But Silber thinks all young patients beginning certain cancer treatment regimes should freeze ovarian tissue regardless of the model. "These young women do lose their fertility. They do become menopausal," Silber says. "Maybe they do hit menstruation, but they do go into menopause early. Up to 90 percent of young women with cancer will lose their fertility from the treatment that cures them."
The procedure costs roughly $4,000, according to Silber, an expense that he says should be (and usually is) covered by health insurance providers. "Insurance is paying $200,000 for cancer treatment; $4,000 isn't too much to preserve fertility," he says.
In the early days of the procedure (about five years ago) the frozen ovarian tissue was re-implanted under the skin of the forearm (for ease of egg retrieval) where it became revascularized and, under stimulation, resumed its natural role producing eggs, despite the very unnatural environment. The eggs would then be collected from the arm and fertilized in vitro. But Silber says that re-implanting the tissue at the ovary site where it belongs using microsurgical techniques allows the woman to conceive naturally.
Wallace and Kelsey's model also predicts that by the age of 30, the ovarian reserve for a normal woman is roughly 12 percent of its original capacity, dropping to three percent by age 40. Unlike some women with cancer, healthy women who put off childbearing because of career demands or a lack of a partner can freeze their eggs. But a 30 to 50 percent in vitro fertilization rate makes this a risky bet. Silber says that rather than putting all their eggs in one basket, so to speak, even healthy women should freeze an ovary to ensure fertility later in life.