After the initial shock of a cancer diagnosis, a patient’s immediate thoughts are probably about how soon cancer treatment can begin. But what many women of child-bearing age don’t think about before it’s often too late is what chemotherapy, radiation and other cancer-killing medications may do to her future fertility. With October being Breast Cancer Awareness month, I thought it would be a good idea to touch on how cancer and its treatment options can affect a woman’s fertility and ways that we can help through fertility preservation.
Forty to eighty percent of female cancer patients become infertile after cancer treatment and for women of child-bearing age, this can be quite devastating, especially if they have yet to start a family. With the rising trend of delaying childbearing, more female cancer patients are diagnosed without having completed their families and thus it is vital to provide reliable fertility preservation methods for these young women.
For women in their 20s and early 30s, fertility preservation most often means using advanced cryopreservation (freezing) techniques to freeze a woman’s oocytes (unfertilized eggs) to store for future use. During an egg-freezing cycle, a patient will go through many of the same steps that are involved in a typical in vitro fertilization (IVF) cycle commonly used for women who are having fertility issues. These steps include ovulation stimulation, ultrasound monitoring, and egg retrieval. After egg retrieval, the eggs are cultured for a few hours and then frozen the same day. If the woman is married, she may also choose to have her eggs fertilized and cryopreserved to be implanted at a later date.
An emerging technique, ovarian tissue freezing, is another option ideal for prepubertal girls, women who cannot delay cancer treatment, or those unwilling to undergo ovarian stimulation. It requires surgery to harvest a part of the ovary before cancer treatment that is cryopreserved for later use. This healthy ovarian tissue is later grafted back into the pelvic area and then stimulated to produce eggs that can be fertilized through IVF.
Another surgical option is to consider moving the ovaries out of the radiation field entirely. In this procedure, the ovaries are surgically removed from the pelvis and reattached to a place where they will not be subject to such a high dose of radiation.
A fairly new technique for fertility preservation is ovarian suppression with hormone medications which has the distinct advantage of being the least invasive therapy of all the preservation methods. Hormones can be given that “protect” the eggs against the harmful effects of chemotherapy. Recent research suggests that temporary suppression of ovarian function with the hormone LHRHa can significantly reduce the risk of premature ovarian failure (POF) caused by chemotherapy. More research is needed to fully judge ovarian suppression, but early results look to be a promising option prior to beginning chemotherapy.
To help patients determine if they are candidates for any of these options, women should discuss the potential effects of their cancer medicine and treatment on their future fertility with their oncologist as soon as possible. Specifically, they need to ask how can the cancer and its treatment affect their fertility, how quickly does cancer treatment need to start, and how much time will she have to preserve her fertility before starting treatments. If fertility preservation can be started before cancer treatment, the oncologist will then work with the patient and a reproductive endocrinologist to discuss in greater detail all of these options available so the patient can make an informed decision.