|Stephen R. Lincoln,
MD, REI, FACOG
Hearing the words, "I am sorry, but you have cancer" is a devastating, emotional, everything changes moment that no one can really be prepared for. So many decisions have to be made in a short amount of time that it can be overwhelming. For the 140,000 Americans diagnosed with cancer each year under the age of 45, one unfortunately overlooked issue is future fertility.
The 77% survival rate in cancer patients is very heartening, and now we need to address the long term consequences of cancer treatments on reproductive abilities in the future after cancer treatments are completed. Unfortunately, cancer treatments such as chemotherapy, radiation and surgery can all be very effective in treating cancers, but have profound effects on future fertility. Abdominal or pelvic radiation as well as chemotherapy regimens including alkylating agents such as cyclophophamide have very high risks of inducing amenorrhea and premature ovarian failure with permanent sterility. More recently we have learned in those women treated for cancer and who still maintained normal menstrual cycles, their fertility potential nonetheless can still be impaired.
There is hope for cancer patients who want to build a family in the future. The most productive step is to have an immediate consultation with a fertility specialist to discuss and begin fertility treatments before the cancer treatment is even started. The most successful techniques include obtaining and preserving the gametes (eggs or sperm) or creating embryos for couples, all for future use after the cancer treatments are completed.
Sperm banking is one the most successful, least expensive options for men diagnosed with fertility associated cancer such as testicular cancer. Even with very low sperm counts, men can have samples frozen for long periods of time followed by successful outcomes in family building. The Fairfax Cryobank at GIVF has been a world leader in sperm storage for male cancer patients and has the resources to immediately help those with the sudden need to freeze sperm or testicular tissue.
For female cancer patients, several options are available now. The most successful option is for the patient to undergo a stimulated IVF cycle and create embryos for cryopreservation and future use. This requires the use of donor sperm or if the cancer patient has a partner, the use of the male partner's sperm. Embryos can be frozen for many years until after the cancer treatment and risk of remission stage have passed. Once the oncologist physician gives the okay, the patient can then proceed with a frozen embryo transfer cycle.
There are exciting new options for patients who do not want to create embryos, but want to preserve their fertility options before cancer treatments begin. The most promising option is the egg freezing or vitrification process. The patient begins a stimulated IVF cycle and the eggs are harvested as usual, but then frozen for later use rather than fertilized with sperm from a donor or current partner. There are many investigational studies that are showing egg vitrification is a safe effective treatment (including at GIVF). Other investigational options being developed include ovarian tissue freezing, which requires removing part or the entire ovary prior to cancer treatment with later re-implantation. Ovarian tissue freezing currently is not as successful as egg freezing.
Pregnancy after cancer treatment can still be a reality. Patients may no longer be limited to donor egg IVF because of harmful side effects of the cancer treatments, but instead may still be able to have their own biological child with the use of their own eggs. Although the data now is limited, there seems to be no increased risk of cancer recurrence, even in breast cancer in those that become pregnant. There also appears to be no increased risk of miscarriage, birth defects or pregnancy complication. In patients that have a genetically linked cancer, there could be potential risks of inheritance, and an even more exciting future therapy may be the use of preimplantation genetic diagnosis to test embryos for the genetically linked cancers before transfer in an IVF cycle. The most important concern for any newly diagnosed cancer patient is to quickly consult with a fertility specialist to see what options may work for their unique circumstances.
Cancer Treatment and Future Fertility
All forms of cancer treatment may have adverse effects on future reproductive capabilities. Radiation, chemotherapy and surgery all have been shown to have minimal or temporary to severe and permanent damage to future reproduction. Many factors can play a role in predicting possible damage to fertility including patient age, type of cancer, duration of treatment, and length of time before attempting pregnancy. The key to maximum protection and preservation of future fertility is having a timely consultation with a fertility specialist before cancer treatment begins.
Fertility Preservation Options
It is important that the patient receiving cancer treatment realize they are not alone and that they have fertility preservation options from egg and sperm storage to embryo or testicular tissue storage to fertility enhancement. The key to delivering these options is a team of experienced fertility specialists who will conform their services to fit into the treatment plan and schedule of the oncologist with the overriding responsibility for treating the patient's cancer.
The Genetics & IVF Institute is the only fertility clinic in the United States to provide a full range of infertility treatment options for both female and male patients.
- First outpatient fertility clinic in the US
- First fertility clinic in the Washington, DC area to offer elective oocyte freezing
- First and one of the largest sperm banks in the US
- National leader in egg, embryo and sperm storage
The Fertility Preservation Center for Cancer Patients provides patients with the ability to schedule a rapid consultation with a fertility specialist who will work seamlessly with the oncologist to provide integrated service.