If you have cancer, surviving the disease is naturally your first priority. But some patients also need to know how to preserve fertility from cancer treatments such as chemotherapy and radiation. Unfortunately, research suggests that many oncologists are not properly advising cancer patients about their fertility options—even when those patients are just children or adolescents.
A new field called oncofertility is empowering doctors to preserve the reproductive health of women, men and children who are diagnosed with cancer. A leading oncofertility researcher and a breast surgical oncologist from the Northwestern University Feinberg School of Medicine have written a guide to help doctors guide patients through new technologies that preserve fertility and the threats posed by cancer treatments.
"Doctors are focused on saving a patient's life and are not used to thinking about preserving a patient's fertility and incorporating fertility preservation into her or his care," said Jacqueline Jeruss, lead author and a surgical oncologist at Feinberg. "When a young patient is diagnosed with cancer doctors feel like it is a medical emergency, even when there may be time to consider fertility before treatment begins."
The guide, developed from the latest research, offers strategies based on each kind of cancer, age and gender of the patient. Woodruff and her Northwestern colleagues also recently launched Myoncofertility.org, an interactive website that educates patients about the possible effects on fertility of cancer treatments and options to preserve it. Here is a summary of the fertility options you may consider:
Embryo Freezing
This is a standard option that cancer patients can take advantage of to preserve fertility. It involves harvesting eggs from the ovaries, in vitro fertilization and freezing the resulting embryos, which can be implanted at a later date. Thousands of children have been born from this technique, and it can be done before or after cancer treatment.
Egg Freezing
If you're single, you may be able to have your eggs frozen. Although it's more difficult to freeze eggs than embryos and the technique is still considered experimental, about 300 to 400 babies have been born worldwide using the technique of freezing and thawing unfertilized eggs. Also, doctors are using new techniques to improve the success rate of this procedure; for instance, Teresa Woodruff, co-author of the guide and chief of fertility preservation at Feinberg, led a research team that has successfully grown undeveloped eggs to near maturity in the laboratory.
Ovarian Suppression
For this fertility option you're given Gonadotropin Releasing Hormone (GnRH) analogs or antagonists to suppress your ovaries. It's used in conjunction with chemotherapy, but doesn't protect your reproductive system against radiation.
Ovarian Tissue Freezing
This procedure is also considered experimental. It involves freezing of the ovarian tissue and having it re-implanted after cancer treatment. According to NUFSM, so far two live births have been reported from this procedure.
Ovarian Transposition
During this standard procedure, your ovaries are surgically repositioned away from the radiation field. It must be done before you receive cancer treatment. Altered blood flow, and the possibility of exposure to scatter radiation, limits the efficacy of this procedure which has about a 50 percent chance of resulting in pregnancy.
Shielding of the Gonads
This standard procedure may help to reduce scatter radiation and protect your reproductive organs. However, it doesn't protect your reproductive system from the effects of chemotherapy, and it can be done only with certain radiation frequencies and on certain parts of the body.
Third-party Assistance
In some cases, you may need to consider the help of a third person to have a child. This could mean using donor eggs or sperm to conceive, hiring a surrogate to conceive and carry your baby, or adoption.
A few things to keep in mind: Some fertility options may require delaying your cancer treatment, and others may not be available to you if you've already started cancer treatment. Plus, the costs of preserving your fertility from cancer treatment varies widely—some may be included in the cost of treatment, others range from about $500 per month for GnRH treatment, to well over $100,000 to hire a surrogate.
Make sure you discuss all your fertility and cancer treatment options carefully with your oncologist. You can also learn more by visiting the Northwester University website, myoncologyfertility.org.
