How to preserve fertility during and after cancer treatments?
This is an important question to address during treatment planning, as all potential chemotherapy can cause infertility, in both men and women. Most of the malignancies that affect people in their young childbearing ages are potentially curable, and the possible effect on future childbearing needs to be discussed.
Men have a long tested and used option of storing frozen sperm. Sperm banks and the technology for banking are commonly available. Sperm count and motility will be tested before storage, to make sure that there is enough viable sperm. In pre-pubescent males, the possibility of storing testicular tissue for future re-implants is being explored, but is not mainstream.
Women in a stable relationship have the option of freezing embryos, similar to the process for IVF. However, they now also have the option of freezing oocytes or eggs, in the absence of a sperm donor. The freezing of ovarian tissue for re-implantation is being used in select centers. This is experimental in pre-pubescent girls, and all re-implantation carries some risk of re-implanting cancer cells.
Harvesting of eggs used to take at least a month, and there was reluctance to delay the initiation of curative chemotherapy. This can be now achieved with a 7-day cycle, as per reproductive endocrinologists.
If fertility is restored naturally, with normal sperm count and function, and normal menstrual cycles with ovulation, there does not appear to be any greater risk to such offspring as a result of treatment, so it is not necessary to use the stored sperm and eggs. However, resumption of menstrual cycles does not mean resumption of ovulation.
When to discuss fertility preservation? There is so much happening with a new cancer diagnosis, that the preservation of fertility takes a back seat. However, with high cure rates, and long life expectancy, this needs to be offered as part of treatment planning. The timeliness of the process can be facilitated if there are existing lines of referral and communication with sperm banks and reproductive endocrinologists.
I have a lovely anecdote of a 27 year old woman, who was going through fertility issues, before her diagnosis of Hodgkin’s lymphoma. At that point, they were not interested in additional procedures for fertility, given her difficulty in conceiving to begin with. We completed her curative chemotherapy, she resumed normal menstrual cycles, and a few years later, had given birth to two naturally conceived children! I have many patients who have happily adopted children to complete their families. And, I have many others, who have chosen not to pursue either.