Woman who recovers from cancer becomes the first in the world to give birth after freezing immature eggs
A cancer survivor is the world’s first woman to give birth to a baby after her immature eggs are harvested and frozen.
The 34-year-old French woman was given the option just before she started breast cancer chemotherapy five years ago.
Doctors took seven eggs from her ovaries before artificially maturing and freezing them in the laboratory – a technique called in vitro maturation or IVM.
The eggs were thawed and fertilized when the woman wanted a baby who, of course, had tried for a year after she had already had her cancer free.
After a pregnancy without hiccups, the woman gave birth in July 2019 to a healthy baby boy named Jules.
Normally, freezing eggs means that drugs are used to stimulate ovulation and allow the eggs to mature before being harvested.
But cancer patients often cannot afford to postpone their life-saving treatment while waiting for this process, and the hormones have a risk of worsening cancer.
Experts said last night that the procedure represents a major breakthrough in fertility for cancer patients, many of whom are left infertile by chemotherapy.
A cancer survivor is the world’s first woman to give birth to a baby after her immature eggs are harvested and frozen. Doctors took seven eggs directly from her ovaries and matured them in a Petri dish. The mature eggs were stored in liquid nitrogen at -196 ° C
The historic case is reported by French doctors at the Antoine Béclère University Hospital near Paris in the leading cancer magazine Annals of Oncology.
The woman, who has not been named, had the opportunity to get IVM and another option – the removal and freezing of her ovarian tissue with the aim of replacing it when chemotherapy was complete.
Although freezing ovarian tissue has been shown to work, it is a radical and invasive option that few women want to undergo when they have just received news about a cancer diagnosis.
Professor Michaël Grynberg, fertility protection expert, said last night: “I saw the 29-year-old patient follow her cancer diagnosis and gave fertility counseling.
WHAT IS THE PROCEDURE?
Before the unnamed woman started her cancer treatment, doctors removed seven immature eggs or ova from her ovaries.
They then used a technique called IVM (in vitro maturation) to enable them to develop further in the laboratory.
Ultra fast freezing in liquid nitrogen, called ‘vitrification’, has prevented them from being damaged by ice crystals.
With this process, the temperature of an egg drops thousands of degrees per minute – resulting in a glassy cell structure.
It can then be stored for up to 25 years in a cryogenic tank with liquid nitrogen at -196 ° C.
When the woman was ready to have a baby, the fertilization method was the same as with normal egg freezing.
The six eggs were thawed and fertilized with sperm. It was not clear whether this was a donor or her partner.
One embryo was transferred to the patient’s womb and she gave birth nine months later.
‘I offered her the opportunity to freeze egg after IVM and also to freeze ovarian tissue.
“She rejected the second option, which was considered too invasive a few days after cancer diagnosis.”
The woman chose to freeze her immature eggs. The option has been given to women for several years, but no births have been reported.
In a woman’s natural cycle, an adult egg is released from the ovaries once a month. An immature egg or egg cannot be fertilized.
The procedure included an ultrasound showing that there were 17 small fluid-filled bags with immature eggs in her ovaries.
Six days later Professor Grynberg picked up seven immature eggs with the help of a long needle, which had been matured for 48 hours in a special mix of chemicals in the laboratory, before six were frozen.
The woman underwent chemotherapy and had recovered from breast cancer after five years.
She tried a year for a baby, but couldn’t get pregnant, so she decided to use her frozen eggs.
All six eggs were thawed and five were successfully fertilized. One embryo was then transferred to the patient’s womb.
Nine months later she gave birth to Jules, who was born healthy on July 6, 2019.
Professor Grynberg said: ‘We were delighted that the patient became pregnant without any problems and successfully had a healthy baby.
“This success means a breakthrough in fertility protection.
“Fertility protection should always be considered as part of the treatment of young cancer patients.”
Immature eggs were taken directly from the woman’s ovaries while she was under anesthesia
Usually women who want to freeze their eggs for later use with IVF must first undergo hormone treatment for a few weeks.
Professor Grynberg said: ‘Egg or embryo [freezing] After ovarian stimulation is still the most established and efficient option.
“However, ovarian stimulation is not feasible for some patients due to the need for urgent cancer treatment or other contraindication.
“In these situations, freezing ovarian tissue is an option, but requires a laparoscopic procedure and, in addition, in some diseases there is a risk of re-introducing malignant cells when the tissue is transplanted back into the patient.
‘IVM allows us to freeze eggs or embryos in urgent situations or when it would be dangerous for the patient to undergo ovarian stimulation. Moreover, its use is not associated with a risk of cancer recurrence. “
HOW CAN CHEMOTHERAPY AFFECT A FEMALE’S Fertility?
Most chemotherapy (chemo) drugs can damage a woman’s eggs. This depends on the age of the woman, the type of medication she receives and the doses of the medication, making it difficult to predict whether a woman is likely to be fertile after chemo.
When a woman is young, she has more eggs in the ovaries, and therefore a greater chance of becoming pregnant after treatment.
Girls who had chemo before puberty or young women whose period starts after chemo run the risk of an early menopause.
Even if a woman’s menstrual period starts after cancer treatment has stopped, her fertility is still uncertain. Some eggs are usually destroyed by cancer treatment.
It is advised not to become pregnant during chemo. Many chemomedicines can damage a developing feotus and cause birth defects or other damage. A woman can be fertile during some types of chemotherapy, so they must use highly effective contraception.
Women are often advised not to become pregnant within the first 6 months after chemotherapy, as the drug may have damaged the eggs that had matured during treatment. If a damaged egg is fertilized, the embryo can have a miscarriage or develop into a baby with a genetic problem.
Source: American Cancer Association
He added: “We are aware that eggs that have matured in the laboratory are of a lower quality compared to eggs obtained after stimulation of the ovaries.
“Our success with Jules, however, shows that this technique should be considered as a viable option for maintaining female fertility, ideally also combined with cryopreservation of the ovary.”
Research by the University of Edinburgh in 2018 has shown that female cancer survivors are 38 percent less likely to conceive.
Cervical and breast cancer survivors are among the most affected – along with those who develop leukemia.
Powerful anti-cancer drugs can permanently damage the ovaries, uterus and brain areas that regulate reproduction.
The issue of maintaining fertility in young cancer patients has become a problem.
Experts greeted the breakthrough as a great success.
Professor Adam Balen, reproductive medicine and surgery at the University Hospital of Leeds, said: “This appears to be the first report of the use of in vitro maturation (IVM) of immature eggs collected from non-stimulated ovaries of a woman who is very fast had to undergo cancer treatment, thereby preserving her fertility.
‘IVM has been used in fertility treatments for over 20 years, but plays a limited role because the success rate is lower than when adult eggs are collected from ovaries stimulated by hormones.
“IVM makes faster progress in cancer treatment possible because the eggs are ripened in the laboratory and therefore a valuable option for those women where a delay can be critical.”
Professor Richard Anderson of the University of Edinburgh said: ‘It is a challenge to let eggs mature successfully after removal from the ovary, so this is a very welcome positive step.
“It requires a different set of skills than normal IVF, so it’s not available everywhere, but this report shows that it can work if the time is very short.
“This progress is especially important for cancer patients, but it is also a step toward simpler and less invasive IVF for other women and couples who need artificial reproduction.”