Prior to cancer treatment

Fertility Preservation in Cancer Patients (Oncofertility)

Cancer patient’s survival rate is increasing day by day but some cancer survivors still face side effects of cancer treatment. One of those side effects includes impaired fertility. According to The National Cancer Registry of India, annually cancer patients are rising from about 9.79 lakhs in 2010 to 11.4 lakhs in 2020. Large numbers of cancer patients are diagnosed in their reproductive years that is, up to the age of 45 years.

Cancer and its treatment often result in reduced fertility. Infertility after cancer treatment may be temporary, lasting months to years, or permanent.

How cancer can affect the fertility – The risk of infertility among cancer patient varies patient to patient and it will depend on

  • Type of cancer (Cancer of reproductive organs, Lymphoma, Leukemia, Breast cancer ect)
  • Treatment (drug & dose of cancer therapy including chemo / radio therapy)
  • Age of cancer patient (risk of infertility increases as women and men get older)

Treatment of cancer is often highly detrimental to both women and men reproductive organs and their function as follows:

 

Cancer Treatment

Affect of Cancer Treatment on Reproductive Organs

Chemotherapy – The degree of damage is dependent upon the type of the agent used, dose given, age of the patient and her ovarian reserve.

  • Can damage the ovaries

  • Reduce number and quality of eggs

  • Cause temporary or permanent menopause

Radiotherapy – The risk of infertility will depend on the area treated and the dose.

  • May damage the reproductive organs

  • Cause temporary or permanent menopause

  • Chances of future miscarriage

Surgery

  • Remove the reproductive organs

  • Cause scarring that impacts fertility

Hormonal therapy

  • Block the production of hormones which required for fertility

Chemotherapy – The degree of damage is dependent upon the type of the agent used, dose given, age of the patient

  • Reduce or stop the production of sperm

  • Cause genetic damage in sperm

  • Reduce the motility of sperm

Radiotherapy – The risk of infertility will depend on the area treated and the dose.

  • May damage the reproductive organs or the pituitary gland, which makes hormones to trigger sperm production

Surgery

  • Effect sperm production

  • The ability to get an erection and ejaculate reduce

Hormonal therapy

  • Decrease the production of sex hormone

 

Management of Oncofertility – Preserving fertility is an extremely crucial method in those cancer patients who want to start their family in future before initiation of cancer treatment. Management of oncofertility included

 

Fertility Preservation Options in Women

Fertility Preservation Options in Men

Embryo Freezing – Egg fertilized with sperm in laboratory and then embryo freezed to future use. (Follow IVF).

Sperm Freezing – Harvesting and freezing of sperm.

Egg Freezing – Harvesting and freezing of unfertilized eggs.

Gonadal shielding during radiation therapy – Use of shielding to reduce the dose of radiation delivered to the testicles.

Ovarian tissue freezing and transplantation – Freezing of ovarian tissue and reimplantation after cancer treatment.

Testicular tissue Freezing – Freezing testicular tissue and reimplantation after cancer treatment.

Gonadal shielding during radiation therapy – Use of shielding to reduce the dose of radiation delivered to the reproductive organs.

Testicular suppression with GnRH analogs or antagonists – Use of hormonal therapies to protect testicular tissue during chemotherapy or radiotherapy.

Ovarian transposition – Surgical repositioning of ovaries away from the radiation field.

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Trachelectomy – Surgical removal of the cervix while preserving the uterus.

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Ovarian suppression with GnRH analogs or antagonists – Use of hormonal therapies to protect ovarian tissue during chemotherapy or radio therapy.

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When a person is diagnosed with cancer (mainly reproductive organ cancers), he /she should consult Oncologist and Infertility Specialist. And discuss the side effects of treatment and possibilities of fertility preservation procedure. Planning of fertility preservation in advance preserve woman’s /man’s fertility until he/she has recovered from cancer and is ready to start family – sometimes years down the track.