Oncofertility: Fertility Preservation Before Cancer Treatment

Essentials

  • Overview (jump to section): Oncofertility refers to assisted reproductive technologies to preserve fertility prior to cancer treatment, which can sometimes damage fertility in men, women and children.
  • How cancer treatment affects fertility: Radiation and chemotherapy treatments can damage female eggs and ovaries, hormone production critical for reproduction, male testicles and sperm quality; surgery for cancer may remove or damage reproductive organs.
  • This is why it is important to discuss future fertility hopes and risks with an oncologist and fertility specialist prior to undergoing cancer treatments.
  • Fertility preservation options commonly involve cryopreserving (freezing and storing) sperm, eggs or embryos before cancer treatment to use in future fertility treatment.
  • After treatment: Those who have finished cancer treatment may still be able to get pregnant, although it may take months or years for fertility to resume naturally. Others may have lingering or lifelong problems that affect fertility, in which case reproductive medicine can help by using cryopreserved specimens, or even donor tissue (eggs or sperm) for those who were not able to pursue oncofertility prior to cancer treatment.

What is oncofertility?

Oncofertility is the medical discipline that helps preserve reproductive potential for patients facing cancer treatments or other medical conditions that may render them infertile. Cancer – and treatment for cancer – can sometimes impair a man’s  or woman ’s ability to have children. Cancer treatment can interfere with fertility in many ways, because the same medicines and treatments that work to kill cancer cells also affect other cells, organs and hormones in the body.

Oncofertility options for cancer patients commonly involve cryopreserving (freezing and storing) sperm, eggs or embryos before treatment for use later in fertility treatments.

Learn about oncofertility options for women Learn about oncofertility options for men

Talk about oncofertility during cancer treatment planning

About 5% of all cancers diagnosed occur in those of reproductive age, roughly 80,000 people each year. It’s vital for these patients (or parents of children with cancer) to speak to their oncologist about possible fertility implications before treatment starts. Not all oncologists bring up this option during cancer treatment planning, so cancer patients may need to be proactive in this regard.

Working with a fertility specialist for a future family

Working closely with oncologists, our fertility specialists can help estimate the risk of infertility based on an individual’s cancer treatment plan.

At The Fertility Institute, we understand a diagnosis of cancer can be overwhelming, and we want to help patients consider all options regarding fertility preservation before beginning treatments.

Before determining the best option for patients and their family, our doctors will consider the type of cancer, the treatment plan and the amount of time the patient has before starting treatments.

We know time is of the essence with cancer treatment. Our doctors are here to listen, inform and guide these critical fertility decisions you need to make so you can focus on the most important thing: your health.

 

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How does cancer treatment affect fertility?

The likelihood that cancer treatment will harm fertility depends on several factors, including the type of cancer, type of cancer treatment and the patient’s age at the time of treatment. The effects of chemotherapy and radiation therapy on fertility also depend on the type of drug or the size and location of the radiation field.

The most severe damage is caused when radiation is applied to the ovaries or testicles and by chemotherapy drugs called alkylating agents. Cancer treatments can harm fertility in the following ways.

  • Radiation or chemotherapy drugs can damage:
    • Hormone levels critical for reproduction
    • Egg and sperm quality
    • The uterus and the cervix.
  • For women, treatment may also cause ovarian damage leading to ovarian failure, early menopause, and/or other reproductive problems.
  • For men, treatments can likewise damage the testes, interfering with sperm production.
  • Some treatments may also remove organs vital to conception (the uterus, ovaries or testicles), ending fertility.

Since every patient is different, there is no way to predict for certain whether cancer treatments will cause infertility. Fertility can be affected by a single cancer therapy session, and those effects can be temporary or permanent.

Oncofertility options for those with cancer

Fertility preservation options differ for men, women and children, outlined below.

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How can women preserve fertility before cancer treatment?

Women wanting to have children someday may consider one of the following preservation methods.

  • Embryo freezing involves extracting a woman’s eggs, which are then fertilized through in vitro fertilization (IVF) with sperm to create embryos. If successful, the resulting embryo is cryopreserved until used at a later date. The embryo freezing process may delay the start of cancer treatments by a few weeks. However, research suggests that this method for fertility preservation has the highest success rate.
  • Similarly, egg freezing involves extracting a woman’s eggs, then freezing the unfertilized eggs for future use with fertility treatments.
  • Gonadal or radiation shielding places small lead guards in a woman’s pelvic area to protect reproductive organs and reduce radiation exposure. This technique is not effective with chemotherapy or other cancer therapies.
  • Ovarian transposition means surgically repositioning the ovaries as far away from the radiation field as possible. This procedure is performed when radiation is used on the pelvis without chemotherapy, and it is a common option for girls either before or after puberty.
  • Radical trachelectomy can be performed if a woman has early-stage cervical cancer. This procedure, which involves the surgical removal of the cervix, can help preserve fertility.
  • Ovarian tissue cryopreservation is a more novel procedure for girls prior to puberty or those who haven’t yet ovulated, which can sometimes occur before puberty. Our surgeon removes the ovarian tissue and cryopreserves it. After the patient’s return to health, the tissue can later be thawed and placed near the fallopian tube in hopes it produces eggs in the future.

Your first “baby”sitters

Our laboratory staff takes excellent care of cryopreserved specimens, following rigorous guidelines and utilizing the best equipment and monitoring procedures. Our embryology lab and cryopreservation tanks supply constant monitoring alarms and emergency generator backup power to protect your precious specimens.
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How can men preserve fertility before cancer treatment?

  • Sperm banking refers to the procedure to collect, freeze and store sperm. When the man is ready to start a family, the sperm can then be thawed and used with intrauterine insemination (IUI) or IVF.
  • Gonadal shielding: By carefully placing shields over the man’s testicles, it reduces their exposure to radiation.
  • Sperm aspiration is a newer option for young boys who have yet to reach puberty. In this procedure, immature sperm cells are surgically removed using a small incision or needle, then frozen and stored for future use in IVF.
  • Testicular tissue freezing is an experimental procedure for prepubescent boys in which sperm is preserved by freezing testicular cells that can later be thawed to retrieve sperm for use in IVF.

Can I still have a child if I didn’t pursue oncofertility?

Those who have already finished cancer treatment may still be able to get pregnant, although it may take months or years for fertility to resume naturally. Others may have lingering or lifelong problems that affect fertility.

For those who have infertility due to cancer treatment and did not undergo fertility preservation, there are still advanced reproductive medicine techniques that can help cancer survivors become parents.

Fertility treatment options largely depend upon a patient’s specific cancer, but may include utilizing donor sperm, eggs or embryos to conceive a pregnancy through IVF.

Adoption may also be considered to build a family.