Oncofertility
What is Oncofertility?
Oncofertility or cancer fertility is a field of Reproductive Health care whose goal is to preserve the fertility opportunity of individuals diagnosed with cancer. The good news is modern cancer care has come a long way in the past 25 years. With increased survivorship, the importance of and opportunity for individuals to pursue fertility preservation options have become an important part of cancer care in reproductive age patients. Unfortunately, many cancer treatments including chemotherapy, radiation treatment, and surgery can impair or even destroy a person’s ability to have children. Specifically, chemotherapy and radiation treatment in women can cause ovarian damage to their oocytes (eggs), ovarian failure, and early menopause. In addition, these cancer therapies may cause genetic changes to the eggs and sperm in women and men respectively.
Today, cancer specialists are trained to let all reproductive age patients know they can consult with a Reproductive Infertility specialist about fertility preserving options before starting cancer therapy. Fertility preservation should be done before any chemotherapy or radiation therapy. Fortunately, for cancer patients there are funds and assistance to help obtain these procedures at affordable prices. Your Reproductive Infertility team will provide this information at your first meeting.
Initial Meeting with the Fertility Specialist
- A complete review of your cancer diagnosis and your proposed cancer treatment. Based on this information an assessment of the risk to your fertility is made.
- Assessment of your health status. A review of pertinent details with your cancer specialist is done to confirm what kind of fertility preservation options you can do.
- Screening blood work and exam.
- Ultrasound of the ovaries to evaluate fertility potential.
- If you are doing egg or embryo freezing, then you will be scheduled with a nurse to review fertility medications used for egg preparation and review the basic egg retrieval procedure.
Fertility Preservation Options
- Shielding the ovaries or testicles during radiation therapy to minimize damage.
- Gonadotropin agonist injections such as Leuprolide Acetate given monthly or in 3-month larger doses to suppress or shut down ovarian and teste’s function. Several studies have shown this may decrease the damaging effects of chemotherapy. There is some controversy about how beneficial gonadotropin suppression is in protecting future fertility. It is not the optimum approach in fertility preservation.
- Egg banking. A patient is given fertility stimulating medications in the form of subcutaneous shots daily for approximately 8-11 days to stimulate the growth of multiple eggs. When they are mature, they are retrieved via an ultrasound guided transvaginal needle aspiration technique. You will be asleep with anesthesia so you will not feel pain from the egg retrieval. The eggs are then frozen and can be stored for future use even years later after successful cancer treatment.
- Embryo Banking. The same process as with egg freezing except once eggs are retrieved, they can be fertilized with sperm and then embryos are cryopreserved for future use.
- Sperm freezing. Males can provide multiple sperm specimens over several days to freeze. These specimens can be used later for insemination or in in vitro fertilization (IVF) procedures.
- Ovarian and Testicular tissue freezing. Newer technology is developing to freeze ovarian tissue and testicular tissue that may be reimplanted in the patient’s body to produce eggs and sperm.
Other Fertility Options
Donor Egg/Donor Sperm. If a cancer patient has permanent damage to their ovaries and cannot produce eggs, then donor egg is an option. Egg donors undergo fertility medication stimulation and egg retrieval. The eggs are then fertilized with sperm. An embryo can then be transferred to the patient’s own uterus so they can conceive and carry their baby.
Donor Sperm. Donated frozen sperm is selected and used to achieve a pregnancy.
Gestational Carrier or Surrogate. If a patient has damage to their uterus from their cancer treatment or if they cannot become pregnant because of the risk of pregnancy, then embryos from the patient can be transferred to the uterus of a gestational carrier or surrogate who can carry the pregnancy to birth for the patient.
Adoption. Reproductive Infertility offices can provide adoption options for cancer patients.
Fertility Preservation information can seem daunting, but the Reproductive Fertility specialist offices can provide clarity. For some patients it may be reassurance that their cancer treatment plan does not pose a significant threat to their fertility. For others, egg, embryo, or sperm freezing options may be recommended. With the right team egg and embryo freezing can be accomplished over a 2–3-week period. The patient then can return to their cancer specialist to start their cancer treatment