Health

HEALTH • Winter 2017 19 "It allows women to preserve reproductive options they may not have as they continue to get older." Dr. Kim Thornton, Reproductive endocrinologist, Boston IVF Source: SART member clinics tion and chemotherapy are needed by a woman with cancer, insurance will cover egg retrieval, she said, as those treatments can damage ovaries. "It's very easy to quickly stimulate the ovaries to produce extra eggs," said Johnson. "More is better." Cancer treatment or lack of a partner aren't the only reasons women freeze eggs. According to Business Insider, Google, Facebook and Apple offer coverage of egg retrieval for women who may be looking to delay childbearing for career reasons. Thornton also said that not just a cancer diagno- sis, but a woman's general medical history may bring them to explore if egg retrieval is right for them. A patient who is a carrier of a BRCA muta- tion, for example — a genetic mutation of tumor suppressor genes — may want to consider having her children earlier. "The point is to have a consultation to discuss the optimal time for them," she said, with egg freez- ing a potential tool now in the medical communi- ty's arsenal of solutions. No local lab Central Massachusetts, however, cannot yet offer complete egg freezing services. Boston IVF and UMass Memorial joined forces about eight years ago, said Johnson, but without a local lab in which to store frozen eggs, UMass Memorial and local Boston IVF locations rely on the Boston IVF facili- ty in Waltham for egg retrieval and storage. Local Boston IVF offices and UMass Memorial counsel women, stimulate ovulation and perform bloodwork; but actual retrieval — which can take as little as 15 minutes — and storage is done in Boston IVF's Waltham location. Anthony Berry, spokesman for UMass Memorial Health Care, said demand for egg freezing hasn't yet required the system to build or renovate a lab for retrieval and storage. "Having a centralized IVF facility allows care providers in the region to focus more of our atten- tion on patients. If we reach a point of critical mass where access would become problematic for our patients, we would certainly consider alternatives to address any gaps" Berry said. Ethics and education No matter where it's done, the concept of egg freez- ing raises ethical questions and underscores the need for education, say Johnson and Thornton. The gender of embryos can be found very early, Johnson said. "You can grow them out until they are multiple cells, pull out one or two cells, freeze, and send the cells to a genetics lab," she said. Jeffrey Steinberg, medical director of The Fertility Institutes, based in Los Angeles, Calif., says more parents are choosing the sex of their babies based on preference only. "Interest has increased tenfold in the last ten years," he said in an interview with TheDenverChannel.com in May. But sometimes, gender has more importance than deciding what color to decorate a nursery. Certain genetic abnormalities like the blood-clot- Dr. Julia Johnson, UMass Memorial Medical Center ting disorder hemophilia are much more likely to affect boys than girls, Johnson said, as an example. She said genetic disorders like cystic fibrosis or multiple sclerosis can also be detected in embryos. Those that don't show the disease can be trans- ferred, the others discarded. "Some could have an ethical issue with that, but I believe it's a family's decision," Johnson said. Thornton finds that a large part of her job as a physician in this field is educating women in gen- eral. She is surprised that more are not aware of the link between age and decreased fertility. She also wants women to know that egg freezing increases women's options, but isn't a guarantee. "Every egg does not result in a baby," Thornton said. Advances in technology have led to increased rates of successful conception after egg and embryo vitrification. A 2015 report by the Society for Assisted Reproductive Technology (SART) showed a success rate of about 41 percent for patients under 35 undergoing in vitro fertilization using frozen eggs and embryos. As is the case with natural conception, success declined significantly with age. Here are success rates, according to age group.* Freezing success Under 35 114 41.2% 35-37 59 33.9% 38-40 94 14.9% 41-42 78 17.9% >42 111 10.8% Age Number of procedures % Resulting in live births H

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