What is Oncofertility? Understanding Fertility Preservation for Cancer Patients

When a person is diagnosed with cancer, there are many treatment options, some of which involve a combination of treatments. One of the major side-effects of cancer treatments is that people are faced with diminished fertility or complete fertility loss. This poses a challenge to people’s family building goals. 

Oncologists together with fertility specialists have found ways to navigate this dilemma, bringing hope to cancer survivors. By cryofreezing eggs, sperm, or embryos ahead of cancer treatments, cancer survivors have been able to realize their family building goals after treatment. In this article we shall discuss how cancer patients can plan for a future with children through oncofertility. 

What is Oncofertility?

Oncofertility is fertility preservation for cancer patients, a process undertaken before they begin their course of treatment. Cancer is typically treated through surgery, chemotherapy and radiation therapy. Depending on the type of cancer, where it is located and how aggressive it is, a person may be treated using one or more of these protocols. These treatments have been known to have a negative impact on reproduction. 

Some of the ways in which cancer treatments can impact fertility are ovarian damage or failure could lead to early menopause in women. For men, some of the effects treatment has on their reproduction are testicular damage, which could impact the production of testosterone, in turn affecting sperm production negatively. Another crucial aspect of fertility that can be negatively impacted by cancer treatment is DNA, which can get damaged in the course of treatment such as radiotherapy or chemotherapy.

The nature of cancer treatments is that it is not possible to determine whether fertility will be impacted early, during or later in the course of treatment. Therefore patients will be discouraged from building their families during treatments and immediately after. However, they are encouraged to preserve their eggs, sperm, or some embryos prior to their treatments. 

How Cancer Treatments Affect Reproductive Health

Cancer treatments impact fertility in different ways, depending on a person’s course of treatment. Treatment using chemotherapy is typically in pill form or intravenously, which results in the medication flowing through the bloodstream. One of the immediate impacts of chemotherapy is on hormone production, which impacts testicular and ovarian function. This leads to lowered or poor production of sperm and eggs. 

Treatment using radiation therapy is typically targeted at the area where the cancer is located. As a result, only the area that is targeted will be impacted. However, if a person’s cancer is located around the pelvic area or the head, radiation therapy could impact fertility. The pelvic region houses our reproductive organs, and the head houses the pituitary gland which is the control center for hormone production.

Surgical interventions for cancer could affect reproduction, particularly if the surgery is performed on the reproductive organs, or in the surrounding areas. Some surgeries could cause scar tissue to obstruct parts of the reproductive system that are crucial to reproduction. For example blockage of fallopian tubes, or the tubes that transport sperm from the testicles to the penis.    

The Role of Fertility Preservation Before Treatment

As we have seen, the consequences of cancer treatment can be quite severe, this is why preserving their fertility before treatment is crucial for cancer patients. Prior to treatment, it is possible to have access to healthy eggs and sperm which can be used once they have completed treatment and have been given the green light to build their families. 

Fertility Preservation Options For Women vs. Men

When it comes to fertility preservation, the process for men is very different from that of women. Men would typically masturbate and ejaculate into a sterile cup that is provided by the medical facility. It is possible for a man to provide several sperm samples quite immediately. 

Women’s fertility preservation is a much longer process, conducted over the course of some weeks or even months. The reason for this is that the process relies on her natural menstrual cycle.  Additionally for women, depending on the type of cancer and how aggressive it is, preserving her fertility has to be determined in light of her need for treatment. 

Fertility Preservation For Women

Oncofertility for female cancer patients can be done as egg freezing or embryo cryopreservation. A woman can also preserve some of her ovarian tissue, or have her ovaries shifted away from the region of treatment, to be returned after treatment is complete. Let us review how each of these options are conducted.  

Egg and Embryo Freezing

Egg retrieval is conducted over several phases. The ovaries are stimulated to develop more than one egg to maturity using hormones. The growth and development of the eggs is monitored closely, and when ready, they are retrieved in a procedure conducted under sedation. At this point they are assessed for any damage or anomalies, and the healthy eggs can either be frozen or fertilized with sperm. 

