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Maggie McKay (Host): Getting a cancer diagnosis can be scary enough, but to add to it, the possibility of not being able to have children in the future because of it, can stack on added stress. That's where a procedure known as fertility preservation comes in. Joining us to talk about whether you should consider fertility preservation is OB GYN, Dr. Lisa Green, with PRISMA Health and the Fertility Center of the Carolinas. This is Flourish. A podcast brought to you by PRISMA Health. I'm your host, Maggie McKay. Welcome Dr. Green. It's so good to have you here.

Lisa Green, MD (Guest): Thank you so much, Maggie. It's a pleasure to be here today.

Host: This has got to be an emotional topic for cancer patients who want to have children in the future. Doctor, can you please explain what fertility preservation is and why a male or female patient would seek it out?

Dr. Green: Thank you so much. That's a great question. So, when we say fertility preservation, it is a process by which we are going to try to freeze or to hold whether eggs or sperm for future use. And there are many different indications, but as you pointed out, cancer is a really common one. So, before someone undergoes cancer treatment, if they think, or the doctors believe that their cancer therapy would hurt their ability to have children in the future, that's when we have this conversation about whether or not we need to preserve their future fertility so that they can have biologic children in the future.

Host: And so would they start that process before they have say sake? chemo?

Dr. Green: Absolutely. Oftentimes we're doing it before someone starts chemotherapy or it could be treatments such as radiation or even surgery.

Host: What happens if the cancer patient is a child?

Dr. Green: So in cases of young children we do have one limitation we're unable to retrieve and store either eggs or sperm, unless that person has undergone puberty. So, for both female and male children, we would need them to at least hit that stage of puberty before we will be able to do a fertility preservation or freezing process.

Host: And if the goal is to be a parent later in life, at what age should you consider starting the process?

Dr. Green: So ideally you would do this before you had treatment because the preservation is to preserve your fertility prior to treatment is where most people have that. And we absolutely, for some cases in which we're unable to do a preservation process, we absolutely can just reassess your fertility after having undergone treatment.

Host: Okay. So it's not always a lost cause if maybe you had radiation or chemotherapy and then you find out about this, or then you change your mind, maybe before it, you thought I don't want children. And then after you go through all that treatment, you might think, oh, I do want children. So it is possible that you could do preservation even after after it?

Dr. Green: It depends. So that is going to depend on the type of therapy that someone has, the type of cancer that they have. That's really a really difficult question to answer about that individual, but absolutely. It's something where you could reassess your fertility and have a discussion with your doctor about your fertility options after treatment.

Host: What's involved? Take us through the process someone goes in for the fertility preservation. What are they gonna go through?

Dr. Green: Yes. If someone is going to let it depends, or we're talking about a male or female patient. So if it's a young woman who wants to preserve her eggs before she's going to have chemotherapy, for example, if she's cleared by her team and we have the two to three weeks that we need in order to do the process, we would get some basic information about her. Maybe some blood work. We do an ultrasound, if everything looks okay and she agrees to moving the process forward, we can start her on stimulation medications in order to have her ovary grow up or generate enough eggs for us to then go in and remove those eggs from her body. We're then able to freeze those eggs for her and then send them off to another facility to store them until she is ready to use them.

Now for male patients, it's a little bit different, but similar we're able to have that male patient give us a specimen of sperm. We freeze that sperm, and then we send that off and that sperm is held until they're ready to use it in the future.

Host: And where do they go? How long will they be viable?

Dr. Green: Yeah. This is different for every clinic. Absolutely. But at our particular facility, we send them to a company called Reprotect. We send them off site and they're held, they can be held for years. Ideally we like for people, if they can, if age-wise, they can, we would use those within five to 10 years. But absolutely. Especially for our young patients, we've had children that have come back that have been born from eggs that have been frozen for more than that amount of time.

Host: And with cancer patients specifically, once treatment is complete, how do they go about becoming pregnant? I mean, they come into your office and how does that work?

Dr. Green: Yeah. So again, it does depend on what your treatment has been and what your plans are. And when. Definitely a conversation with your doctor about whether or not you can carry a pregnancy if you're a female patient. But essentially that process would be us having the eggs called back, you know, having the eggs or the sperm, we would fertilize them and create embryos.

And we're talking about either transferring them into a female patient, transferring them into your wife, if you're married or your partner, or transferring them into a surrogate for some couples that are unable to carry.

Host: And Doctor, what if somebody chooses not to use the preserved sperm or eggs, then what?

Dr. Green: So if you frozen them and you choose not to use them, then there are several options that are available. Some people would desire to discard them because they're not going to use them. Some people donate them to science, if they're no longer going to use them. And in certain cases, there are some families that have decided in that case to even donate their eggs or their sperm to person or a couple in the future. So you have a couple of options that there that you could choose from.

Host: Wow. Isn't that amazing? I mean how new is this, 40 years ago, could you have done, this? Was this an option?

Dr. Green: Yeah. That's an interesting question. So how new is it? It's actually quite old. So the first case reports from freezing, you know, sperm and eggs, they go back as, as early as the 80s. So 40 years, yeah, that we've been doing this. Definitely, we're doing it more often. There's a lot more knowledge and just recognition of this technology that exists. A lot more insurance companies are covering it. And it's a benefit that is more readily available than it used to be. So a lot of old science here. We've been doing this for years, but absolutely, this is something that a lot of people are hearing more about day to day.

Host: That's so wonderful to have that option, especially after a cancer diagnosis. Are there any downsides to fertility preservation?

Dr. Green: There aren't many. So definitely when we're talking to the team. And when I say your team, this is your cancer doctors, your nurses, your staff, everybody that's taking care of you as you're going through a cancer journey. You know, we want to make sure, first of all, it's a safe procedure. It generally takes us about two to three weeks with which to harvest eggs.

If we're talking about getting eggs from someone there aren't really many downsides it's really considered very safe. It has very few complications. And we don't believe that for most patients that it hurts their care in any way, in terms of, you know, that delay of the two to three weeks that we need in order to harvest eggs for. Freezing of sperm, usually we're talking about a matter of days in which to do that. And so there aren't really going to be many downsides to this, but absolutely it is going to be a decision that every individual would have to make for themselves.

Host: Okay. Is there anything else you'd like to share about the process that we didn't ask?

Dr. Green: this is just such a, I will say that it is a blessing to be able to do this and very thankful to help people to build their family. It's such an exciting thing to be a part of. And I'm glad that we're more and more recognizing, you know, that piece of people, you know, you're in a tough time and, you know, taking a second to think about the future before starting your, your treatment, sometimes I think that's amazing. But yeah, I think you've touched on all the major parts. Absolutely. For our cancer patients, this is a benefit that we have here at PRISMA Health that is going to help a lot of people in order to, you know, plan for the future. Even in a very difficult time.

Host: Thank you so much, Dr. Green, I'm sure you helped a lot of people just by sharing your knowledge and your expertise today. We appreciate it.

Dr. Green: Oh, well, thank you so much for inviting me. It was a pleasure to speak with you guys today.

Host: That is Dr. Lisa Green, OB GYN with PRISMA Health and also Physician with Fertility Center of the Carolinas. For more information and other podcasts, just like this head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm your host, Maggie McKay. Be well.