LV fertility doctor keeps hopes on ice

Molly Ball

Thursday, Nov. 4, 2004 | 11:11 a.m.

The patient was a soldier on her way to Iraq. She didn't know what would happen to her, but she could think of lots of tragic possibilities.

One possibility: that she would return unable to bear children and spend the rest of her life irreversibly sterile. So she called Dr. Jeffrey Steinberg.

Steinberg, whose Fertility Institutes, which has a site in Las Vegas as well as California and Mexico, is one of a handful of clinics in the world that are offering women the ability to freeze their eggs, storing them for use in the uncertain future -- a future in which injury, disease or plain old aging could render them unable to conceive.

"This is the biggest advance in reproductive medicine for women in the last 20 years, maybe ever," Steinberg, said during a recent tour of his clinic near Desert Springs Hospital.

Of the many women who have consulted Steinberg, a few have been military women who were about to head over to Iraq; most are students and cancer patients, he said.

However, Steinberg's vision is controversial in the lucrative, competitive fertility business. Many experts say he's being irresponsible in urging people to spend thousands of dollars on a technique that hasn't been scientifically proven.

Some fertility experts say Steinberg's promotion of egg freezing, or oocyte cryopreservation, is premature. The procedure, they say, is still in the experimental stages and shouldn't be advertised as a working treatment. To do so, they charge, is to peddle false hope.

"There have been encouraging advances in technologies related to egg cryopreservation," said Marc Fritz, a professor of reproductive endocrinology at the University of North Carolina at Chapel Hill. "But at the present time, the process cannot be regarded as a proven technology."

But in the brave new world Steinberg envisions, professional women could bank their eggs for the decade or two it took them to climb the career ladder. Female cancer patients could freeze eggs before undergoing chemotherapy or radiation, which can be sterilizing. It might be the norm, rather than the exception, for couples in their 40s to easily conceive healthy babies.

"Let's say you're 21 years old, you're in the university, you're going to get a Ph.D.," Steinberg explained. "You're going to be in school for six or seven years; then you have 10 years of building your career.

"Then you want a baby, but you have the fertility of a 38-year-old, which is half or one-third of what it was when you got out of college."

It has long been possible to freeze embryos -- eggs that have already been fertilized. But that's not ideal for women who "don't have Mr. Right yet," Steinberg noted.

By contrast, men can safely and cheaply freeze their sperm indefinitely, and doctors urge them to do so before undergoing dangerous treatments.

Cycling champion Lance Armstrong stored his sperm before being treated for cancer of the testicles, lungs and brain; otherwise, he could never have sired three children by a woman he met after his illness.

Men can also donate sperm to be banked anonymously and used by women or couples they don't know. Steinberg is offering this service for eggs, too, and is providing the donors' eggs free, although recipients must still pay the other costs of in-vitro fertilization.

Steinberg, who is not associated with the well-known Steinberg Diagnostic Medical Imaging Centers in the Las Vegas Valley, says his is the first bank of donated, frozen eggs in the world. Since he opened it at the beginning of the summer, 21 women -- mostly college students -- have become anonymous donors. They were paid $3,000 each time they underwent the procedure. Steinberg's 12-year-old Las Vegas clinic has been freezing eggs for a year and a half. At this and his two other locations, Steinberg claims about 40 women have frozen their own eggs.

Of those, six have thawed their eggs and three have become pregnant, Steinberg said. One woman gave birth to a healthy baby; two others are still pregnant, including one who had the procedure done in Las Vegas, Steinberg said.

Women's fertility declines with age, usually ending by the mid-40s. At the same time, the incidence of abnormalities such as Down syndrome increases. These problems stem almost entirely from the aging of eggs; the uterus remains usable.

For these reasons, egg freezing is obviously attractive.

Fritz argues that egg freezing should only be done as part of an organized, controlled scientific experiment supervised by a government-sanctioned body. Women freezing their eggs are advancing the cause of science, but they are not guaranteeing their own future.

Fritz is chairman of a committee of the American Society for Reproductive Medicine that for more than a year debated the egg-freezing issue. In October, the society published the committee's conclusions in the monthly journal Fertility and Sterility, classifying egg-freezing as experimental.

The committee gave the same designation to another therapy that holds promise for prolonging women's fertility in the face of cancer treatment or aging: the freezing of ovarian tissue.

In September, a Belgian woman became the first to give birth after having ovarian tissue removed and frozen while she underwent cancer treatment.

After the cancer treatment, the tissue, unaffected by the treatment's harsh effects, was reimplanted. Researchers said that, barring the slim chance that the woman's ovaries were not affected by the treatment, the birth proved that tissue freezing could work.

Steinberg is also not the only American doctor promoting egg-freezing -- unscrupulously, in the society's view. The most visible is a California-based chain called Extend Fertility, although Steinberg notes that it has not yet created a successful pregnancy.

The problem is that scientists don't yet understand how freezing affects the egg's ability to grow into an embryo, said Dr. Geoffrey Sher, whose Las Vegas-based chain of fertility clinics is the largest in the country.

"No one has been able to prove in large enough studies that these (frozen) eggs, even if they survive and get fertilized, are going to make healthy babies," Sher said.

Even in young, healthy, fertile women, ova are abnormal 50 percent of the time; harvesting them yields only a small batch, with no guarantee that any of them will be usable, Sher pointed out. If freezing erodes the eggs' viability further, the chances get even smaller.

A woman might thaw her eggs 20 years down the line, only to find that not one of them could grow into a baby.

"Unquestionably, it (egg freezing) is the way of the future," Sher said. "Unquestionably, when we crack the riddle, it will open a major door in the barrier to human reproduction. It will be an incredible breakthrough. But nobody as yet is ready to market this breakthrough to the general public."

Steinberg acknowledged that the effect on eggs of years in the freezer is not known. While sperm have come back to life after four decades, eggs have so far only been thawed after a year or two.

Steinberg is no stranger to controversy. As a pioneer of a process that allows prospective parents to choose the gender of their offspring, he has been reviled by some ethicists who see sex selection as tantamount to eugenics.

For egg freezing, his clinic offers two cycles of egg harvesting for $8,800, which he said is less than the national norm of $12,000.

Each cycle involves taking fertility drugs, then undergoing a brief procedure in which a needle is inserted and pulls eggs out of the ovary. Storing the frozen eggs is free for the first year and $300 per year after that.

Two cycles will produce six to 20 eggs, which should be enough to ensure that at least one is viable, Steinberg said.

Steinberg's egg freezing is not part of a clinical trial. His institute's Web site, www.fertility-docs.com, includes in its explanation of the promise of egg-freezing an asterisked disclaimer: "Egg freezing is considered investigational by the American Society for Reproductive Medicine."

Asked how he explains this designation to patients, he said, "We tell them it's only investigational in the U.S., but we don't agree with that," he said. "We explain to them that babies have been born and everything is fine, but the technology is new."

Fritz of the medical society said about 100 births have been documented using frozen eggs. But those births have occurred scattered around the world over the course of 20 years, under various circumstances, and no one knows how many failed tries accompanied those 100 successes.

To Steinberg, the society's caution amounts to timidity and a refusal to recognize innovation.

"The U.S., like everything else in fertility, is really dragging their feet on this," he said. "It's sad. We've got the ability to do it. This is really fertility-preserving therapy."

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