Cancer survival rates are so much better than they were 20, 25 years ago so a lot of people have the ability, and the choice, to be able to create children and have families,” says SIMS IVF embryologist Mandy Leslie who is lab manager at the clinic in Swords, Co Dublin.
SIMS IVF, which has clinics in Swords and Clonskeagh in Dublin as well as Cork, Carlow, Dundalk and Limerick, offers a range of fertility services for men and women who are on a journey to conceive.
In support of its Daffodil Day issue, or sister magazine Chic spoke to embryologist Mandy Leslie about the emergency fertility services which are offered, free of charge, to people diagnosed with cancer.
“We offer fertility preservation services so that means for men diagnosed with cancer we can do sperm freezing where they come in, they give a sample and we can freeze that for use in the future.
“That’s pretty much what we can offer them at that point. If they get diagnosed, they’d get some blood tests done and then we’d get them in as soon as possible.Obviously if people are quite sick, we don’t have a lot of time to be messing around so as soon as we get the blood results done, we can have them in the next day. So it’s not a big time investment for the men.”
For women, however, it takes, on average, three weeks for the egg retrieval process.
At SIMS, though, they work in tandem with oncologists to ensure that everything is expedited as quickly as possible so that treatment for illness can begin without too much delay.
“There is a slot or two that we can pop you into if we need it and those slots will be taken last minute so if we have an oncology patient that needs that slot, great. We do protect some slots for the oncology section because we do know we have some coming through every week,” Mandy says.
“It’s a much bigger time investment for the ladies,” she adds. “For the ladies, the oncologists need to give us clearance and a three-week period of time before you start your oncology treatment.
“We need that period of time to be able to stimulate the ovaries to produce those eggs. Then if the ladies are young, or single, we can freeze the eggs.
“If they have a long-term partner they can choose to freeze embryos. All that will be done in the lab.
“First, we’ll get them in, get them stimulated, get the eggs collected as quickly as possible and then they can get back to the oncologist after that and start their treatment.”
Fertility treatment can seem like a daunting process, especially for cancer patients who are already dealing with so much upheaval and uncertainty in their lives.
Mandy, however, says that even if you choose not to use your sample in the end, it is “not something you will regret doing but it may turn out to be something you regret not doing”. And as this is a treatment offered free of charge at SIMS clinics for referred cancer patients, it puts no financial burden on the person undertaking treatment.
Mandy adds, “You would need a referral from your oncologist sent to us and your oncologist would typically do your blood tests at that point.
“So they would take some blood and they would test it for different viral infections.
“Once we get all those results back in, we would schedule a call or a meeting with the doctor as soon as we can so there’s no waiting period because we understand this is a time-sensitive issue.
“We’d then get you in in a couple of days and we’d make a plan.
“The plan would involve stimulating the ovaries to produce more eggs and then you would be taking hormone stimulation — injections [at home] — and you’ll be having scans and blood tests every couple of days while you’re taking those injections just to watch the follicles growing and see if your hormones are reacting to the drugs we’re giving you.
“Then when the follicles have reached the appropriate size, you’ll be given a trigger injection and what that trigger injection does is it tries to mimic the process of ovulation so it starts the process of ovulation.
“Then 36 hours following your trigger injection we would do an egg collection.
“And the reason it’s 36 hours is we want the eggs to be as mature as possible so they are as ready as they can be before ovulation but we want to catch them before they ovulate because if they ovulate out of the ovaries, we lose them.
“So once we do the trigger injection, 36 hours later you would attend the clinic for egg retrieval and that’s done under a light sedation.
“We collect the follicles and we pass (that) through to an embryologist and then they would find the eggs.
“If you want to freeze the eggs, that will be done on the same day and if you want to create embryos we would then request a sperm sample from your partner.
“In that case, they would then mix the eggs and sperm together and let them fertilise themselves.
“If the sperm sample is poor — there’s not many sperm or they’re not moving very well — then we would do what’s called an ICSI procedure and we would inject a single sperm into each of the mature eggs that we’ve collected and they would grow in the lab hopefully for the next five days and then we would be able to freeze embryos at the end of that point.” After your eggs are collected, SIMS store them for you for 10 years, at no cost, to use if and when you choose.
“Eggs and embryos are in suspended animation for as long as you need them so after the oncology programme you’re entitled to 10 years of storage. So we cover 10 years of storage costs for you, then after that you’d be requested to cover an annual storage fee,” Mandy tells us.
“They don’t degrade, they don’t go anywhere, they’re just in suspended animation.
“Keep in mind that the pregnancy is going to be created by the egg or embryo that are the age you were when you created them.
“So if you were 34 when you created them and you come back at 44, your chance of pregnancy is still a 34-year-old’s chance.”
When it comes to freezing eggs or embryos, Mandy says that while it’s not a guarantee that this will eventually result in a pregnancy, it gives you a “chance” that many patients may not have otherwise following cancer treatment.
Speaking about the average treatment results, Mandy adds, “On average the retrieval would be about 10 eggs.
“It really depends on how many eggs are remaining in the ovaries.
“So we get ladies that come in who are 25 and have a tiny AMH (an ‘egg timer test’) and we have ladies coming in in their forties and they have a huge AMH. So it all depends on what your body is able to produce — and nobody reacts the same to these injections that we give to people.
“On average, the number would be about 10 to be collected.”
Following your cancer treatment and if and when it comes to a point that you are ready to try to get pregnant, Mandy says SIMS will be there for you every step of the way — even if that includes trying to conceive naturally.
“You can come in and have a chat with the doctors, we can check your hormone levels first, we can say ‘okay go and try with your partner for six months, see how you go’. If not, we can use what we’ve got in the freezer for you.
“Our doctors can give you a good idea of where to go.”
If you don’t fall pregnant naturally, you can then return to SIMS to begin the IVF process (the cost of this is not covered by the clinic).
“If you froze 10 eggs, we’d store all 10 eggs and then when you wanted to use them we’d inject them with your partner’s sperm, then they would go through the process of fertilisation,” Mandy says.
“From those 10 you’d probably expect seven to be fertilised and from those seven you might get three, maybe four to get to nice day five embryos.
“One will be transferred and the other couple would be frozen, and if you’re pregnant with that embryo that’s been transferred into your uterus then brilliant. If you don’t, we can put the next best one in until we get the baby.
“Now, there’s no guarantees. If you have three embryos you might end up with three babies, on three separate occasions, or you might not end up with a baby at all.
“But it just takes one!
“Ladies who are 35 years old, your chances of pregnancy with one embryo transferred is 50/50. But if we transferred two, your chances don’t double, so it doesn’t go from 50/50 to 100 per cent.
“It might increase it a little bit but what you do do if you transfer two embryos is you significantly increase your chances of twins. And twins sound great but twins will miscarry more often and deliver early more often.
“So what we want, what we’re trying to do here at the fertility clinic is create babies to take home.
“So in most of the patients we would recommend a single embryo transfer because that is your best chance of taking home a baby.
“So if you have two lovely embryos on day five, we would transfer one and freeze one. So you have a 50/50 chance with the one we’ve transferred.
“And you also have a 50/50 chance with the one that’s in the freezer.”
“So your chance overall is better if you take them one at a time.”
- For more information on the services offered at SIMS IVF, see www.sims.ie
