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Fertility Preservation For Cancer Patients/Onco Fertility

Fertility Preservation for Cancer Patients and Survivors

Oncofertility is a medical field that bridges oncology and reproductive endocrinology. Oncofertility aims to maximize the chances that cancer patients and survivors can have a family despite their illness.

We know that life-saving cancer treatments—including chemotherapy, radiation, and surgery—can interfere with a person's ability to have children later in life. While the priority used to be surviving the cancer diagnosis, current higher survival rates mean that fertility preservation strategies are increasingly important. For women, these therapies can cause ovarian damage, early menopause, or other reproductive problems. For men, treatments can cause damage to the testes, which interferes with sperm production.

How does cancer treatment affect fertility?

Certain cancer treatments can harm your fertility. The effects might be temporary or permanent. The likelihood that cancer treatment will harm your fertility depends on the type and stage of cancer, the type of cancer treatment, and your age at the time of treatment. Cancer treatments and their effects might include

Surgery: Fertility can be harmed by the surgical removal of the testicles, uterus or ovaries.

Chemotherapy: The effects depend on the drug and the dose. The most damage is caused by drugs called alkylating agents and the drug cisplatin. Younger women who receive chemotherapy are less likely to become infertile than are older women.

Radiation: Radiation can be more damaging to fertility than chemotherapy, depending on the location and size of the radiation field and the dose given. For example, high doses of radiation can destroy some or all of the eggs in the ovaries.

Other cancer medications: Hormone therapies used to treat certain cancers, including breast cancer in women, can affect fertility. But the effects are often reversible. Once treatment stops, fertility might be restored.

When should I talk to my doctor about fertility preservation?

If you are planning cancer treatment and want to preserve your fertility, talk to your doctor and a fertility specialist as soon as possible. A fertility specialist can help you understand your options, answer questions and serve as your fertility advocate during your treatment. Your fertility can be damaged by a single cancer therapy session, and for women, some methods of fertility preservation are typically done during certain phases of the menstrual cycle. Ask if you will need to delay cancer treatment to take fertility preservation steps and, if so, how this might affect your cancer.

How can women preserve fertility before cancer treatment?

Women who are about to undergo cancer treatment have various options when it comes to fertility preservation. For example

Embryo cryopreservation: This procedure involves harvesting eggs, fertilizing them and freezing them so they can be implanted at a later date. Research shows that embryos can survive the freezing and thawing process up to 90% of the time.

Egg freezing (oocyte cryopreservation): In this procedure, you'll have your unfertilized eggs harvested and frozen. Human eggs don't survive freezing as well as human embryos.

Radiation shielding: In this procedure, small lead shields are placed over the ovaries to reduce the amount of radiation exposure they receive.

Ovarian transposition (oophoropexy): During this procedure, the ovaries are surgically repositioned in the pelvis so they're out of the radiation field when radiation is delivered to the pelvic area. However, because of scatter radiation, ovaries aren't always protected. After treatment, you might need to have your ovaries repositioned again to conceive.

Surgical removal of the cervix: To treat early-stage cervical cancer, a large cone-shaped section of the cervix, including the cancerous area, is removed (cervical conization). The remainder of the cervix and the uterus are preserved. Alternatively, a surgeon can partially or completely remove the cervix and the connective tissues next to the uterus and cervix (radical trachelectomy).

What can men do to preserve fertility before cancer treatment?

Men also can take steps to preserve their fertility before undergoing cancer treatment. For example

Sperm cryopreservation: This procedure involves freezing and storing sperm at a fertility clinic or sperm bank for use at a later date. Samples are frozen and can be stored for years.

Radiation shielding: In this procedure, small lead shields are placed over the testicles to reduce the amount of radiation exposure they receive.

What can parents do to preserve the fertility of a child who has cancer?

Fertility should be discussed with children treated for cancer as soon as they are old enough to understand. Your consent and your child's might be required before a procedure can be done.

If your child has begun puberty, options might include oocyte or sperm cryopreservation.

Girls who have cancer treatment before puberty can opt for ovarian tissue cryopreservation. During this procedure, ovarian tissue is surgically removed, frozen and later thawed and reimplanted.

One method being researched to preserve fertility in boys who have cancer treatment before puberty is a procedure in which testicular tissue is surgically removed and frozen.

Can fertility preservation interfere with successful cancer therapy or increase the risk of recurring cancer?

There's no evidence that current fertility preservation methods can directly compromise the success of cancer treatments. However, you could compromise the success of your treatment if you delay surgery or chemotherapy to pursue fertility preservation.

There appears to be no increased risk of cancer recurrence associated with most fertility preservation methods. However, there is a concern that reimplanting frozen tissue could reintroduce cancer cells — depending on the type and stage of cancer.

Can cancer treatment increase the risk of health problems in children conceived afterward?

As long as you don't expose your baby to cancer treatments in utero, cancer treatments don't appear to increase the risk of congenital disorders or other health problems for future children.

However, if you receive a cancer treatment that affects the functioning of your heart or lungs or if you receive radiation in your pelvic area, talk to a specialist before becoming pregnant to prepare for possible pregnancy complications.

How do I determine the best fertility preservation option for me?

Your medical team will consider the type of cancer you have, your treatment plan and the amount of time you have before treatment begins to help determine the best approach for you.

The diagnosis of cancer and the treatment process can be overwhelming. However, if you're concerned about how cancer treatment might affect your fertility, you have options. Don't wait. Getting information about fertility preservation methods before you begin cancer treatment can help you make an informed choice.

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