Fertility Preservation – Cancer Patients

Cancer can impair fertility, depending on the type of cancer in question and the treatment regime. Thankfully, there are ways to protect one’s fertility for the future.

Studies indicate that about 10% of cancers occur in those below 45 years old. Invasive breast cancer (BC) is the most frequent cancer among young women, and women under 40 years comprise about 5% of the overall BC population. Treatment is increasingly effective, but will render many affected women infertile; and they may not have completed child-bearing at the time of diagnosis. If the cancer involves the reproductive area, fertility would most likely be affected. Preserving fertility is, therefore, a major concern, especially for women without children.

Some patients require surgery to remove their reproductive organs, while others may need chemotherapy or radiotherapy which can reduce their reproductive function. And even though chemotherapy, radiotherapy and bone marrow transplantation can cure up to more than 90% of girls and young women with certain cancers and diseases, these treatments can result in premature ovarian failure or early menopause.

Certain cancer drugs are also required for a prolonged period to prevent recurrence, and these include certain hormonal medications prescribed for breast cancer patients. Over time, fertility will be affected, particularly because the number and quality of eggs in the ovaries decreases with age.

The unfortunate news is that even if the cancer involves other areas of the body and requires certain types of chemotherapy or radiotherapy, these very treatments may harm the reproductive system.

Preserving fertility for the future

For men, the options are extraction and storage of sperm and/or testicular tissue before the cancer treatment. Freezing of semen is an established technique for adult males, but it is difficult in adolescents. For adolescents as well as pre-pubertal boys, testicular tissue may be harvested before cancer therapy and frozen for future use.

For women, a wide range of options is now available, depending on the patient’s age, diagnosis, and treatment modality:

• Conservative surgery
  Fertility-preserving cancer treatment may be possible in the early stages of some cancers. Th ese include conservative surgery for early stage cancer of the cervix or ovary. For early stage endometrial cancer, hormonal therapy may be considered to induce regression of cancer.
• Freezing of embryos
  Freezing of embryos may be performed if the patient is married. Th ese embryos are obtained through ART or IVF. Hormonal injections are required, followed by egg/oocyte retrieval. Th e eggs are then fertilised with sperm to form embryos which are frozen for future use.
• Freezing of eggs or ovarian tissue
  Freezing of eggs or ovarian tissue is considered more experimental as a method to preserve fertility, although successes have been recorded. Today, eggs can be frozen with minimal damage using a technique of rapid freezing called vitrification. Vitrified eggs have been thawed for fertilisation to form embryos resulting in healthy pregnancies. Ovarian tissue, which may be obtained by laparoscopic or minimally-invasive surgery, can be frozen, then thawed and transplanted back into the patient at a future time.

It is important to discuss options with your doctor to decide on the safest and most suitable option. A multi-disciplinary approach is required, with close collaboration between cancer doctors, anaesthetists, haematologists and, if the patient is a child, paediatricians.

It has been estimated that one in 250 young adults will be childhood cancer survivors. The five year survival rate at all cancer sites has improved from 56 to 75%. With the recent advances in fertility preservation for cancer patients, international guidelines now recommend that these options be discussed with the patient. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during the treatment planning process.