If retrieved eggs are frozen at that point, they will be thawed and fertilized with sperm when a person is ready to build their family. If they are fertilized after retrieval, the embryos will be allowed to develop for a few days independently before it is preserved. When a person is ready to build their family, these embryos will be thawed and transferred into the uterus of the person who will be carrying the pregnancy to term. 

Ovarian Tissue Banking

When egg or embryo freezing is not an option for a patient, they have an option for preserve tissue from their ovaries. This process takes the outer cortex of the ovary which contains oocytes, cutting this tissue into strips and cryofreezing it. As we had mentioned earlier, fertility preservation is weighed against the treatment a patient would require. This particular option is typically given to patients who have a narrow optimal treatment window.  

Ovarian Transposition

Ovarian transposition is applied when a patient will be undergoing radiation therapy. The ovaries are moved away from the area of radiation in a surgical procedure. They are repositioned surgically after the treatment is complete. An assessment would be carried out to determine if the ovaries were affected in any way by the radiation. If they were not affected, it is quite possible for such a patient to become pregnant.  

Ovarian Shielding

This is another option available to patients who are undergoing radiation therapy. A shield made of lead is placed over the pelvic area during treatment with the aim of limiting the amount of radiation reaching the ovaries. After treatment, an assessment is carried out to check if the radiation had any impact on the ovaries. Similar to ovarian transposition, if radiation has not had a negative impact on a person’s ovaries, it is possible to become pregnant after treatment, although maybe not right away.  

Fertility Preservation For Men

Fertility preservation for men is done through sperm banking, cryopreserving testicular tissue, sperm extraction and gonad shielding 

Sperm Banking

For many men, this is the most straightforward method of preserving their fertility. This is because it is non-invasive and does not take a long time to do. Typically, a man will be given a sterile container in which he is to masturbate and ejaculate into. However, this method is only applicable to patients who have reached or passed puberty, and those who have no obstruction in their reproductive tubes.

Testicular Tissue Cryopreservation

Testicular tissue contains sperm in different stages of development. In order to cryopreserve this tissue, a surgical procedure is conducted, taking a portion of this tissue from the testicles. After treatment, it is possible for this tissue to be transplanted back, triggering natural sperm production and restoring fertility. 

Testicular Sperm Extraction

In patients who cannot ejaculate sperm either because they have not reached puberty, or have blockage in their reproductive tubes, it is possible to extract sperm directly from their testicles. For them, the sperm is examined for any damage or anomalies, and the healthy sperm are preserved until the time that the patient will be able to build their family. Typically assisted reproductive technologies (ARTs) will be applied to family building in such a case. 

Gonad Shielding

Gonad shielding is similar to ovarian shielding in that a shield made of lead is used to cover over the testicles during radiation therapy around the pelvic area. At the end of treatment, one of the aspects of evaluation will be to see if the treatment had any impact on the reproductive organs. One can begin building their family once the doctor clears them to do so.

Choosing The Right Fertility Preservation Method

Typically, a patient cannot simply select the method of fertility preservation they prefer and then go ahead with it. Oncofertility is done in consultation with a fertility specialist and an oncologist. Based on the type, location, and aggressiveness of the cancer being treated, as well, the treatment protocol that will be used and the duration of treatment, contribute to this determination. 

A person’s age, fertility prior to treatment, medical conditions or previous treatments, the likelihood of successful treatment are additional considerations made before professional healthcare providers can provide suitable options for oncofertility. To learn more about oncofertility, contact the team of experts at Utah Fertility Center. 

FAQs

Who needs oncofertility treatment?

Oncofertility treatment is for cancer patients who would like to build their families, but may not be able to do so once treatment is complete.

Does chemotherapy always cause infertility?

Not all the time. Chemotherapy protocols vary in type and duration as well, and these determine how much chemotherapy will impact fertility. 

Can I get pregnant after chemotherapy?

Yes, it is possible for a person to become pregnant after chemotherapy. However, it depends on the chemotherapy protocol applied for their treatment.  

Is fertility preservation covered by insurance?

Fertility preservation is usually covered by insurance. However State Law regulates the conditions for fertility preservation, which in turn determines what insurance will cover. Additionally, the amount covered by insurance is based on a person’s cover. Speak with your insurance provider for details regarding your cover. As well, know that many fertility centers offer discounted programs for oncofertility.