EGG FREEZING

Fertility preservation is effective in female cancer patients

Fertility preservation is effective in female cancer patients

The largest study looking at long-term outcomes of fertility preservation in female cancer patients has demonstrated how successful it can be, in particular for breast cancer patients.

The research, presented at the virtual meeting of the European Society of Human Reproduction and Embryology 2020 followed 879 young female patients (mean age 33.8) over a period of 19 years (2000-2019) – the longest reported follow-up of fertility preservation in cancer patients.

‘Currently, there is limited long-term outcome data [on fertility preservation] and this makes it difficult to counsel patients about the likelihood of success.’ said study author Dr Dalia Khalife from Guy’s and St Thomas’ Hospital, London. ‘Our study offers the largest cohort and longest follow-up of fertility preservation in female cancer patients… Around one in six of those who stored their gametes had a good outcome.’

However, she noted that there is a need for longer follow-up of patients and that early referral for fertility treatment is vital.

After counselling, 373 patients (42 percent) chose to have fertility preservation using one of three fertility preservation techniques: egg freezing (53 percent), embryo freezing (41 percent) and ovarian tissue cryopreservation (1%); with 5% using both egg and embryo freezing.

A total of 61 patients (16.4 percent) returned to use their eggs and 44 of them were successful following fertility treatment (live birth rate 72.1 percent).

Women diagnosed with breast cancer were the most likely to return for treatment and also had the highest live birth rate (70 percent versus 30 percent for lymphoma patients).

‘A fertility preservation service must be integral to a modern cancer care pathway. Fertility preservation with eggs and embryos has been beyond experimental for some time. And it’s important that clinicians across the world continue to collect and share data on long-term outcome for all methods, including ovarian tissue preservation, to provide patients with robust information’ said Dr Khalife.

Commenting on the study, Dr Melanie Davies, consultant obstetrician and gynaecologist at University College London Hospitals NHS trust and chair of Fertility Preservation UK, :

‘This is fantastic news – proof positive that fertility preservation is effective and worthwhile. It gives excellent outcomes for those women who return to use frozen eggs/embryos, as 44 of 61 achieved successful pregnancies and births. The proportion of patients who came back to the fertility clinic to use their frozen eggs/embryos (16 percent) is notably higher than for men who store sperm. More will return as the years pass. These results confirm that young women with a new diagnosis of cancer should be offered fertility preservation as part of their treatment pathway as long as they are well enough and time allows.’

Read more: https://www.eshre.eu/ESHRE2020/Media/2020-Press-releases/Khalife

Ten-year storage of eggs, sperm and embryos may be extended in the UK

Ten-year storage of eggs, sperm and embryos may be extended in the UK

The period of time for which eggs, sperm and embryos can be frozen could be extended, as the UK government calls for views on the current 10-year limit.

It said women’s choices on when to have children were being restricted, despite advances in freezing technology.

Only the eggs of people whose fertility may be affected by disease can be kept for longer – up to 55 years.

Current law generally permits frozen eggs, sperm and embryos to be stored for a maximum of ten years, after which patients must choose either to attempt a pregnancy, destroy the frozen material, or transfer it overseas for fertility treatment abroad.

The regulator said the time was right to consider a “more appropriate” storage limit, so the government has now launched a consultation on the current law.

It will also consider the safety and quality of eggs, embryos and sperm stored for more than 10 years and any additional demand for storage facilities that could result.

“Although this could affect any one of us, I am particularly concerned by the impact of the current law on women’s reproductive choices,” said Caroline Dinenage, a minister in the Department of Health. “A time limit can often mean women are faced with the heart-breaking decision to destroy their frozen eggs or feel pressured to have a child before they are ready.”

A fertility charity has previously said women were being pushed to delay egg freezing later and later, because of the 10-year storage limit.

The number of women choosing to freeze their eggs has more than tripled in the last five years. There were 1,462 egg freezing cycles in 2017 compared with 410 in 2012, and four out of five of these women are freezing their eggs for non-medical reasons, data suggests.

A much smaller number are freezing eggs before having unrelated medical treatment, such as to combat cancer.

For women freezing their eggs, the viability of eggs is at its highest in a woman’s early twenties, therefore eggs frozen at this time will have the best chance of leading to a successful pregnancy.

However, under the current law, these frozen eggs would need to be either used or discarded in a woman’s early to mid-thirties, before she may be ready to become pregnant. The most common age for freezing eggs is now 38.

Sally Cheshire, who chairs the Human Fertilisation and Embryology Authority, said the regulator had heard the voices of patients and doctors.

“While any change to the 10-year storage limit would be a matter for Parliament, as it requires a change in law, we believe the time is right to consider what a more appropriate storage limit could be that recognises both changes in science and in the way women are considering their fertility,” she said.

The announcement of the consultation follows the launch of the #ExtendTheLimit campaign, begun by the Progress Educational Trust (PET).

The consultation is available until 5 May 2020.

French National Assembly approves IVF for lesbians, single women

French National Assembly approves IVF for lesbians, single women

France’s lower house of parliament overwhelmingly passed a bill that aims to give single women and lesbian couples legal access to in vitro fertilization, egg freezing and fertility medication.

The assisted reproduction measures are part of a broader bioethics bill voted by the National Assembly, the lower house, where French President Emmanuel Macron’s government has a majority. The bill passed 359-114. It must still go to the Senate for debate.

The new legislation will mean that two bioethical cornerstones of former French ART regulation – a diagnosis of infertility and the requirement of marriage or partnership – will now be removed in favour of a more liberal framework for treatment. Thus, single and lesbian women will be eligible for sperm donation or even IVF treatment.

The new legislation will also mean that ‘fertile’ women will now be able to freeze their eggs for later use as some kind of biological insurance against age-related infertility.

France’s health care system would cover the cost of the assisted reproduction procedures for all women under 43.

French law currently allows in vitro fertilization and related procedures only for infertile heterosexual couples. Many ineligible French women travel abroad to undergo IVF treatment.

Lesbian couples, single women or both already have legal access to medically assisted reproduction in 18 of the European Union’s 28 countries.

France’s pending legislation also would allow children conceived with donated sperm to find out the donor’s identity upon demand when they reach age 18, a change from France’s current strict donor anonymity protections.

The legislation does not address surrogate motherhood arrangements, which are banned in France.

‘This new law responds to a societal demand,’ health minister Agnès Buzyn told Le Parisien newspaper. ‘Family patterns have changed. All the studies now show that children raised in homosexual couples or by single mothers do not have any particular problems as distinct from children raised in more traditional types of family situations.’

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