Fertility Preservation Options for Cancer Patients
In the face of a cancer diagnosis and subsequent treatment, the prospect of a future scenario where they recover and have children may seem to be of the lowest priority. It is, however, crucial and an integral part of cancer therapy to carefully assess each patient’s medical situation, their cancer treatment plan, and their goals for the future including marriage and children. It is important to consider fertility preservation options for cancer patients.
Medical cancer treatments can affect a patient’s ability to have children even long after the treatment has been completed. This is especially true for the types of cancers that affect or are near the reproductive organs like the ovaries or the testicles or the types of therapy that may cause permanent damage to those organs like chemotherapy. Also, surgeries that involve the reproductive organs including the testicles, ovaries, fallopian tubes, or the uterus can decrease fertility. Depending on the location of the cancer, the surgeon may need to remove a part or all of the reproductive organs even in cases where the cancer does not directly involve the organ. Radiation therapy can also effectively kill cancer cells but as an adverse effect can permanently damage the ovaries and the uterus.
What are the fertility preservation options for women?
The main technique for fertility preservation in women is the freezing of either eggs or embryos. These techniques have been proven to be very successful. However, the successes of them are dependent on the following:
- Age of the woman
- The medical and fertility history of the woman
- Her genetics
- The type of cancer diagnosis
What is the process of preservation?
The woman first undergoes a period of ovarian stimulation to mature multiple ovarian follicles. Medications that will stimulate the ovaries are administered through injections or orally to stimulate the ovaries to develop multiple eggs at the same time. These medications are usually specifically prescribed, and the patient must follow the prescription. This is usually similar to an IVF procedure.
In cancers that are hormone-affected, administration of these drugs may as a side effect hasten the growth of these cancers. It is important in such cases to weigh up the potential benefit of future children against the risk of worsening the cancer situation. The ovarian response is closely monitored through ultrasounds and blood tests. When the follicles are ready, the eggs are then harvested. This is done by placing an ultrasound probe in the patient’s vagina as a guide to the needle that will aspirate the mature follicles. The procedure is done under sedation of the patient. The entire process usually takes from 10-30 minutes.
After the harvesting, the eggs are put in a special solution and then taken to the laboratory. The eggs can then be frozen at this point, after which they are then placed into liquid nitrogen and can be stored indefinitely. Egg freezing was considered experimental until recently, but with advancements in technology, it has become a routine non-experimental procedure.
The next option is to fertilize the eggs with donor sperm or sperm from the woman’s partner. This creates an embryo which can subsequently also be frozen. It is also noteworthy that embryo freezing has been performed longer than egg freezing and depending on the clinic’s proficiency, may have a better success rate than egg freezing. It is also important to consult with a fertility expert on which option is the best and the cost of freezing.
Another important topic to discuss is what they will do to the frozen eggs and embryos if the woman does not need or want them again. On the other hand, when the woman wants to get pregnant, the eggs or the embryos are removed from the freezer and thawed. Some of the eggs or embryos will not survive the thawing process but most will. The embryologist will check and determine which ones survived and which didn’t. The eggs are fertilized after to form embryos then the embryos are transferred into the woman’s uterus. In some cases, the woman is specially prepared for the transfer usually by prescribing estrogen through pills or skin patches and progesterone through suppositories or injections. In other cases, the woman’s natural cycle is used to time the transfer of the embryos.
Fertility Preservation in Men
Fertility preservation in men is different and simpler in many ways when compared with the process in women. For women, the process of egg collection is a complicated process that can involve a medical procedure. This is different in men as sperm collection is a simple and noninvasive process that can be accomplished with absolutely no medical help or intervention. Men can also hand in their samples at any time, without the need for any preparation or consideration.
Men produce millions of sperm with each ejaculation without the need for any medication. But in women, the ovaries mature only one egg per month except they are stimulated with medication. Men also do not need to take any hormone medication which may adversely affect their cancer unlike in women. For collection, men are given a collection device and shown a private room. There, they usually masturbate until they ejaculate, while some men who are unable or unwilling to masturbate are given a special condom that will collect the sperm sample during intercourse. After collection, the semen containing sperm is mixed with special fluids that will prevent damage during the freezing and thawing process. Then it is frozen and stored in liquid nitrogen for future use.
In some cases where the men cannot ejaculate, for some reasons like spinal cord injuries, emotional reasons, or damage to the nerves that control ejaculation; strategies like bladder collection, electroejaculation, and vibratory stimulation can be used to help collect the sperm from those men. For other men, that have no mature sperm or small amounts of sperm, the sperm can be retrieved surgically. For boys that have not attained puberty, there are experimental fertility preservation techniques to explore.
In some research, samples from the testes are removed and frozen. When the time to impregnate comes, the tissues are examined for stem cells. The idea is to isolate these few cells and mature them into functional sperm. It is recommended that two or three samples are collected so that they can be divided into multiple vials which can serve for multiple attempts to conceive. The sperm can be stored indefinitely as well, it is also recommended that the male abstain from any sexual activity for about 3-5 days before collection.
The information provided in this blog is for educational purposes only and should not be considered as medical advice. It is not intended to replace professional medical consultation, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any decisions regarding your health. Read more