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New techniques help preserve fertility before cancer treatment

Frederick Sengstacke MD

Frederick Sengstacke MD

Upstate‘s Frederick Sengstacke MD was completing a fellowship in reproductive endocrinology at Georgetown University and the National Institutes of Health in 1983 when Howard Jones, Jr. MD spoke at a conference.

“Dr. Jones was the first person to achieve an invitro fertilization pregnancy in the United States. This was following the British breakthrough,” Sengstacke says. “He brought the technology back to the United States and was subsequently able to have an IVF pregnancy, and then he held a big conference for doctors interested in that technology – and I was fortunate enough to attend that first conference.”

The first IVF pregnancy was achieved without the assistance of medications to stimulate ovulation, which are commonly used today. The eggs were retrieved through laparoscopic surgery, which has been largely replaced by transvaginal ultrasound guided needle aspiration today.

Q What else has changed?

“We have had sperm banks for many, many years. But egg freezing and embryo freezing, a lot of these technologies are still evolving.

“The egg or oocyte is a very unique cell. It is the largest cell in the human body. It contains a large amount of water. When you freeze a cell that contains a large amount of water, it causes the water to crystallize, and that can damage the genetic portion of the cell. That can interfere with normal cell division, and the cell can die if you crystallize it. Techniques have now evolved for freezing eggs. Pregnancies have resulted from oocyte cryopreservation, or freezing. It‘s a technology that is now accepted as a fairly standard technology, but it‘s not as routine as embryo (after the egg is fertilized) freezing. It requires much more technical savvy.

“The idea is to be able to preserve fertility in patients who might otherwise not have that option. For example, take a young woman who is still in her reproductive age group who has breast cancer. She may not only require surgical therapy, but chemotherapy and radiation therapy, which can be destructive to the gametes, to the sperm and to the eggs. So as a result, once you have treated that patient, you have either completely devoided her of her egg supply, or you have significantly reduced that egg supply. What egg freezing allows you to do is to simulate the ovary in advance of her therapy, extract the eggs and freeze them, and then after she has completed her therapy she now has frozen eggs that can be used for invitro fertilization in the future.”

Q Have there been advances in male infertility?

“Intracytoplasmic sperm injection, ICSI, is a technique that was first used in humans in the 1990s and has allowed us to overcome male infertility in a significant way. The embryologist can take one spermatozoa, one sperm cell, and inject it directly into the egg, and you get over 80 percent chance of that egg being fertilized.”

Q Are these technologies safe?

“Many people thought if you are manipulating human gametes in the laboratory you are going to create some sort of monster. That really has not borne out in reality. However, there have been some recent studies that have shown ICSI is associated with a slightly increased risk of certain genetic abnormalities. The data is still being analyzed. We‘re being cautious about it in terms of advising patients. Anytime you change the natural selection process, there is a potential risk.

"Obviously these infertility patients have infertility problems. So if you‘re doing ICSI because of a male factor, if the embryo results from fertilization of that egg with a Y- bearing sperm, one that‘s going to produce a male offspring, then whatever problem that father had may be transmitted to his son. We know that‘s a potential risk.

“Now, when you look at the overall risk, there‘s a 2 to 3 percent chance that any baby born can have a minor congenital anomaly. So the question is, if the babies that we‘re seeing are within that 2 to 3 percent, was it really the invitro procedure -- or is that something that would have occurred naturally?”

Sengstacke, an assistant professor of obstetrics and gynecology, is director of Upstate‘s In Vitro Fertilization program. For referrals call 315-464-8668. Listen to his radio interview on this subject.