What is Oncofertility? Understanding Fertility Preservation for Cancer Patients

Many people desire to build families at a point in their lives. Assisted reproductive technologies have granted more autonomy for women in their family building choices and at the same time provided solutions for people who otherwise thought they could not have biological children. As well, ARTs have provided a way for differently structured families, such as same sex couples to have children who carry their genes. One area in which ARTs have been particularly  valuable is in the preservation of fertility.

Fertility preservation in simpler terms is cryofreezing eggs, sperm or embryos in order to use them later to build families. While many may opt to cryofreeze out of preference, others cryofreeze for medical reasons. The treatment of cancer tends to have a negative impact on a person’s fertility, even when treatment is successful. Let us discuss oncofertility; how reproductive health is managed in the face of cancer treatments. 

What is Oncofertility?

Oncofertility is a specialized area of fertility preservation for cancer patients prior to their treatments. Depending on the cancer that is being treated, chemotherapy, radiation or surgical procedures may directly affect a person’s ability to build their family naturally. Sometimes, the impact to reproductive health is immediate, and in other cases, it could be during the course of treatment. 

Cancer treatments could lead to ovarian damage and failure, which in turn could lead to early menopause. As well, they could cause testicular damage, resulting in poor testosterone secretion, which in turn could lead to poor sperm production. Chemotherapy or radiation could result in damage to the DNA which would affect the embryo negatively. Consequently, cancer patients are discouraged from building their families during and for a time after their treatment.   

How Cancer Treatments Affect Reproductive Health 

There are many ways that treatments for cancer impact the reproductive system. This is based on the type of treatment being administered, whether chemotherapy, radiation or surgery. Chemotherapy is typically administered intravenously or orally, in the form of pills. The production of testosterone in the testicles or estrogen in the ovaries can be impacted. When key hormones cannot be efficiently produced in the body, the result is that a woman’s ovarian reserve will be diminished impacting regular ovulation, as well, a man is likely to produce less sperm.

Radiation therapy is a more targeted treatment restricted to the region being treated. However, if the treatment is being administered on the pelvic area, it could impact the ovaries and testicles, damaging the eggs and sperm. If being done on the head, such as in brain tumours, it can affect the pituitary gland which is central to the regulation of hormone production.  

If the cancer requires surgical intervention on or around the reproductive organs, it could have an impact on reproduction and future fertility, where parts of the reproductive organs such as ovaries or testicles may be removed, or where the reproductive system is removed entirely, such as in hysterectomies.   

The Role of Fertility Preservation Before Treatment

Since the effects of cancer treatment could cause irreversible damage to the reproductive system, cancer patients are advised to consider preserving their fertility before undergoing treatment. This allows them the opportunity to preserve whatever healthy eggs and sperm they may have at the time. When they are ready to build their families after treatment, then they can have the use of healthy eggs and sperm. 

Fertility Preservation Options for Women vs. Men

Fertility options for men and women differ because of the process of collecting their sperm and eggs. Men typically masturbate and ejaculate into a sterile container in order for their sperm to be collected. This means that they can do fertility preservation as soon as they desire, in a matter of minutes. 

Egg retrieval for women is not so direct. It is a process that has to be synchronized with their natural menstrual cycle. As well, it could take anywhere from weeks to months. This in turn has an impact on their options because fertility preservation has to be weighed against delayed treatment.

Fertility Preservation for Women:

Fertility preservation for female cancer patients has a few options which include egg or embryo freezing, or ovarian tissue banking or ovarian transposition. Let us look at what each process entails.  

Egg and Embryo Freezing

These two options are available once a woman’s eggs are retrieved. The process of egg retrieval is done in several phases. Typically, in a menstrual cycle, only one egg matures per cycle whereby it is fertilized or a woman experiences menstruation. When ovarian stimulation protocols are applied, the ovaries develop several mature eggs simultaneously within that cycle. These eggs are retrieved, counted and examined before they are either frozen as they are, or fertilized then frozen a few days thereafter as embryos. 

