Loss of fertility is one of the most pervasive regrets for cancer patients
Dr Sneha Sathe, Fertility Consultant at Nova IVF Fertility Clinic, Chembur (Mumbai) speaks about the links between cancer and fertility and the options available
In recent decades, advancements in cancer treatments have led to a growing population of young cancer survivors of reproductive age. Certain types of cancers, particularly those affecting the reproductive tract or reproductive system are predominantly diagnosed among women of childbearing age. Unfortunately, discussions about fertility preservation services are often overlooked prior to commencing cancer therapy, leaving patients shocked by the potential loss of their fertility after treatment. Studies have shown this to be one of the most pervasive regrets, as, for many of these patients negative impact on fertility is the most traumatic aspect of their diagnosis.
How does cancer affect fertility?
Cancer treatments, including surgery, chemotherapy, radiation and certain other medications, can interfere with various aspects of the reproductive process, potentially affecting the ability to have children. These effects can be temporary or permanent, depending upon factors such as the patient's age, cancer type and stage, and the treatment method.
Surgical procedures such as orchidectomy (testis removal), hysterectomy (uterus removal), and oophorectomy (ovary removal) have an obvious negative impact on future fertility. Additionally, surgeries for tumours in the abdominal or pelvic regions can lead to scarring, potentially obstructing the fallopian tubes or impeding the implantation of a fertilized egg.
The impact of chemotherapy on fertility is dependent on the specific drugs and dosages. Alkylating agents and drugs like cisplatin are known to cause significant damage. Women requiring higher doses or combinations of chemo and radiation therapy in the abdominal or pelvic areas are at higher risk of permanent fertility impairment.
The damage caused by radiation therapy hinges on factors like location, size of the radiation field, and dosage administered. High doses of radiation can destroy many or all of the eggs in the ovaries, leading to infertility and early menopause. Uterine radiation damage can increase the risk of miscarriage, preterm birth, and low birth weight babies.
Medication including hormone therapies, utilized in treating specific cancers like breast cancer in women, can also impact fertility. In most cases, these effects are reversible, and fertility may be restored after treatment.
What is fertility preservation?
Fertility preservation (known as oncofertility in the context of cancer patients), is the process of safeguarding a person or couple's ability to start a family when they choose. Current data suggests that, for most tumours, pregnancy after cancer treatment does not elevate the risk of cancer progression or adverse obstetric and neonatal outcomes. In the light of improved survival rates after cancer treatment, the focus has shifted from merely providing life to enhancing its quality.
What are the available fertility preservation options for women?
Embryo Cryopreservation: This involves an IVF cycle with ovarian stimulation, egg retrieval, fertilization, and subsequent freezing of embryos for potential later transfer. Embryo cryopreservation is a well-established technology that provides a good success rate depending on the number and quality of embryos.
Oocyte Cryopreservation (Egg Freezing): This procedure entails retrieving eggs after ovarian stimulation and subsequently freezing the unfertilized eggs. It is the standard method for preserving fertility in young single women facing cancer.
Oophoropexy (Ovarian Transposition): For women requiring pelvic radiation therapy, this surgical procedure relocates the ovaries to a position outside of the radiation field.
Fertility Sparing Surgery (FSS): This technique aims to retain enough uterine and ovarian tissue to allow for future conception. It may be an option for young women with early-stage cervical cancer and specific types of ovarian and endometrial cancers.
What are the fertility preservation options for men?
Sperm Cryopreservation (Semen Freezing): This procedure involves freezing and storing sperm at a fertility clinic or sperm bank for use later.
Radiation Shielding: Small lead shields can be placed over the testicles to reduce radiation exposure.
Is there a need for collaboration among different specialists while preserving fertility?
The damage caused by cancer treatment to fertility is often irreversible and hence collaborative effort between oncologists and fertility specialists, is of paramount significance. This partnership ensures that cancer patients are not only provided with the best possible treatment for their condition but are also made aware of the available fertility preservation options. By fostering this dialogue, patients can make informed decisions about their reproductive future, adding a layer of hope and empowerment during a challenging time. Together, oncologists and fertility specialists can pave the way for young cancer survivors to embark on their journey towards parenthood, ultimately enhancing their quality of life beyond the realm of survival.