Gamete preservation is indicated because cancer treatments interfere with fertility, but the high cost of this procedure can be a deterrent – ranging from $ 10,000 to $ 18,000. To facilitate access, some programs offer services for free or at discounted rates for those diagnosed with several types of tumors.
Knowing the existence of such a social project was a relief to Alexandra Maria Velho Martins when, earlier this year, she received a second diagnosis of breast cancer. "Chemotherapy can put an end to the possibility of becoming a mother, but that is a determinant of the value problem. I don't believe when doctors talk about the program, so I decided to do (freeze eggs)," said human resource manager of 38 years. The procedure must be done before tumor treatment begins.
Last week, the day after speaking with the report, he underwent surgery to remove his ovaries after being detected with a mutation in the BRCA gene, which increased his chances of getting cancer in his glands and breasts. Preventive procedures are similar to what Angelina Jolie did in 2013 when performing a double mastectomy.
Without an ovary, there would be no possibility of Alexandra becoming a mother if she did not choose to maintain fertility. "One more reason that gives me a lot of excitement. My feeling today is security, peace. If I ever find someone who wants to be the father of my child, I have that security, whenever it is in my life."
Alexandra carries out the procedure through Huntington's Reproductive oncofertility Medicine program. In this initiative, men and women diagnosed with cancer pay a small amount so that the gametes are maintained – in the case of women, that is $ 6,000, a third of what is normally charged. The maximum age to be part of this project is 42 for both sexes.
"A very expensive part of freezing eggs and embryos is ovary induction. In this project, hormones are donated by the pharmaceutical industry, maintenance costs are finally subsidized and only the freezing price is paid," explained reproductive specialist Mauricio Chehin. assisted and program coordinator at Huntington.
The ovarian induction treatment that he referred was done with the application of subcutaneous hormones every day so that the woman produced several eggs at one time. This step lasts from ten to 14 days. "For women with cancer, the idea of using hormones may be frightening, but this hormone does not reach the breast. Along with induction, a second drug that inhibits estrogen production is 100% safe and does not worsen its prognosis." said Chehin.
Medication to stimulate egg production is provided free by the Protect Ferring Laboratories program. Pharmaceutical companies have partnerships with around 20 clinics or hospitals in all regions of Brazil where injections are intended. "These clinics diagnose patients and send treatment requests. Some are free of charge and others charge lower fees, but the important part is medicine (ovarian induction)," Eli Lakryc, the company's medical director said.
He explained that, after approval of the request, women need up to two days to receive the hormone. If he is in Sao Paulo, he can arrive on the same day. Time is very valuable in this scenario because cancer treatments cannot wait long and fertility maintenance procedures must be carried out before that.
Lakryc highlighted the importance of so-called onkop preservation, the collaboration between oncologists and human reproductive specialists "for women to realize their dreams of becoming a mother." For this, he needs to be told about the damage caused by chemotherapy and radiotherapy to fertility.
In the Sao Paulo State public network, Pearl Byington Hospital, a referral center for women's health, invests around $ 2 million per year to maintain assisted reproductive services, which have been offered since 1991.
To get access to egg freezing, women undergoing cancer treatment must schedule the procedure through the Basic Health Unit (BHU). Immediately after the patient is treated, treatment is indicated and the necessary examination is requested for referral to a medical center. From 2016 to the first half of 2019, 325 people were preserving fertility in this condition.
The hospital is one of Ferring's partners, which provides free ovary induction treatment. Another client of a pharmaceutical company that has a free program is Instituto Ideia Fértil, with Guardando Sonhos. The clinic itself freezes the eggs or semen of people undergoing cancer treatment.
"The criteria for a woman is to have a normal ovarian reserve and a regular cycle. The patient must go for a consultation and come with a referral from an oncologist. If he does not have a letter from a doctor, he can seek a request, but we contact an oncologist" explained Emerson Barchi Cordts, clinical director of Fertile Ideas. The institute has three units in São Paulo, but this project works within the ABC Medical School in Santo André.