Fertility Preservation in Cancer
The incidence of cancers is on the rise worldwide. Daily scientific advancements and availability of newer diagnostic and therapeutic techniques not only make earlier detection of cancers but also make them amenable to treatment. They improve survival and increase the disease-free period.
A lot of cancers are detected very early in life-in childhood, adolescence and young adulthood which are the prime years for fertility. A multidisciplinary approach in improving the quality of life of such a group of cancer survivors is to provide them an opportunity to produce their own biological child, when they are disease free, despite the disease and its associated chemotherapy and radiotherapy that have damaging effects on their the reproductive organs (ovaries and testes).
The role of the cancer specialist is paramount in such a scenario.The guidelines published by the American Society of Clinical oncology in 2006 states that the treating oncologist should include in their counseling the need for fertility preservation before therapy. They should educate the patient regarding the impact of cancer treatments on the future reproductive potential of the patient and refer them to a reproductive medicine specialist for fertility preservation. This would be based on the nature, aggressiveness, intended surgery including chemotherapy and radiotherapy and prognosis of cancer. Cancers like lymphomas, leukemia, breast cancer etc can be addressed and fertility preserving treatments given either before or in the time intervening between two therapeutic modalities.
Options of fertility preservation are available for both the sexes.
In men, the option of semen cryopreservation or semen freezing is available in which semen collected by masturbation is frozen in the laboratory and used in future IVF process when fatherhood is desired.
For women, the options available are as follows–
- For young girls and women without partners, the options available are oocyte freezing and ovarian tissue freezing. For oocyte freezing, the patient’s ovaries are stimulated to make eggs using artificial hormones and the eggs once mature are collected under anaesthesia and frozen in the laboratory for future IVF use whenever motherhood is desired. The advanced regimens available to make eggs are safe and cause no delay in initiating the actual cancer treatment.The results of ovarian tissue freezing, although considered experimental, have the advantage of keeping the fertility window open for a longer duration of time.
- For women with partners, the option of embryo cryopreservation is available. As already explained, the woman’s ovaries are stimulated to produce eggs and the eggs thus obtained are mixed with the partner’s sperm in the IVF laboratory to make embryos which are frozen to be used in future whenever parenthood is desired.
To sum up,
- Cancers with a good prognosis and survival, early in life should be managed by a multidisciplinary team approach which should include a reproductive medicine specialist to keep the future fertility needs in mind
- Safe regimens for ovarian stimulation are available that do not worsen the existing disease
- Time to start the cancer therapy is not delayed as newer regimens to stimulate the ovaries are available that can be started randomly irrespective of the woman’s menstrual cycle
- Fertility preservation can be seen as a means to improve the quality of life of a cancer survivor by producing his/her own biological child.