Fertility Preservation in Oncology: Paving the Way to Parenthood

Understanding Oncofertility

Oncofertility is an emerging interdisciplinary field that bridges cancer and reproductive medicine. It focuses on addressing fertility issues in patients undergoing cancer treatment, as these treatments can increase the risk of future infertility. With the rising survival rates due to advances in cancer therapies, there is a growing need to improve post-treatment care, especially regarding fertility preservation. Many cancer survivors still hope to become parents, making oncofertility a crucial aspect of comprehensive cancer care. Counselling patients is very important, as the damage to gametes cannot be reversed after the cancer treatment, and fertility preservation is a boon for their future progeny.?

Effects of Cancer Therapies on Fertility?

Cancer treatments like chemotherapy, radiotherapy, and some surgeries can significantly disrupt the normal working of the reproductive system. Alkylating agents, especially those used as chemotherapeutic drugs, are well-known for their gonadotoxicity, which may cause premature ovarian failure in women, whereas men become azoospermic. Radiotherapy can either permanently or temporarily make one sterile by causing destruction of the ovaries, testes, and hypothalamic-pituitary-gonadal axis. Loss of fertility due to surgical procedures also occurs, particularly when they involve the reproductive organs. All these risks have helped us tailor our strategies towards fertility preservation.

Options for Women to Preserve Their Fertility

A number of options are available to women opting for fertility preservation that can be tailored according to age, cancer type, and the time available before initiating cancer therapy.?

●?????? Oocyte and Embryo Cryopreservation: This is the most established method in which oocytes (eggs) are removed from a woman’s ovary using a transvaginal ultrasound-guided approach, frozen or fertilised through in-vitro fertilisation techniques, and then cryopreserved. With advances in vitrification, success rates have significantly improved. The thaw survival is near 100% in the present era due to improvements in technology, media, and skill set.?

●?????? Ovarian Tissue Cryopreservation: This is still an experimental technique involving freezing ovarian tissue prior to cancer treatment and re-implanting it post-treatment. It is especially useful for girls who have not started puberty yet and women who are in an advanced stage and cannot wait for gamete preservation, which needs around 10-12 days.?

●?????? Ovarian Suppression: By causing a temporary menopause, gonadotropin-releasing hormone (GnRH) agonists help protect ovaries during chemotherapy, thus decreasing ovarian damage. This is especially offered in prepubertal or early pubertal adolescent girls, especially in lymphoma and leukaemia treatments.?

Male Fertility Preservation Options

Globally, the freezing of semen is still the benchmark for preserving fertility in men.?

Sperm Banking: Men are advised to provide multiple samples of their sperm before they begin cancer treatment. These samples are cryopreserved and kept for use later on via Assisted Reproductive Technologies (ART).

Testicular Tissue Cryopreservation: This is one experimental method used for children who are not yet into puberty and cannot produce sperm. The harvested testicular tissue can be preserved for potential future generations of sperm.?

Challenges and Ethical Concerns: Several challenges characterise oncofertility, including the urgency that comes with commencing cancer therapy, and the emotional burden on patients, as well as the possible financial implications that may accompany fertility preservation procedures. Ethical considerations such as determination of minors’ decision-making capacity or what to do with preserved gametes when a patient cannot survive cancer also crop up. A multidisciplinary approach involving oncologists, reproductive specialists, and legal teams is vital to tackle these intricate issues.?

The Role of Healthcare Providers?

As healthcare providers, it is our responsibility to talk to cancer patients about fertility preservation as early as possible after diagnosis. Thorough counselling should include a discussion on the risks of infertility, preservation options that are available, and what can be expected. In order to get individualised and appropriate treatment, patients must be referred promptly to reproductive specialists.?

Striving for Hope and Parenthood Post-Cancer?

Oncofertility offers immense hope to those cancer patients who want to become parents. Integrating fertility preservation into cancer care may enable patients to imagine a future where survival from cancer also means they could one day have their own genetic children. As we continue pushing the frontiers of both oncology and reproductive medicine, the dream of maintaining fertility during cancer therapy is gradually becoming a reality, which in turn fosters optimism and resilience along the journey from being diagnosed with cancer through recovery and beyond.

Dr. Runa Acharya, M.D. (Obs & Gynae) (PGIMER, Chandigarh), FRM, DNB

Clinical Director & Senior Consultant, Reproductive Medicine & Surgery