Ovarian Tissue Banking

This option is given to women for whom egg or embryo freezing is not a viable option. This occurs when one has a narrow treatment window, whereby the best odds of survival are based on how quickly treatment must begin. Ovarian tissue banking is done by surgically taking a part of, or a full ovary and freezing the outer cortex containing the eggs in strips. 

Ovarian Transposition

Ovarian transposition is an option where radiation therapy is being used as the mode of treatment around the pelvic area. It involves temporarily moving the ovaries away from the field of radiation, surgically. After treatment is complete, a second procedure will be done to reposition the ovaries, and if they are unaffected by treatment, it is possible for a person to become pregnant.  

Ovarian Shielding

This option is another way of protecting the ovaries from the impact of radiation around the pelvic area. A shield made of lead is placed on the pelvis during treatment , to limit the amount of radiation that reaches the ovaries. When treatment is complete, a person can become pregnant, however, it is recommended that they wait for a period of time after treatment, before they try.  

Fertilization Preservation For Men

Similar to women, men can preserve their fertility through sperm banking, testicular sperm extraction, testicular shielding cryopreservation and gonad shielding. 

Sperm Banking

This is the quickest and least invasive procedure for fertility preservation. A man will be required to provide several sperm samples by masturbating and ejaculating into a sterile container. This is the first line of sperm collection, where the patient has no issues producing sperm that can be ejaculated. If the patient has not yet reached puberty, other options of oncofertility are considered. 

Testicular Tissue Cryopreservation

This method of oncofertility is a surgical procedure that takes some testicular tissue and preserves it. Sperms are produced within the testicles and can be found in different stages of development here. Once a patient has completed their treatment, the tissue can be transplanted back, which in turn will trigger the natural production of sperm in the body. 

Testicular Sperm Extraction

This is another surgical option for male oncofertility, where a person cannot ejaculate sperm. This procedure retrieves sperm from the testicles and after they are examined, they can be preserved. Typically, when the patient is ready, the preserved sperm would be used in ART therapies for family building. 

Gonad Shielding

This method is used when cancer treatment is done through radiation to the pelvic area. For this, a lead shield is used to cover over the testicles to limit the amount of radiation that could affect the testicles during treatment. Once treatment is complete, a fertility evaluation would be conducted in order to check whether a person’s fertility was affected in any way by the treatment. 

Choosing the Right Fertility Preservation Method

For a cancer patient, consultations with an oncologist and fertility specialist must be done alongside each other. In this way, the best course of treatment can be determined having weighed the options of fertility preservation in light of the necessary cancer treatment. Oncofertility depends on the type of cancer being treated, the type of treatment being administered, the duration of treatment, the window within which treatment must begin, a person’s age and other health or medical conditions, a patient’s reproductive health prior to treatment, and the odds of treatment being successful. Contact the fertility specialists at Dallas Fertility Center to learn more. 

FAQs

Who needs oncofertility treatment?

Oncofertility treatments are for cancer patients who will undergo cancer treatment that could harm their reproductive organs, but still desire to build their families once they have completed their treatment.

Does chemotherapy always cause infertility?

Chemotherapy does not always cause infertility, as it is dependent on the type of chemotherapy treatment prescribed, the age of the patient before treatment begins, the course of treatment, and if additional interventions would be required. 

Can I get pregnant after chemotherapy?

Yes. Once can become pregnant after chemotherapy, but this also depends on whether oncofertility was conducted prior to treatment, how long treatment lasted, as well as the aftereffects of treatment. If one becomes infertile permanently, then there are family building alternatives one could consider such as surrogacy or adoption.  

Is fertility preservation covered by insurance?

Insurance coverage for fertility preservation varies by state based on fertility preservation laws. The sum insured per insurance provider varies based on a person’s cover. As well, there are discounted programs for oncofertility at many fertility and cancer centers. It is recommended that you consult with your insurance provider and your care teams at the cancer center and fertility centers.