Fertility Preservation –
Oncofertility Options for Cancer Patients
Cancer and its treatment can damage the reproductive system. These lesions can lead to fertility problems that affect a woman’s ability to get pregnant or carry a pregnancy, or a man’s ability to make a woman pregnant.
If you want to get pregnant, talk to our doctor at Eden Fertility Center, before starting cancer treatment. In order to be offered as many options as possible, it is best to consult a fertility doctor before starting treatment.
A fertility specialist can tell you about:
- possible effects of cancer treatment on fertility
- the most appropriate infertility treatment options for you
- the cost of different infertility treatment options, including the cost of long-term storage
- your chances of having children using medically assisted procreation (MAP)
- your legal rights and obligations
Most likely, your doctor will talk with you about whether or not cancer treatment may increase the risk of, or cause, infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.
Whether or not fertility is affected depends on factors such as:
- your age when treatment is initiated
- your baseline fertility
- the length (duration) of treatment
- the type of cancer and treatment(s)
- the amount (dose) of treatment
- the amount of time that has passed since cancer treatment
- other personal health factors
It’s important to learn how the recommended cancer treatment may affect fertility. Consider asking questions such as:
- Could treatment increase the risk of, or cause, infertility?
- Could treatment make it difficult to become pregnant or bearing the child in the future?
- What fertility preservation options are available?
- Would you recommend a fertility specialist (such as a reproductive endocrinologist) who I could talk with to learn more?
- Is birth control recommended?
- After treatment, what are the chances that my fertility will return?
- Are there other recommended cancer treatments that might not cause fertility problems?
- Which fertility option(s) would you advise me?
- Is condom use advised, based on the treatment I receive?
- How long might it take for my fertility to return?
If your condition is not good enough for fertility interventions to be performed before cancer treatment begins, you may be offered other options later. A fertility specialist can help you assess your options when you are ready to have children.
Cancer Treatments May Affect Your Fertility
One of the most important things you can do is talk to your doctor about fertility factors before your treatment. Ask what possible types of side effects you should expect and how long they will last. This way, you will know what to expect. You should also discuss these changes with your partner.
Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. If your treatment may cause problems with fertility, you may want to consult a fertility doctor before your treatment to discuss your options if you wish to have children. These options may include egg freezing or ovarian tissue banking.
Radiation therapy uses high-energy rays, such as X-rays, to destroy cancer cells and reduce tumors in different parts of the body. Some organs, such as the ovaries, can often be protected by ovarian shielding or by oophoropexy—a procedure that surgically moves the ovaries away from the radiation area. Radiation therapy to the brain can also harm the pituitary gland. Radiation can also damage normal cells that are close to cancer cells. However, normal cells usually repair themselves, while cancer cells cannot.
It is a treatment that adds, blocks, or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy is also called hormone suppression, hormone manipulation, or endocrine therapy.
Freezing of embryos
An egg fertilized by a sperm becomes an embryo. The sperm used for fertilization can be that of a partner or a sperm donor. In vitro fertilization is used to design embryos. The embryos are then frozen and stored (cryopreserved). Later, they will be implanted in the woman’s uterus.
If the sperm or eggs come from a partner, from a legal point of view, that partner has rights over the embryos. So if you and your partner are designing and freezing embryos, you both need to agree on when they will be used or given to other people. Decisions about embryos conceived using donor sperm rest with the woman whose eggs have been fertilized.
Bank or freeze eggs
The banking or freezing of eggs is also called embryo banking or embryo cryopreservation. The eggs from a woman’s ovaries are frozen. Later, when the woman is ready to have children, the eggs are thawed and then fertilized with a man’s sperm.
It has been observed that the eggs freeze and thaw less well than the embryos. Fertility clinics today use a rapid freezing technique called vitrification, which would do less damage to the eggs. Some clinics offer egg banking or freezing of eggs only to women who have reached a certain age because younger women have more eggs and they are generally healthier. The choice of age varies from clinic to clinic.
