Fertility Preservation for Cancer Patients

When someone is diagnosed with cancer, their first thought probably is about getting treatment to survive.  But if  they are young enough to bear a child, their second thought may be, will cancer treatment make me infertile?  Does this mean I can’t have a child in the future?  Parents of a child diagnosed with cancer may have similar fears for their child’s fertility as an adult.The first goal is to cure the cancer.  But there are ways to protect and preserve fertility for both females and males who have reached puberty, and fertility treatment options for when you are cancer-free and ready to start a family.  In many cases cancer survivors can have children after cancer treatment.

How Does Cancer Treatment Affect Reproduction?

Let’s go back to reproductive biology 101.  In order to conceive and eventually deliver a baby, the male partner’s sperm must be delivered to the female partner’s egg, by sexual intercourse or intrauterine insemination (IUI), and the egg must be fertilized.  When all goes well the fertilized egg implants in the woman’s uterus and begins to grow, eventually resulting in the delivery of a healthy baby.Cancer treatment can disrupt this process in several ways, depending on the type of cancer and the treatment prescribed.

• Surgical removal of the testicles in the male or the ovaries or uterus in the female can cause infertility.
• Radiation to the ovaries or testicles may cause severe damage to eggs or sperm, according to the American Society of Reproductive Medicine (ASRM.)  Women are born with all the eggs they will ever have.  Eggs cannot regenerate; their loss is permanent and may result in premature menopause.
• Certain cancer drugs also may result in severe damage to sperm or eggs.

Preserving Fertility Before Cancer Treatment

For men or boys who have achieved puberty, semen samples can be frozen at a sperm bank or fertility center before their treatment begins.  Frozen sperm can be stored for years and used later for IUI or IVF (in vitro fertilization.)  This is basically the same process used by sperm banks with donors and has been used successfully many thousands of times.The alternatives for women were developed more recently.  IVF to produce embryos for freezing has been the most successful way to preserve a woman’s fertility to date.  If she has a male partner or uses donor sperm, her eggs can be extracted and fertilized in the fertility clinic laboratory.  The embryos can be frozen until she is ready to have them implanted.  If her uterus has to be removed as part of the cancer treatment, a gestational carrier can bear her child.  Embryos survive the freezing and thawing process about 95 percent of the time, according to the Mayo Clinic.  Recently implantation of an embryo which had been frozen for 19 years resulted in the birth of a baby.Another alternative for women or girls past puberty may be to remove the ovaries and reposition them inside her body but outside the range of the radiation, depending on the area to be treated.  This reduces the risk of damage by radiation.Egg freezing is a newer technique.  The eggs are collected as they would be for IVF and then frozen.  Some fertility clinics offer this procedure, and egg banking is becoming more widely available A new report found that the success rate of IVF with frozen eggs was comparable to that with fresh eggs if the patient was young when her eggs were frozen.Another experimental technique is to remove and freeze ovarian tissue.  According to ASRM, experimental studies have found that reimplanted ovarian tissue may be able to produce eggs for a short time.  So far 29 women around the world have been able to get pregnant with eggs produced by their reimplanted ovarian tissue which was able to grow on or near their ovaries.  Just recently a woman in Australia was the first to become pregnant via IVF with eggs produced by ovarian tissue reimplanted in her abdomen.  This procedure is highly experimental, difficult and expensive according to Dr. Kate Stern, leader of the team which carried out the procedure in Melbourne, Australia, as reported on Healthline.com.

Fertility After Cancer Treatment

For men who froze their sperm before treatment, IUI, IVF and IVF with ICSI (intracytoplasmic sperm injection) are fertility treatments that can result in conception.  It may take several years for their sperm production to resume after cancer treatment.The first step for a woman after cancer treatment is to find out if it’s safe for her to get pregnant.  If her physician agrees, then there are several alternatives.  Consulting a fertility specialist will let her find out if she can conceive naturally or with fertility treatments, or if she should consider other ways to start a family, such as egg or embryo donation, a gestational carrier, or adoption.