There will be times in your health care when science and experience tells you conflicting things. The breast self-exam is a big one. For years, I’ve shown women how to examine their breasts themselves. Until recently, breast self-exam was thought to be a good way for women to examine themselves for early signs of breast cancer.

            Then came a 2002 study in Shanghai that showed no difference in overall deaths from breast cancer between women who did self-exams and women who did not. Also, the self-examiners would find benign lumps that would then have to be looked at with a biopsy, which can be stressful.

            Since then, I have stopped pushing the monthly self-exam. “Wait a minute,” said a patient I saw last week, “My sister found her cancer as she was doing a self-exam in the shower.”

            And there’s the controversy. I know from experience, not science, that many women find their own lumps. Statistically there may be no difference in the death rate, but for many individual women finding the lump is life saving.

            What do you do? My recommendation is that you get to know your breasts as a first step. Examine them after your period when they are least lumpy. The shower is a good place to check them. Check them from time to time on a schedule that is easy to remember--the first day of each season, for example, or monthly if you prefer. Become familiar with your breasts. If you come across something that doesn’t feel right, have your doctor check it out.

     It’s the ultimate career woman’s dream: work now; conceive later. Can this be possible? There are advanced technologies that can help you have a baby when nature doesn’t work out. In vitro fertilization (IVF) is a method of assisted reproductive technology that involves combining an egg with sperm in a laboratory dish. If the egg is fertilized and begins cell division, the resulting embryo is transferred to the woman’s uterus where it will, if all goes well, implant in the uterine lining and develop into a baby. IVF may be performed in conjunction with medications that stimulate the ovaries to produce multiple eggs, to increase the chances of successful fertilization and implantation. If more embryos are produced than are needed, the extra ones can be frozen for future use.

     Assisted reproductive technologies such as IVF have given older women some hope of pregnancy when nature has quit and gone home, but even this runs up against the physiological limitation of aging eggs. No one understands exactly what happens to eggs after several decades of waiting in the body. When you are twenty, 90 percent of your eggs are normal. By the time you are forty, 90 percent of your eggs are abnormal.  

     Is it possible to prevent eggs from aging, to keep them frozen in time until you are ready to use them? By freezing eggs instead of embryos, a woman eliminates the need to have a partner before taking action. And once frozen, an egg can theoretically last forever. Has technology advanced enough to allow this? Promising research is going on now, but we are not yet ready to offer this option routinely to all women.

     The trouble is that eggs are more difficult to freeze than sperm or embryos. Because they are comparatively large single cells filled with water, eggs are particularly vulnerable to the formation of ice crystals. Researchers have tinkered with the formula for decades, with some successes, but none consistent.

     Very recently, though, Italian scientists have perfected a slow-freezing method that takes the temperature of the egg down a couple of degrees a second, and they’ve developed a new recipe for a cryoprotectant solution (liquid to protect eggs during freezing) that includes just the right amount of nutrients. With their techniques, they’ve averaged a 17-percent pregnancy rate from frozen eggs. This is actually close to the success rate with frozen embryos, a much more mainstream practice.

     Egg freezing is an expensive bet--and far from a guarantee. It’s usually better, if possible, to meet your partner sooner than later, and find a way to balance work and family together.