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First comes love, then marriage, but a baby carriage isn’t always next or guaranteed.
So it was for Katharine Losavio, a 36-year-old healthcare administrator from Manhattan who wed in 2022. Then, days before their first wedding anniversary, Losavio learned she had non-Hodgkin lymphoma, an aggressive cancer affecting the lymphatic system. While more than half of those afflicted are first diagnosed after age 65, it can occur at any age, according to the American Cancer Society.
“I’d had severe, sharp, shooting abdominal pain and went to the emergency room, but other than that no symptoms,” said Losavio. “A 12-centimeter mass was found in my spleen through a CT scan and a biopsy subsequently determined it was Stage 1 (early),” said Losavio.
Losavio met with an oncologist as well as Dr. Tomer Singer, system chief of reproductive endocrinology and infertility at Northwell Health.
“I knew I wanted to do embryo freezing, as chemotherapy exposure can cause premature menopause. Your eggs can get damaged or destroyed and egg quality decreases as you age, with or without chemo,” said Losavio.
Preserving fertility before treatment for cancer is on the rise over the past decade, said Singer.
“The increase in popularity is largely due to improvements in the freezing technology,” said the doctor. Plus, “the American Society of Reproductive Medicine removed egg freezing off the experimental procedure list in 2012, leading to greater public awareness. Financial barriers are also slowly being reduced, as insurance companies are covering it more broadly.”
“I knew I wanted to do embryo freezing, as chemotherapy exposure can cause premature menopause. Your eggs can get damaged or destroyed and egg quality decreases as you age, with or without chemo.”
Katharine Losavio
Other medical reasons for egg freezing include endometriosis, fibroids, blocked fallopian tubes, ovarian cysts, polycystic ovary syndrome (PCOS) and autoimmune diseases.
Parents may also want to check for inheritable genetic conditions such as Fragile X, which causes intellectual disabilities, or BRCA, which increases the risk of breast cancer.
“We now know of more than 40 genes that correlate with women developing breast and other types of cancer, as 1 in 8 women will develop it and a lot of cases are genetic in nature,” said Singer.
Luckily, “Ovarian egg stimulation and egg freezing for medical purposes has been shown to be safe and doesn’t increase [cancer] staging, grading or morbidity, so most patients can delay oncology treatment by eight to 14 days without jeopardizing the likelihood of cure,” said Singer.
Fortunately, in Losavio’s case, “My oncologist thought I had enough time to do one fertility treatment cycle (two to three weeks) before starting chemo,” she said.
Losavio underwent daily hormone injections and visits to Singer for ultrasounds and bloodwork.
“You’re trying to stimulate follicles to produce eggs and once ovulation hits, his team retrieves them,” said Losavio. “Thirty-two eggs were retrieved and fertilized with my husband’s sperm. Sixteen embryos resulted and after testing for genetic disorders, I had eight genetically viable embryos left. I froze all eight,” she said.
The survival rate of frozen eggs and embryos reaches more than 90% in good in vitro fertilization labs when a patient is younger than 35, but some risks remain, said Singer. This includes rare events, such as failure to thaw.
Just two days after her egg retrieval, Losavio started chemotherapy, occurring every three weeks.
“I began in November of 2023 and finished in February of 2024. Then I had to return every three months for scans and bloodwork. The mass initially didn’t diminish, but by August of that year, I was declared in remission,” said Losavio.
Risk of recurrence is higher in the following first two years, but dramatically drops after that, so Losavio and her husband are waiting until the two-year mark to decide if and when they’d like to conceive.
It’s a tough discussion whether or not to inseminate eggs, said Singer, so as not to add a layer of complexity.
“If the patient doesn’t survive, the embryos may or may not be used in the future, depending on the couple’s consent prior to retrieval,” said Singer. “When a patient freezes her eggs, she consents to either discarding her eggs if she dies, donating them to research or to a family member,” he added.
Costs vary, but at Northwell, medical egg freezing averages several thousand dollars per cycle, plus medication, which can add up to $5,000 per cycle. You also need to factor in egg storage fees, which range from $350 to $1,200 annually.
Unfortunately, “many patients don’t freeze eggs or embryos due to their medical condition, as they may not be cleared by their oncologist to delay their cancer treatment, or due to financial reasons,” said Singer. “These patients will have an opportunity to build their family using egg donation or surrogacy.”
After treatment is completed and the patient is in remission, clearance for pregnancy varies.
For Losavio, “I’ve been strongly advised not to try to conceive until I’m past my two-year remission mark due to risk of relapse,” she said. “Surrogacy is a real consideration, as my body’s been through so much, but it’s extremely cost prohibitive — upwards of $100,000.”
Egg freezing had an unexpected upside for Losavio. “It was one of the only aspects of the cancer journey that I felt I had some control over, and the only part where I felt my body actually cooperated and showed strength, in a time when I felt weak and uncertain about the future,” she said.
