. According to Fertile Hope, a New York-based nonprofit group that assists cancer patients, 22 percent of the embryos developed from a frozen egg will result in a pregnancy.
Depending on the age of the woman, the pregnancy rate is up to 32 percent using frozen embryos, and at 43 percent with fresh donor eggs.
Because the birth rate with frozen eggs is so low, the American Society for Reproductive Medicine considers the technology experimental. Still, it says it may be appropriate for cancer patients who have no viable alternative, as long as they are informed about the potential risks of fertility drugs and egg retrieval, the costs and the low success rates.
The private Reproductive Care Center in Sandy plans to provide egg freezing soon. But it and the Utah Center for Reproductive Medicine at the University of Utah offer alternatives: Women can freeze embryos or use donated eggs. Both centers offer financial breaks to cancer patients.
A difficult decision
But fertility doctors say not enough cancer patients know their options. That’s why the Huntsman Cancer Institute is training a nurse to help cancer patients navigate fertility issues, and the U.’s infertility clinic has been meeting with adult and pediatric oncologists.
“I don’t think cancer doctors or patients think about their future as a living person,” says Kirtly Parker, a U. infertility doctor who retrieved Shah’s eggs. “In the past, we treated cancer survivors as just lucky to be a survivor. Don’t ask for anything more.”
Saundra Buys, medical director of Huntsman’s High Risk Breast Cancer Clinic, expects to see more cancer patients who want to get pregnant as more women delay childbearing into their 30s and 40s, the same time when breast cancer is most likely to occur.
Pregnancy after cancer raises difficult issues, she says. Advances in chemotherapy and radiation mean better survival rates, but the treatments can lead to infertility, depending on the dosage, location and the woman’s age.
And if a patient is young enough to think about having children, she says, they’re young enough to get cancer again.
She tells patients, which includes Shah, “Look, you’ve had cancer. There’s a possibility that you won’t be around to raise this child. Do you have the support you need to feel like that will be OK?”
‘Part of being human’
There’s a good chance Shah will be able to get pregnant naturally. After chemotherapy, women her age usually regain their fertility, but it may be for a smaller window — they still may go into menopause permaturely, Buys says. If Shah does not use her eggs and embryos, she will donate them to the clinic.
Still, she feels like she’s taking control of her life, even while giving up a part of her body. What brought her to tears after her diagnosis was the realization she would need a mastectomy because the tumor was large and the cancer aggressive.
“I’m 30. I’m single. When you’re in the dating market . . . you’re already so self-conscious. What is it going to look like?” she recalls thinking. She also thinks about not being able to breast-feed on that side.
After her mastectomy but before chemotherapy, she took drugs to boost egg production and maturation. When an ultrasound showed plenty of eggs, she opted to quickly fertilize some and freeze the embryos. “Listen,” she told an out-of-state sperm bank, “I’m on a tight schedule. I need some sperm.”
She paid $300 for a vial from a tall, blond, green-eyed man with a cute baby photo and good SAT scores.
Before cancer, Shah wasn’t ready to think about having children. But the disease has a way of bringing clarity. As her mother sat at her side and rubbed her back, Shah noted the first thing she did when she heard she had cancer was go home to her mom.
“She’s the person I’m biologically connected to. My existence, I’m here because of her. In terms of life cycle, part of being a human is reproducing.”