What is Oncofertility? Understanding Fertility Preservation for Cancer Patients

Cancer is a disease that has the capacity to greatly diminish the quality of life of those who are affected by it. As well, cancer treatments tend to have a negative impact on a person’s fertility. There are many cancer patients who go on to live a full healthy life after successful treatment. In this article, we shall discuss how cancer patients can still go on to build their families, even after their reproductive health has been impacted by the treatments. 

What is Oncofertility?

Oncofertility is a field in reproductive medicine that focuses on preserving the fertility of cancer patients through sperm, egg or embryo freezing ahead of undergoing treatment. Chemotherapy, radiation and surgical procedures in the treatment of cancer often have an impact on reproductive health. Oncofertility is a way to help these individuals to build their families with their biological children in the future. 

In women, cancer treatments could cause damage to the ovaries which leads to ovarian failure. As well, due to the lack of eggs, a woman may experience menopause early. In men, treatments may cause testicular damage which has a negative impact on testosterone secretion and sperm production. When the center where eggs and sperm are produced is damaged, it results in genetically damaged eggs and sperm.  

How Cancer Treatments Affect Reproductive Health 

Cancer treatments affect reproductive health in different ways, depending on the type of treatment. To illustrate this, let us use cancer treatment options for women, which could be in the form of chemotherapy, radiation, or surgical interventions. 

Chemotherapy may reduce or diminish the number of eggs in the ovaries. This in turn reduces the amount of estrogen produced in the body, which impacts the body’s ability to ovulate regularly. 

Radiation therapy, if targeted at the brain, will have an impact on the pituitary gland which produces hormones that signal menstrual cycles. As well radiation could impact the ovaries if targeted at the abdomen, damaging the eggs or the ovaries entirely. 

Surgical procedures such as oophorectomies which move the ovaries, trachelectomies which remove the cervix and upper vagina, or hysterectomies which remove the entire uterus all have an impact on future fertility and the ability to become pregnant. 

The Role of Fertility Preservation Before Treatment

Fertility preservation before treatment gives patients a chance to preserve any healthy eggs and sperm ahead of undergoing treatment. Treatments such as chemotherapy can damage fertility even after one course of treatment. As such it is important for patients to discuss what their fertility preservation options are, if they desire to build families thereafter. 

For men, fertility preservation can be done almost right away. However, for women, fertility preservation is dependent on their menstrual cycle. As a result there may be a delay in beginning their treatment. It is important for women to discuss with a fertility specialist how the delay to accommodate fertility preservation will affect the cancer, and their options for treatment. 

Fertility Preservation Options For Women vs. Men

Fertility Preservation For Women:

There are several options available to assist cancer patients in preserving their fertility. for women fertility preservation includes egg freezing, embryo freezing, ovarian tissue banking and ovarian transposition. 

• Egg freezing involves ovarian stimulation to retrieve the eggs and freezing them once they are retrieved. Embryo freezing involves ovarian stimulation to retrieve eggs and fertilizing them before freezing the embryos. 
• Ovarian tissue banking is usually done when the window for treatment is narrow. It is a surgical procedure that takes a part of, or the full ovary and freezing strips of the outer cortex which contains the eggs. 
• Ovarian transposition is also a surgical procedure that moves the ovaries out of the radiation field prior to radiation therapy. Once treatment is complete, another procedure repositions the ovaries and if they are unaffected after treatment, a person can become pregnant again. 
• Ovarian shielding is another alternative during radiation therapy, where the ovaries are shielded in a way that limits the amount of radiation that penetrates into the ovaries. It is possible for the patient to become pregnant, however perhaps not right away.

Fertilization Preservation For Men:

Options for fertilization preservation for men are similar to those of women and include, sperm banking, testicular tissue cryopreservation, testicular sperm extraction, and gonad shielding. 

• Sperm banking is non-invasive and involves giving several samples of semen by masturbating and ejaculating into a sterile cup. However, this option is used when a patient is producing sperm that can be ejaculated. Pre-pubescent patients would have to consider other options. 
• Testicular tissue cryopreservation involves taking testicular tissue, and preserving it and any sperm cells it may hold for future fertility options. Ideally, this tissue would be transplanted back to trigger the natural production of sperm in the body. 
• Testicular sperm extraction is a surgical procedure that takes sperm cells directly out of the testicles. These are then preserved for family building in the future using assisted reproduction technologies. 
• Gonad shielding is similar to ovarian shielding and is used in radiation therapies. In this case, the testicles are covered with a lead shield to prevent radiation from affecting the testicles during treatment. After treatment fertility will be evaluated to check if the shielding was effective, and to what degree.  

Choosing the Right Fertility Preservation Method

In order to choose the right fertility preservation method, you will have to have consultations with your oncologist and fertility specialist. There are no hard and fast rules in making such decisions, even when cancer is not involved. Some factors professional medical practitioners may consider are your age, the type of cancer you have, the options for treatment, the urgency of treatment, chances of beating the cancer, and the impact treatment is likely to have on your fertility. 

FAQs

Who needs oncofertility treatment?

Oncofertility is recommended for cancer patients and individuals who will undergo cancer treatments that may harm their fertility. This includes patients diagnosed with cancer; patients who will undergo chemotherapy or radiation therapy that may harm their sperm, eggs or reproductive organs; individuals who will undergo surgery to remove their reproductive organs in part or entirely; patients requiring treatments that are gonadotoxic such as lupus and sickle cell disease treatments; and patients who are prepubescent children.

Does chemotherapy always cause infertility?

No, chemotherapy does not always cause infertility. However, depending on the type and dosage of chemotherapy drugs administered, the age of the patient at the time of treatment, the reproductive health of the patient prior to treatments, and whether additional treatments like surgery or radiation will be required. Fertility preservation is a preventative measure because infertility is a possible risk when one undergoes treatment for cancer. 

Can I get pregnant after chemotherapy?

Yes, it is possible to become pregnant after chemotherapy. However, this also depends on a person’s age and ovarian reserve before treatment, the type and duration of chemotherapy received, hormonal function after treatment, and if fertility preservation was done before treatment began. If a patient experiences permanent infertility after treatment, alternatives to family building such as using frozen eggs or embryos, using donor eggs, or surrogacy, can help them fulfill their family building goals. 

Is fertility preservation covered by insurance?

Insurance coverage for fertility preservation varies by state, insurance provider, and the patient’s diagnosis. Some states have laws requiring insurance to cover fertility preservation for cancer patients. Some plans cover egg, sperm, or embryo freezing if deemed medically necessary, and many cancer centers and fertility clinics offer discounted programs for cancer patients. It is always best to check with your insurance provider or consult with a fertility clinic’s financial counselor for clarification.