Although freezing eggs does not result in as many successful pregnancies as banking or freezing embryos, this option may be considered by some women, for example, those who do not have a male partner or those who do not wish to use a sperm donor.
Other surgical options
Doctors are sometimes able to offer surgical options that are less likely to affect fertility for women with very early-stage cancer of the female reproductive system. These less invasive procedures are only offered if they do not have a negative effect on the prognosis.
Talk with our doctor at our fertility clinic in Newport Beach, about other types of treatment such as immunotherapy and targeted cancer therapy that may affect your fertility.
Fertility Preservation Options for Girls and Women
There are times when the ability of women to be a mother is threatened. Fertility preservation refers to medical and/or surgical interventions aimed at protecting the fertility of these patients and they are especially used in women with cancer who will require treatment that can cause a failure of ovarian function. Unlike adult men, in women, there are relatively few clinical options to preserve fertility, especially if they are going to undergo aggressive treatment with chemotherapy or radiotherapy. Embryo cryopreservation is currently the most proven alternative and with the highest rates of effectiveness.
Ovarian transposition before radiation therapy is also a proven method. Nevertheless, the rest of these treatments are still experimental and their efficacy and reliability have not yet been well determined.
The limits and the choice of the most suitable technique depends on many parameters:
Oocyte Vitrification: conservation of mature oocytes
This is a conservation of female gametes (oocytes), eliminating the problem related to the conservation of embryos, which involves the couple and not the patient alone. This technique is possible if the patient is single.
This technique requires hormonal stimulation and a free interval of 2 to 3 weeks before the start of oncological treatment. It must, therefore, be validated by the oncology team because of the hyperestrogenism it induces, as well as the processing times.
In vitro fertilization (IVF) and embryonic preservation
This involves carrying out in vitro fertilization and freezing the embryos obtained. These can be transferred back after the end of treatment if the patient wishes to become pregnant.
This technique can be indicated for adult patients, in a couple, considering a parental project. Its limits are age and the need for hormonal stimulation. In addition, it binds the partners in a parental project sometimes hitherto not considered by the couple.
It is indicated in patients with good ovarian reserve, who should receive highly gonadotoxic treatment also called gonadal shielding. Because of its still experimental nature, this technique is only proposed in the case of treatment deemed sterilizing, such as myeloablative treatments before bone marrow transplant. This technique is rarely used in breast cancer because the chemotherapy regimens used are only partially gonadotoxic.
The expected benefit of a still-experimental procedure (removal of part of the ovary/freezing/thawing/reimplantation of the ovary) must, therefore, be weighed against the damage potentially caused by chemotherapy. No study today has been able to quantify whether this technique brought a benefit in terms of fertility compared to the fact of not performing this technique.
It is (especially alkylating agents) can affect the ovaries, causing them to stop releasing eggs and estrogen. This is called primary ovarian insufficiency (POI). Sometimes POI is temporary and your menstrual periods and fertility return back to normal after treatment. Other times, damage to your ovaries is permanent and fertility doesn’t return. To find out if chemotherapy can be prescribed for you, a number of tests will be performed.
These fertility treatments have shown their effectiveness in terms of early recovery of ovarian function, in terms of the number of pregnancies obtained, and are not associated with a recurrent risk, They are an option offered more and more often to young patients having to undergo chemotherapy.
Prior to cancer treatment, women have the option to either bank embryos or eggs. For patients who will receive abdominal or pelvic irradiation, it may be possible to perform a surgery in which the ovaries are moved out the radiation field. For patients with early stage gynecologic cancers, it may be possible to conserve reproductive organs at the time of cancer surgery.
For men and women who are sub-fertile after cancer treatment, assisted reproductive technologies may help achieve pregnancy. For cancer survivors who become menopausal after cancer treatment, egg donation is a highly effective option. A gestational surrogate may also be an option for women who are unable to carry a pregnancy after cancer therapy.