Fertility Preservation & Oncofertility

Fertility preservation & oncofertility facts

  • Oncofertility is a form of fertility preservation that takes place before a person undergoes cancer treatment that can harm fertility.
  • Treating cancer with surgery, chemotherapy and/or radiation can cause, or negatively affect, infertility in a person.
  • Risks to fertility relate to the type of cancer and the form of treatment, so it is something you and your physician should discuss. Dallas IVF provides fertility preservation options for cancer patients that include cryopreservation of eggs, embryos and sperm.
  • Our fertility specialists work closely with the patient and his or her oncologist to determine if oncofertility is appropriate.

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What is the oncofertility form of fertility preservation?

Oncofertility merges the fields of cancer medicine (oncology) and reproductive medicine. Cancer treatments can cause infertility in men and women. Oncofertility is a form of fertility preservation that allows people facing cancer treatment to have biologically related children after treatments that can cause or affect infertility. Such treatments are also called gonadotoxic therapies.

Dallas IVF utilizes the same fertility preservation treatments for oncofertility as we employ to treat several forms of infertility. Depending on the kind of cancer and the type of treatment, these include cryopreservation (freezing and storage) of eggs for women, of sperm for men, and of embryos for men and women. Other actions taken during cancer treatment can help spare fertility, such as shielding the woman’s reproductive organs from radiation.

Oncofertility can also involve cryopreservation of reproductive tissue of children undergoing cancer treatment before they reach reproductive age. Cryopreservation of ovarian tissue in girls and women is considered experimental by the American Society for Reproductive Medicine (ASRM) and must be done in a research setting. The same is true for cryopreservation of testicular tissue in boys who haven’t reached puberty.

The importance of time and collaboration in oncofertility

A key concern in oncofertility is time, as fertility preservation treatments need to take place before cancer treatments. Most fertility preservation methods can be initiated near immediately upon diagnosis. Treatments such as in vitro fertilization (IVF) or egg freezing typically take less than two weeks from initial consultation to having reproductive material preserved for the future. ASRM suggests a collaborative, multidisciplinary approach to oncofertility. This requires thorough interaction between the patient, oncologist and the fertility specialist. Dallas IVF also assists oncofertility patients in receiving proper counseling for the psychological and social issues they face.

A related concern is that not all oncologists automatically discuss the option of oncofertility. Patients may need to bring it up and are always welcome to meet with a reproductive specialist prior to initiating cancer treatments.

Not all cancer treatments affect fertility in a person. The type of cancer, its stage, the treatment and the patient’s specific factors all influence the risk of infertility. Some effects on fertility are permanent and some are temporary. Both our fertility specialists and the oncologist will discuss these issues with the patient.

How cancer treatments affect fertility

  • In women, chemotherapy and radiation can damage the quality of eggs, reproductive hormone levels, the cervix, uterus and ovaries. Even when periods return after chemotherapy, a person can still be infertile due to damage to the eggs.
  • In men, chemotherapy and radiation can damage male sperm quality, lowering his ability to produce sperm or stopping it.
  • Surgical removal of the uterus or ovaries in women renders them infertile.
  • Surgery to remove both testicles in men causes infertility. Men are encouraged to undergo oncofertility if one testicle is removed. Even though one can create sperm, there may be issues preventing that testicle from doing so. Male prostate removal or surgery can also result in infertility.
  • The potential from the newer treatments of immunotherapy and targeted therapy to harm fertility has not been studied enough to make a definitive conclusion.

Oncofertility to preserve female fertility

Women wanting biological children in the future and are facing cancer treatments that may cause infertility have several options.

Embryo freezing

This is a common form of oncofertility for women. In order to obtain embryos, a person must undergo IVF, which involves the use of medications to produce multiple eggs. Newer protocols allow patients to start stimulation at any point in their menstrual cycle. On average, it takes less than two weeks between initial consultation with a reproductive specialist and harvesting eggs that can be used to create embryos. When the woman is ready, she will undergo embryo implantation to hopefully achieve pregnancy.

Egg freezing

This involves the IVF steps through egg retrieval, at which point the eggs are frozen to complete the IVF process in the future.

Hormonal medication

Gonadotropin-releasing hormone (GnRH) agonists and antagonists can be used to help prevent the testicles and ovaries from making sex hormones. Injections of GnRH prior to chemotherapy can minimize ovary and testicle activity, making them less likely to be damaged.

Ovarian transposition

This surgical procedure is not meant to replace egg or embryo freezing, but can be used when radiation on the pelvic area is the treatment (not used when chemotherapy is also part of treatment) in the hopes of minimizing damage to ovarian tissue. The surgeon repositions the ovaries away from the field of radiation to protect them. Dallas IVF or the oncologist can perform ovarian transposition.

Gonadal shielding

A surgeon positions shields in the woman’s pelvic area to protect the reproductive organs from radiation.

Freezing ovarian tissue

This experimental treatment is an option for girls who have not begun ovulating. The surgeon removes and cryopreserves ovarian tissue. After the patient recovers back to full health, the thawed tissue is placed near her fallopian tube in hopes that it will produce eggs in the future.

Fertility preservation to prevent male infertility from cancer treatment

Sperm freezing is the most common means of oncofertility in men. A blood test checking for infectious diseases is required by law before sperm freezing. The man provides a semen sample in our office, and our lab performs a semen analysis to verify the quality of the sperm. If needed, another sample may be gathered. The sperm can be used later in IVF or intrauterine insemination (IUI).

 

In prepubescent boys facing fertility-damaging cancer treatment, we can retrieve sperm surgically. Called surgical aspiration, the procedure involves removing sperm that hasn’t matured yet using a needle or a small incision. The sperm are cryopreserved for future use in IVF or IUI.

Freezing of testicular tissue, also considered experimental, can be used for prepubescent boys. Immature sperm in the surgically removed tissue is frozen for future use.

Possibilities for pregnancy without fertility preservation

In someone who has undergone cancer treatments but did not receive oncofertility services to preserve fertility, having a baby can still be possible. Evaluation with a reproductive specialist can help determine if one’s own gonads can be used in assisted reproduction, such as IVF or IUI.  Also, a donor embryo can be implanted in a woman’s womb. A couple or a patient can use donor eggs, which would be fertilized by the male partner’s sperm in IVF. Similarly, donor sperm can be used in IUI or IVF if the male is infertile after cancer treatment.

Surrogacy with a gestational carrier is another option in those who have received hysterectomy or radiation to the pelvis. A gestational carrier is a woman who carries the pregnancy for the intended parents but is not genetically related to the child. This is achieved through IVF, in which the intended mother’s eggs, or donor eggs, are fertilized with her partner’s sperm, or donor sperm, and the resulting embryo developed in the IVF lab is implanted in the gestational carrier. If the intended mother has a frozen embryo, this can also be implanted in the gestational carrier.