Egg Freezing Before Chemotherapy: What You Need to Know

A cancer diagnosis can be overwhelming. Amidst the whirlwind of medical appointments and treatment plans, considerations about future fertility might not be at the forefront. However, for many individuals, the ability to have biological children post-treatment is a significant concern. 

Chemotherapy, though life-saving, can adversely affect reproductive health. Understanding and exploring fertility preservation options, like egg freezing, before starting chemotherapy can offer hope and choices for the future.

How Chemotherapy Affects Egg Quality

Chemotherapy works by targeting rapidly dividing cells in the body. This is an essential function of chemo when combating cancer. Unfortunately, even the good cells get caught up in this process. The ovaries contain rapidly dividing cells, specifically developing eggs (oocytes), which makes them vulnerable to damage during treatment. 

As a result, many chemotherapy drugs, especially alkylating agents. Alkylating agents are anticancer drugs that damage DNA, stop cell division, and trigger cell death in rapidly dividing cancer cells. As they work, these drugs can negatively impact egg quality and quantity.

The impact of chemotherapy on fertility varies based on:

• Type and dosage of chemotherapy drugs. The type and dosage of chemotherapy drugs play a major role. Some medications are more toxic to reproductive cells than others. Alkylating agents, for instance, are known to be particularly harmful to fertility.
• Age at the time of treatment. One’s age at the time of treatment also matters. A younger woman typically has a higher ovarian reserve and better chances of recovery after chemotherapy. 
• Pre-treatment fertility health: Pre-treatment fertility health influences outcomes. Women with a lower ovarian reserve to begin with may be more susceptible to permanent damage.

In some cases, chemotherapy may lead to premature ovarian insufficiency, a condition where the ovaries stop functioning before the age of 40. For others, menopause may occur earlier than expected. Because this risk is difficult to predict precisely, fertility preservation through egg freezing is often recommended before treatment begins.

Egg Freezing: How the Process Works

Egg freezing, or oocyte cryopreservation, is a procedure that allows women to preserve their fertility before undergoing potentially harmful treatments like chemotherapy. The process begins with hormonal stimulation, where you give yourself daily hormone injections over 10 to 14 days. These daily injections stimulate the ovaries to produce multiple eggs, rather than the single egg typically released each menstrual cycle.

During this time, you are frequently monitored. Blood tests are done to measure hormone levels, and ultrasound scans check the growth and development of follicles (the fluid-filled sacs in the ovaries where eggs mature). 

Once the follicles have reached an optimal size, a final “trigger shot” is given to prepare the eggs for retrieval. Around 36 hours after the trigger shot, the eggs are retrieved. This is an outpatient procedure that involves using a thin needle guided by ultrasound to access the ovaries and collect the eggs. It’s done under light sedation or anesthesia, so the patient is comfortable and doesn’t feel pain during the process.

The final step is vitrification. Here, the eggs are rapidly cooled to prevent ice crystals from forming. The frozen eggs are then stored in liquid nitrogen and can remain viable for years. Once the patient is ready to try for a baby, the eggs can be thawed, fertilized with sperm, and implanted via in vitro fertilization (IVF).

Success Rates of Pregnancy After Egg Freezing

The success of achieving pregnancy with frozen eggs depends on several factors.

• Age at the time of freezing: Younger eggs generally have higher success rates.
• Number of eggs frozen: More eggs increase the chances of a successful pregnancy.
• Overall fertility health: Underlying fertility issues can influence outcomes.
• Thawed egg survival rate: Studies have shown that approximately 90% of thawed eggs survive. 

Around 75% to 80% of eggs fertilized succeed, and the live birth rate per frozen egg roughly stands at 5–12%, with higher rates for eggs frozen before age 35. Freezing 10–15 eggs before age 35 can offer a 70–80% chance of future pregnancy.

How Long Can Eggs Be Frozen?

Thanks to advances in fertility technology, eggs can be frozen and stored for a surprisingly long time without a noticeable decline in quality. The rapid freezing method used today has significantly improved egg survival rates during thawing compared to older slow-freezing methods. Because of this, frozen eggs can remain viable for five, ten, or even more years, offering cancer patients long-term reproductive flexibility.

There is no definitive expiration date for frozen eggs. Scientific studies have reported successful pregnancies using eggs stored for over a decade. The key factor isn’t how long the eggs have been frozen, but rather the age at which the eggs were retrieved. Eggs frozen at a younger age (ideally under 35) are typically healthier and more likely to result in a live birth when used later.

That said, clinics may have different storage policies and time limits, often regulated by national or local laws. It's important to speak with your fertility clinic to understand their guidelines on long-term storage, ongoing fees, and the process for transferring eggs if needed.

Cost and Insurance Coverage

The cost of egg freezing can be substantial, encompassing:

• Ovarian stimulation & medications: $3,000 and $5,000
• Egg retrieval & freezing: $5,000 and $7,000
• Annual storage fees: $300 and $600 per year

Insurance coverage varies:

• Medical necessity: Some insurance plans cover fertility preservation if deemed medically necessary, such as before chemotherapy.
• State mandates: A few states have laws requiring insurance to cover fertility preservation for cancer patients.

Additionally, organizations like Livestrong Fertility and Fertility Within Reach offer financial assistance and discounted programs for cancer patients.

FAQs

How does chemotherapy affect fertility?

Chemotherapy can damage eggs, sperm, and reproductive organs. The extent of the impact depends on the type and dosage of drugs, the patient's age, and pre-treatment fertility health. In women, it can lead to ovarian damage or early menopause. In men, it can reduce sperm production or cause permanent infertility.

Is egg freezing painful?

The egg freezing process is generally not painful. Hormonal injections may cause mild bloating or discomfort. Egg retrieval is performed under light sedation, so no pain is felt during the procedure. Some cramping and bloating may occur afterward, but these typically subside within a few days.

How much does egg freezing cost for cancer patients?

Egg freezing cost depends on the clinic you choose and the location where it’s done. On average:

• Ovarian stimulation and medications can cost between $3,000 and $5,000
• Egg retrieval and freezing costs anywhere between $5,000 and $7,000
• Annual storage fees for frozen eggs cost between $300 and $600 per year

Discounted programs and financial aid may be available through some organizations. Additionally, some insurance plans cover fertility preservation if deemed medically necessary.

What is the success rate of IVF with frozen eggs?

Success rates depend on age at the time of egg freezing, number of eggs frozen, and overall fertility health. On average, the thawed egg survival rate is 90% while the fertilization success rate is approximately 75% to 80%. Live birth rate per frozen egg is 5% to 12% higher for eggs frozen before age 35. Studies have shown that freezing 10 to 15 eggs before age 35 offers a 70% to 80% chance of future pregnancy.

How soon should I freeze my eggs before chemo?

Ideally, egg freezing should occur 2 to 4 weeks before starting chemotherapy. A single cycle takes about 10 to 14 days, but some patients may require more than one cycle. Acting quickly is crucial, as chemotherapy can damage eggs and reduce fertility potential.