Being diagnosed with cancer is one of the most devastating life events a person can face.
While recent advances in cancer therapy have given many patients hope and have lead to survival rates of approximately 66%, treatments such as radiation, chemotherapy and surgery may have life-altering implications.
For women and men of reproductive age, cancer therapies can often lead to ovarian damage and premature menopause – both of which can have significant impact on current and future fertility.
Thanks to significant advances in reproductive medicine, there are technologies now available that can help to preserve fertility prior to undergoing cancer treatment. The following provides a brief review of these options.
The decision to preserve fertility in the face of cancer is difficult. Decisions regarding the timing of cancer treatment and disposition of the eggs or embryos, should the patient not regain the health needed to carry a pregnancy, are never easy and require the support of family and friends and the expertise of a wide range of health care specialists.
The doctors and staff of USC Fertility are committed to providing you the option of fertility preservation and will do so in an open and frank manner under the guidance of the University of Southern California Research Ethics Board. Please contact us for further information on any of the following fertility-preserving options.
Option: Egg Freezing
Egg freezing offers one option to preserve fertility prior to commencing cancer treatment therapies. With egg freezing technology, multiple eggs can be harvested through the process of in-vitro fertilization (IVF) and frozen. (See Egg Freezing for further detail.)
When the cancer is cured, the eggs can be thawed, fertilized and transferred to the uterus since most cancer treatments do not involve removal or damage to the uterus. However, there are some limitations to this technology. First, from the time the IVF treatment begins until the eggs are retrieved takes 2-6 weeks. Delaying cancer treatment may not be prudent in all cases and requires the input of the oncologist. Second, if the cancer is “estrogen-dependent,” fertility treatments should be modified to reduce the impact of estrogen in the system that could accelerate the growth of the cancer. Other considerations include patient age, whether the uterus will be removed and the stage of cancer.
Alternatives to egg freezing are still very preliminary. Harvesting of ovarian tissue through laparoscopic surgery prior to cancer treatment with subsequent transplant has been done successfully but reports of residual cancer cells in frozen tissue make this option less than optimal.
In Vitro Maturation
Another option is to harvest immature eggs from the ovary without hormonal stimulation, or with limited stimulation and then grow the eggs in the laboratory until they are mature, a process called in-vitro maturation. This option is still preliminary in nature.
The longest-standing practice for women faced with fertility-compromising therapies is to retrieve eggs through IVF, fertilize them with sperm and freeze embryos. Frozen embryos yield acceptable pregnancy rates and are a common part of IVF practice. However, some women may not have a partner or may not be willing to create embryos from an anonymous sperm donor. In such cases, frozen eggs is an excellent option.
When men undergo treatment for cancer, including chemotherapy, radiation and surgery, their reproductive potential is threatened. Cancer itself can also impair spermatogenesis (formation of sperm in the testicle). Sperm cryopreservation prior to initiating life saving treatments offers the opportunity to preserve the ability to father a child. Sperm can be stored indefinitely in liquid nitrogen, even in the setting of poor semen quality that is already impacted by the cancer itself.