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Fertility Preservation Options for Men and Women Facing Cancer

Overview
Chemotherapy
Radiation
Surgery
Fertility Preservation
Is Pregnancy Safe After Treatment?

Summary

 

Overview

More and more patients seeking infertility treatment at TFC have been recently diagnosed with cancer or other chronic diseases.  When they come to see us, they want to understand the available options that will hopefully allow them to preserve their fertility.  In the past, all we could do for these patients was bank sperm or embryos and hope that a few would survive their cancer long enough to return for a chance for pregnancy.  As a result of significant advances in cancer treatment, however, more and more patients are surviving their cancers and they are therefore very interested in subsequent fertility.  After winning their battle against their disease, they understandably have high expectations for a successful outcome.  Fortunately, there have been many recent advances in gamete and embryo cryopreservation that allow us to offer these patients significant hope for achieving a family of their own.

Fertility threatening treatments, whether for cancer or other types of chronic disease such as rheumatoid arthritis or others, primarily include chemotherapy, radiation therapy and surgery.  Factors to consider when trying to determine the best alternatives and approaches for fertility preservation include the age of the patient, the site of treatment, and the types of medication or other therapy that will be administered to treat the underlying disease.

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Chemotherapy

There are many different types of chemotherapeutic protocols and medications that are widely used today.  Some medications are well known to have a profound adverse effect on subsequent fertility, whereas others are much more mild.  The chemotherapeutic agents that appear to have the most severe adverse effects on fertility include drugs such as cytoxan, cisplatin, and procarbazine, whereas medications such as methotrexate or 5-flourouracil appear to have a substantially milder effect.  Obviously the timing of your therapy, as well as the choice of specific drugs is up to your oncologist.  Nevertheless, we will work closely with your other physicians to allow you to cryopreserve as many gametes as possible without interfering with your chemotherapeutic plan.

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Radiation

The effects of ionizing radiation on fertility can also vary markedly – depending primarily on the dose administered and the site(s) being treated.  While effective gonadal shielding may serve to limit total radiation exposure, there are other options available to patients as well.  As survival rates have improved, the radiation oncologists have become much more sensitive to fertility preservation.  They will, therefore, thoroughly discuss your options with you prior to the initiation of treatment.

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Surgery

Surgical treatment may involve resection or removal of the ovaries or the testicles, as well as other parts of the reproductive anatomy.  Adjunctive treatment with either chemotherapy or radiation therapy is frequently given either before or after surgical resection.  Advance planning, through inclusion of your TFC physician in the treatment process, can serve to maximize your opportunity for fertility preservation. 

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Fertility Preservation

As a result of recent research that has been performed in our field, we now have fertility preservation options that can be employed very effectively – preferably before – but frequently even after chemotherapy, radiation, or surgery.  In the event that male patients contact us prior to undergoing treatment, we can offer sperm banking, freezing of testicular tissue, or testicular sperm extraction.  Women who seek assistance prior to chemotherapy or radiation can have their oocytes retrieved for either oocyte cryopreservation or embryo cryopreservation.  In addition, some women who are going to subsequently undergo chemotherapy or radiation therapy may elect to have treatment with medications such as Depot Lupron, in the hope of minimizing the adverse effect of the cancer therapy on their ovaries.  Similarly, women who are going to undergo radiation therapy may desire to have their ovaries surgically relocated within the pelvis.  Ovaries can be placed higher in the pelvis and potentially out of the area that will subsequently be affected by radiation, minimizing the overall dose of radiation they receive. 

The resumption of normal testicular or ovarian function following chemotherapy, radiation, or surgical treatment is very variable.  Even if hormonal production becomes normal again, that does not guarantee that gamete production will do so as well.  Fortunately, men do occasionally recover enough sperm production to cause a pregnancy – sometimes even without fertility treatment.  Women, depending upon their resulting ovarian function, can sometimes conceive naturally as well.  Other patients may require the use of gametes or embryos that were frozen prior to their cancer treatment.  Even in the worst case scenario, in which either the man or the woman has no remaining reproductive function following treatment, successful fertility treatment is usually still available in the form of donor eggs, donor embryos, donor sperm, or traditional surrogacy. 

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Is Pregnancy Safe After Treatment?

In the overwhelming majority of cases, pregnancy following cancer treatment does appear to be safe.  This holds true even following treatment for breast cancer.  Although oocytes may be damaged temporarily, and ovarian function may be significantly impaired – even resulting in menopausal symptoms – ovarian function does occasionally return to a pretreatment state.  Similarly, although sperm cells may be damaged by either chemotherapy or radiation, there are studies that suggest that the cells may very well become normal again at a later date.

Several studies have evaluated the rate of birth defects in children born to cancer survivors.  These rates fortunately do not appear to be any greater than that of the normal population, ranging from 2 % to 6%.  In addition, with the exception of families who have true genetic cancer syndromes, there does not appear to be any increased risk of cancer in offspring of cancer survivors. 

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Summary

In summary, fertility preservation is a very viable option for most patients undergoing treatment for cancer or other chronic diseases.  Inclusion of your TFC physician as early as possible in the treatment planning process is important in order to achieve the best results.