Cancer and fertility. How to preserve the fertility of the sick?

By Reproclinic Editorial Committee
 
Thanks to early diagnosis and treatment improvements, the survival rate of cancer patients has increased. Currently, one of the great challenges of this disease is to continue their life normally, including the possibility of having children, if they wish. Because, usually, oncological treatments tend to have secondary or definitive sterility as a sequel. Thankfully, today’s reproductive medicine allows preserving the fertility of patients diagnosed with cancer and keep open the possibility of having children once the disease has been overcome.

 

Cancer and fertility. What should I know?

 

In general, the drugs that are used to attack cancer cells usually also damage healthy cells and those that intervene in cell division, such as the producers of female and male gametes (sperm and eggs). Therefore, they can affect the fertility of patients.

Before a cancer diagnosis and the need to apply any type of treatment (be it surgical, chemotherapy or radiotherapy), it is important to consult with the specialist the consequences that cancer may have on the patient's fertility. Thus, patients can make the best decision, according to their circumstances.

It is important for you to consult with the doctor all the concerns you have about fertility before the treatment begins. Not all cancer treatments affect fertility, but if the treatment does involve risk, there are different ways to reduce or prevent that risk.

Although there are several options for preserving the reproductive health of cancer patients, many are in the experimental stage. Currently, there are two very effective techniques to preserve fertility in adults:

• Freezing of sperm in men
•  Egg vitrification or embryo vitrification for women.

 

How should fertility be preserved when faced with a cancer diagnosis?

 

First of all, we must bear in mind that the patient's health goes before anything else. It may not be appropriate to delay the start of cancer treatment to preserve fertility. Certain aggressive tumors need to urgently start therapeutic measures, as they can put the patient's life at risk.
The age of the patient and their personal situation (if they have or want to have children later) will also influence the decisions to be considered.

 

The preservation of women fertility

 

Cancer treatments can result in temporary infertility or the development of early menopause in women. The closer a woman is to menopause, the more likely it is that oncological treatments will advance her.

In chemotherapy, for example, patients' survival is prolonged but the probability of preterm ovarian failure is between 53-89%, according to the study of Fertility Preservation in women with breast cancer, developed by Dr. Miguel Angel Checa

The main methods to preserve women fertility are:

Egg vitrification

It is the most appropriate technique to preserve the fertility of patients. In this technique, the woman receives a treatment of ovarian stimulation to induce the maturation of several ovules in the ovaries. Afterward, the extraction and vitrification (freezing) of the ovules is carried out to be used in the future. This technique requires high doses of estrogen, so it is usually discouraged in breast cancer, as they can stimulate tumor growth.

 

Embryo vitrification

As in the vitrification of ovules, the woman undergoes ovarian stimulation. Once the ovules are extracted, they are fertilized in the laboratory with the sperm of the couple or donor and are preserved until they are transferred in the future.

 

The preservation of male fertility

In men, cancer treatments can alter testicular function, generating a decrease or loss of sperm production, both in number and mobility. Also, they can get altered testosterone and produce genetic alterations that affect the DNA integrity of sperm.

The fertility of men suffering from cancer can be resolved by freezing semen samples, a very simple technique that will preserve their fertility until the sample is used in the future. Sperm cryopreservation is best done before starting cancer treatment, as there is some risk of genetic damage to the sperm during treatment. There are other methods that are being studied, such as cryopreservation of testicular tissue and reimplantation.

 

Preserving fertility in children

 

Currently, 75% of childhood tumors are curable. But, unfortunately, these treatments can affect the children's future fertility.

Just like with adults, the preservation of fertility in adolescents is based on the freezing of semen and eggs. But in children who have not yet passed puberty, it is not possible to apply these techniques, because children do not produce sperm or mature eggs.

Currently, several alternatives are being studied, including the cryopreservation of testicular tissue for males and the cryopreservation of ovarian tissue for girls. Both techniques are still experimental.

 

Will I be able to have children after overcoming my cancer?

 

Chemotherapy and radiotherapy are very aggressive treatments that usually have strong side effects in the patient, in the short and long term, including their reproductive health.

The ability of cancer patients to recover their fertility and have children after overcoming the disease depends on a variety of factors:

• Age and sex of the patient
• Type of cancer and the applied treatment
• The area where cancer has developed
• The degree of toxicity that remains in the body after treatment
• Type of drugs used
• The reproductive health of the patient before initiating cancer treatment.

It is very important to consult with your specialist what time he/she recommends to miss before trying to conceive.

In men, for instance, the negative effects of radiation therapy and chemotherapy are usually maintained longer than in women. Recovery usually occurs 3 to 6 months after the end of treatment.

 

What if I can not preserve fertility?

 

The total recovery of cancer patients is always the main objective. For this reason, although it has not been possible to preserve the patient's fertility, there are always alternatives that allow you to make your wish of having a child come true. The donation of gametes (eggs or semen) is usually the first option to be considered. If this option is not viable, you can resort to adoption or surrogacy.

Although the preservation of the fertility of a cancer patient is very important, first and foremost it's their health and recovery.

Ask our specialists for more information! Contact Reproclinic.

 

Medical Director at Reproclinic
Specialist in Obstetrics/Gynecology and Reproductive Medicine