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Fertility options for cancer patients

Cancer treatments such as chemotherapy, radiation, bone marrow and stem cell transplants and surgery may cause temporary or permanent infertility. Infertility is the inability to start or maintain a pregnancy.

Several factors affect the extent of damage that may occur

  • Sex of the patient
  • Age at time of treatment
  • Type and dose of chemotherapy
  • Location and dose of radiation
  • Location and extent of surgery
  • Pre-treatment fertility status (which is often unknown)

Other medical treatments and protocols may also damage fertility. Patients should consult with their doctors to determine their fertility risks based on their individual medical treatments.

Our Fertility center can help cancer patients and survivors whose medical treatments present the risk of infertility. As the survival rates of young cancer patients continue to rise, how we can prevent or treat infertility become very important. Decisions about protecting fertility must be made during the short time period between a cancer diagnosis and the onset of treatment. It is critical for patients to be informed of their reproductive risks, educated about fertility preservation options, and empowered to make decisions about their reproductive future.

Fertility preservation options in women:

Embryo Freezing :

Eggs are matured through use of injectable hormones, removed, fertilized in vitro with sperm, and the resultingembryos are frozen and stored

  • Experimental regimens using letrozole or tamoxifen instead of standard ovarian stimulation protocols may be of interest to patients with hormone-sensitive cancers
  • Partner or donor sperm is required
  • Outpatient regimen of shots, blood tests and ultrasounds for 10-14 days and a minor surgical procedure to remove mature eggs vaginally
  • Females, after puberty

This is an established clinical treatment for infertility with pregnancy rates of approximately 50 % per transfer; thousands of babies born worldwide

Egg Freezing :

  • Eggs are matured through use of injectable hormones, removed, frozen (without being fertilized), and stored
  • Two freezing techniques are now available: slow-freezing or vitrifi cation (fl ash freezing)
  • Outpatient regimen of shots, blood tests and ultrasounds for 10-14 days and a minor surgical procedure to vaginally remove mature eggs
  • Females, after puberty
  • Experimental; pregnancy rates are approximately 21.6% per transfer; 500+ babies born worldwide

In Vitro Maturation :

  • Immature eggs are removed and matured in vitro They are then either fertilized in vitro with sperm and frozen as embryos or are frozen as unfertilized eggs
  • Standard ovarian stimulation using injectable hormones is not necessary
  • Outpatient procedure; takes 2-10 days and a surgical procedure to vaginally remove mature eggs
  • Females, after puberty
  • Experimental; success rates unknown

Ovarian Tissue Freezing :

  • An ovary is removed laparoscopically, divided into small strips, frozen and stored
  • Thawed tissue must later be transplanted back into woman’s body; techniques that extract immature oocytes from this tissue and mature them in the lab as an alternative to transplantation are being studied
  • Outpatient surgical procedure
  • Females, after puberty
  • Experimental; a handful of reported live births to date

Ovarian Transposition :

  • Ovaries are surgically moved away from the radiation field to minimize damage
  • Outpatient surgical procedure
  • Females, after puberty
  • Ovarian function success rates approximately 50%, pregnancy rates unknown

Radical Trachelectomy :

  • Fertility-preserving surgery for early-stage cervical cancer patients; cervix is removed, but uterus is preserved
  • In-patient surgical procedure
  • Females, before or after puberty (although most cervical cancer patients are post-pubertal)
  • Pregnancy rates uncertain, but recent study showed 5-year cumulative pregnancy rate of 52.8%

Ovarian Suppression :

  • A medication administered during chemotherapy that may reduce the risk of infertility
  • Monthly injection
  • Females, after puberty
  • Experimental; most studies show no effect, but further studies are underway

Fertility preservation options in men

Sperm Banking :

  • Semen is collected; sperm cells are then analyzed, frozen and stored
  • Outpatient procedure; if unable to donate sperm through sexual stimulation, sperm cells can be obtained through minor surgery or electrical stimulation
  • Males, after puberty
  • Success rates vary depending on sperm quality; multiple donations are generally recommended, but even individual sperm may be used with ICSI (Intracytoplasmic Sperm Injection)

Testicular Sperm Extraction :

  • Procedure used for males who have no sperm in their semen. Testicular tissue is obtained, usually through open biopsy, fragmented, and examined for sperm cells. If sperm cells are found, they are removed and either used immediately or frozen for future use with in vitro fertilization (IVF) and ICSI
  • Outpatient surgical procedure
  • Males, after puberty
  • Success rates vary (30-70%), depending on technique used

Testicular Tissue Freezing :

  • Testicular tissue, including the cells that produce sperm, is surgically removed, frozen and stored
  • Outpatient surgical procedure
  • In post-pubertal males, used to store tissue for use with sperm extraction at a later date
  • Experimental in pre-pubertal boys post-treatment parenthood options

Options for survivors who are infertile after cancer treatment

  • Donor sperm, eggs and embryos
  • Surrogacy or a gestational carrier
  • Adoption

Pregnancy and children after cancer

  • While data are limited, current studies indicate that pregnancy does not cause cancer recurrence (even after breast cancer)
  • Eggs and sperm exposed to chemotherapy and/or radiation may suffer genetic damage; this appears to be repaired with in six months (eggs) to one year (sperm)
  • An increased risk of miscarriage is only a concern for a small percent of patients who had radiation to their pelvic area or some fertility sparing gynecologic surgeries
  • Long-term heart or lung damage from treatment may complicate the ability to safely carry a pregnancy; patients should ask their oncologist about the need for an echocardiogram or a high-risk obstetrician before becoming pregnant
  • There is no evidence that a history of cancer or cancer therapy increases the occurrence of birth defects or cancer in offspring (except in the case of hereditary genetic syndromes)
  • Patients with genetic cancers may be able to use preimplantation genetic diagnosis (PGD) to screen embryos and avoid passing on the gene