Dear Doctors: My sister was diagnosed with cancer, and her doctors say she should consider freezing her eggs. It’s not definite that the treatment will affect her ability to get pregnant, but it’s a real possibility. I don’t know how freezing one’s eggs works. Can you explain? Is it expensive?

Dear Reader: Unfortunately, it’s true that certain medical treatments can, in addition to saving the person’s life, adversely affect their future fertility. This can occur in both women and men. For men, an option to preserve fertility is to freeze their sperm.

Women who wish to safeguard their future ability to have children can opt to freeze their eggs. The technical term for this is oocyte cryopreservation. The process was developed in the 1980s, with the first birth from a frozen oocyte taking place in Australia in 1986. In the decades since, the techniques have been refined. Today, oocyte cryopreservation has moved from an experimental procedure to an accepted treatment. It is so widely used that some large employers cover the procedure in their employee health insurance plans.

If your sister chooses to move forward with freezing her eggs, she will begin by seeking out the professionals who will help her. That means an experienced fertility specialist and a reputable reproductive clinic, preferably with an on-site lab. The medical team overseeing her cancer care may be able to offer recommendations.

The actual process begins with one or more prep appointments. These typically include an office meeting to explain the procedure, answer questions and fill out paperwork related to the process. Patients also undergo a blood draw to determine certain hormone levels and have a transvaginal ultrasound to allow the doctor to visualize the ovaries. In order for the ovaries to release multiple eggs, patients are prescribed synthetic hormones with which to inject themselves. This is known as ovarian stimulation, and it takes place on a precise schedule.

Over the next few weeks, patients return to the clinic for further blood tests and ultrasounds. These are used to track the body’s response to the injections. When the eggs are ready to be retrieved, the patient receives an injection of a medication that helps the eggs mature. Retrieval takes place at the clinic, with the patient under sedation. Guided by ultrasound imaging, the doctor uses a needle to pierce the sac that contains the egg. A suction device helps to gently remove it. The harvested eggs are then cooled to a subzero temperature and placed in a specialized storage facility, where they are preserved until needed.

The process of oocyte cryopreservation can help preserve fertility, but your sister will be advised that it isn’t foolproof. It can also be costly. When not covered by insurance, egg freezing can range from about $10,000 to more than $20,000 per cycle. Multiple cycles can be needed in order to collect enough eggs. Additional costs include an annual fee to store the eggs and the fee for in vitro fertilization when it comes time to use them.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I had just started a new job when the pandemic happened. On top of the lockdowns and home-schooling our kids, I was diagnosed with IBS. My husband read there’s research that it’s caused by stress, and that makes a lot of sense to me. Can you please talk about that research?

Dear Reader: IBS is short for irritable bowel syndrome. It affects the stomach and the intestines, which are part of the gastrointestinal tract. The word “syndrome” means that IBS isn’t a disease, but rather a collection of certain types of symptoms. These can include abdominal gas, chronic bloating, constipation, diarrhea and ongoing changes to the frequency and urgency of bowel movements. Someone with IBS also often has increased sensitivity to abdominal pain. Taken together, these symptoms indicate that something has gone awry in the inner workings of the bowels.

IBS is seen in women more often than in men, and it typically arises in younger populations, generally under the age of 50. It’s fairly common, occurring in up to 15% of the population. Because the symptoms are not life-threatening, many people don’t take the time to get diagnosed. That means the percentage of people living with IBS is likely higher than the rate doctor visits may indicate.

The symptoms of the syndrome can range from mild enough to just be annoying to severe enough to interfere with daily life. Previous research into the causes of IBS has focused on unresolved abdominal infections and changes to the makeup and behaviors of gut microbiome. Now, as your husband has read, newer research has found evidence that stress and anxiety may play a role.

The study he is referring to, conducted by researchers in Tokyo, was published last fall. They found that mice who were repeatedly placed in psychologically stressful situations went on to develop gastrointestinal symptoms consistent with IBS. Although previous research has looked into stress as a trigger for IBS, those studies used physical situations to trigger that stress. In this new study, the mice were placed into situations that didn’t stress them physically, but instead caused them to feel social anxiety.

During the 10-day study, the researchers found that mice who spent 10 minutes each day in a socially stressful situation developed abnormally high levels of cortisone, the hormone associated with stress. The stressed mice also had changes to their bowel movements that are consistent with IBS, as well as increased sensitivity to abdominal pain. These changes persisted for weeks after the study concluded. The control group of mice, who did not undergo any social stressors during the study, did not have any of these physical changes.

Although this research doesn’t explain the gut-brain connection in IBS, it does suggest new ways to look into the causes of the syndrome. It also underlines the importance of lifestyle changes for people with the condition. As someone living with IBS, you should avoid using tobacco and take steps to get quality sleep. If possible, add a stress reliever like yoga, meditation, tai chi or just a daily walk outside to your daily routine.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I went to our local pharmacy to get a flu shot for myself and also for my dad. It turns out that because he is 68 years old, he didn’t get the same vaccine as me. They gave him something called “fluad quadrivalent.” How is that different from the regular flu vaccine? Why did he need it?

Dear Reader: First, we want to thank you for taking an important step in safeguarding your health and that of your father. Flu season in the United States started early this year, and it is turning out to be particularly severe. It has resulted not only in widespread illness, but also in high rates of hospitalization. That makes getting vaccinated particularly important.

Due to age-related changes to the immune system, older adults are at increased risk of developing potentially life-threatening complications from a case of the flu. According to data collected by the Centers for Disease Control and Prevention in recent years, well over half of hospitalizations due to the flu, and up to 85% of flu-related deaths, have occurred in adults 65 and older. People of all ages who are living with underlying conditions such as diabetes, asthma, lung disease and heart disease are also at increased risk.

The good news is that this year’s flu vaccine is proving to be effective at reducing the severity of disease and decreasing the risk of hospitalization. By getting vaccinated, you and your dad are protecting yourselves, as well as the people around you.

To understand the difference between the shots you and your father received, we should first define a few terms. All flu vaccines contain something called an antigen. That’s a molecular structure found on the surface of viruses, including the influenza virus. When a virus infects the body, the antigens it contains act as an alarm bell. Their presence triggers the immune system to produce specialized proteins known as antibodies, which attack the invaders.

Flu vaccines work by teaching your immune system to recognize specific antigens. This primes the immune system to be ready with a strong protective response. Although your father got a different shot than the one you received, he did not get a different vaccine. Rather, he was given what is known as a high-dose flu vaccine. That’s a shot that contains the same antigens as the regular flu vaccine but is specially formulated to elicit a stronger immune response. At this time, several types of high-dose flu vaccines are approved for use in the U.S. Each one is formulated in a slightly different way, but all have the same effect -- that is, to rev up immune response.

The fluad quadrivalent shot that your father received contains something called an adjuvant. That’s an added compound that causes a markedly stronger immune response. Another high-dose flu shot, known as Fluzone High-Dose quadrivalent, achieves the same result by upping the quantity of antigens contained in the vaccine.

As with all flu shots, side effects can include soreness or swelling at the site of the injection, fever, muscle aches, headache or nausea. To locate a high-dose flu shot near you, visit vaccines.gov/find-vaccines.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)