Cancer & Fertility Preservation
Cancer and fertility preservation at a glance
- Because cancer and its treatment can sometimes damage fertility in men, women and children, specialists often take steps to preserve a patient’s fertility before treatment begins.
- Fertility preservation techniques increase an individual’s chances of conceiving after undergoing fertility-damaging cancer treatments such as radiation and chemotherapy.
- The most common way to preserve fertility involves freezing and storing eggs, embryos or sperm for use in future in vitro fertilization (IVF).
- Testicular or ovarian tissue banking is also available for children who have yet to enter puberty. However, this is still considered experimental and is not widely available.
How does cancer treatment affect fertility?
Cancer treatments such as radiation, chemotherapy and surgery can sometimes affect a man’s or woman’s ability to have children. It’s important for those of childbearing age (or parents of children diagnosed with cancer) to speak to their oncologist about possible fertility implications prior to starting treatment.
For women, this should be done as soon as possible because preserving their fertility often requires IVF procedures that take time to set up and must be coordinated with their cancer treatment. Sometimes women need to weigh their desire to preserve fertility against the need to begin cancer treatment as soon as possible.
Not all cancers or their treatments affect fertility. Many people treated for cancer, especially those treated as children, go on to have a family of their own later in life. The chance of infertility from cancer treatments depends on the type of cancer, the stage of its progression, the type of treatment, and the woman’s age.
Cancer treatments affect fertility in several ways, some permanent and others temporarily:
- Strong radiation or chemotherapy drugs can cause damage to egg and sperm quality, hormone levels critical for reproduction, a woman’s ovaries, uterus and cervix.
- Removal of organs vital to conception (the uterus or ovaries) ends fertility.
- Men may experience lowered ability or an inability to make sperm.
There is no evidence that fertility preservation procedures themselves directly affect the overall success of cancer treatments. The most important consideration of fertility preservation methods is balancing a patient’s desire to preserve fertility with saving his or her life.
Oncofertility at Women & Infants’ Fertility Center
The field of oncofertility, which merges oncology and reproductive medicine, has grown in its ability to preserve the reproductive future of men, women and children facing a cancer diagnosis.
Dr. Eden Cardozo specializes in oncofertility and fertility preservation, staying on the cutting edge of research. She recently attended a meeting for Northwestern University’s Oncofertility Consortium, the nation’s leading cancer fertility preservation initiative and uses her expanding knowledge to grow and develop the oncofertility program at Women & Infants’ Fertility Center.
Our approach to oncofertility involves a collaborative effort between our team of reproductive endocrinologists, the Women & Infants cancer care team, as well as a host of other specialists in our area.
We also work in tandem with on-site psychologists and social workers that help guide patients toward their specific treatment plan.
Fertility preservation procedures for males with cancer
- Sperm banking, also called sperm freezing, is a noninvasive procedure to collect, freeze and store sperm (called cryopreservation). The sperm can then be thawed and used in IVF and in intracytoplasmic sperm injection (ICSI) if it is an element of IVF.
- Sperm aspiration is a newer option for young boys who have yet to reach puberty. In this procedure, immature sperm cells are surgically removed using a small needle or surgical incision, then cryopreserved and stored for future use.
- Testicular tissue freezing is an experimental procedure for boys who have yet to go through puberty. In this approach, a lab technician saves sperm by freezing testicular tissue.
In all scenarios, fertility specialists use sperm later to fertilize an egg in a laboratory using IVF.
Fertility preservation procedures for women with cancer
Female cancer patients wanting to have children someday may consider one of the following methods to give themselves the best chance of building a family.
- Embryo freezing is the most established technique to preserve a woman’s fertility, according to the American Society for Reproductive Medicine (ASRM). During this process, patients undergo IVF, which first includes extracting a woman’s eggs. The eggs are then mixed in the laboratory with either a partner’s sperm or donor sperm and, if successful, the resulting embryo is frozen and stored.
- Egg freezing, which is similar to embryo freezing, and involves extracting and cryopreserving unfertilized eggs for future use in IVF.
- Gonadal shielding places shields in the woman’s pelvic area to protect reproductive organs from radiation exposure. This technique is not used with chemotherapy, as that may damage the organs even with shields in place.
- Ovarian transposition surgically repositions the ovaries as far away from the radiation field as possible. This procedure is used when radiation is used on the pelvis without chemotherapy.
- Ovarian tissue cryopreservation is also an option for prepubescent girls who haven’t yet ovulated. An oncofertility surgeon removes the ovarian tissue and cryopreserves it. After the cancer treatment and the return to good health of the girl, the ovarian tissue is implanted near the fallopian tube where it may possibly produce eggs in the future. This remains an experimental procedure.
- Use of suppressive medications such as Lupron which prevent active egg development in the ovary. This approach remains somewhat controversial but is widely used.
These fertility preserving techniques are generally used in cases of non-aggressive cancers. Ovarian tissue cryopreservation is classified by ASRM as an experimental procedure, though a promising one, and several live births using the procedure have been reported.
Oncofertility specialists may use it for women who can’t use other fertility preservation techniques. It is also an option for women who can’t delay the start of their cancer treatment to undergo egg retrieval.
Getting pregnant after cancer treatment
Men and woman who have become infertile due to cancer treatments and did not preserve their eggs, sperm or embryos still have options for having a family. These include:
- Using donor eggs, embryos or sperm to conceive.
- Using surrogacy, an arrangement in which a woman carries and delivers a child for another person.
- Adopting a child.
Individuals with cancer can schedule a fertility preservation consultation with one of Women & Infants’ Fertility Center’s reproductive endocrinologists by calling (401) 441-5336.