Oncofertility is a specialized field that focuses on addressing fertility for individuals who are undergoing cancer treatment. When diagnosed with cancer, the primary concern is often fighting the disease and undergoing necessary treatments such as chemotherapy, radiation therapy, or surgery. However, these treatments can have adverse effects on reproductive organs, and may affect hormone production or lead to fertility issues or even infertility.
Cancer treatments, while crucial for combating the disease, can damage the reproductive
system in both males and females. In women, chemotherapy and radiation therapy can harm the ovaries and potentially lead to a decrease in the number of eggs or early menopause. In men, treatments can affect sperm production and quality. These reproductive side effects can affect hormone production and affect an individual’s ability to have genetically related children in the future.
This blog sheds light on the importance of oncofertility and provides information about the options available to individuals undergoing cancer treatment. It aims to raise awareness about the impact of cancer treatments on fertility and emphasize the significance of discussing fertility preservation options with healthcare providers before starting cancer therapy.
Understanding Fertility and Cancer Treatment
Fertility preservation is a vital consideration for individuals undergoing cancer treatment, as certain cancer therapies can significantly impact reproductive health. Understanding how cancer treatment affects fertility and exploring available options for fertility preservation is crucial for those who wish to have children in the future.
Types of Cancer Treatments and their impact on fertility
Cancer treatments such as chemotherapy, radiation therapy, and certain surgeries can directly or indirectly affect fertility. Chemotherapy drugs, for example, are designed to target rapidly dividing cells, which include both cancer cells and reproductive cells. This can lead to a decrease in the number and quality of eggs in women and sperm production in men. Similarly, radiation therapy to the pelvic area can damage the reproductive organs and impact their function.
The impact of cancer treatment on fertility varies depending on the type of cancer, the specific treatments used, the dosage, and the individual's age and overall health. It is important for patients to have open and honest discussions with their healthcare team about the potential effects of treatment on fertility.
Fertility Preservation and Oncofertility Treatment Options
Oncofertility treatment options encompass various methods of preserving fertility for individuals facing cancer treatment. These options provide the opportunity to safeguard reproductive cells to allow for future family-building possibilities and in some cases help preserve endocrine function and hormone production.
Fortunately, there are several fertility preservation options available to individuals before they start cancer treatment. These options include: oocyte cryopreservation, sperm cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, and ovarian suppression during cancer treatment.
Oocyte Cryopreservation (Egg Freezing):
Oocyte cryopreservation involves the extraction and freezing of a woman's mature eggs. Before cancer treatment, the woman undergoes ovarian stimulation to encourage the production of multiple eggs. These eggs are then collected from the ovaries via an oocyte retrieval procedure performed under anesthesia and frozen through a process known as vitrification. In the future, when she is ready to conceive, the eggs can be thawed, fertilized with sperm in the laboratory, and transferred to the uterus as embryos to attempt to achieve pregnancy.
Sperm Cryopreservation (Sperm Freezing):
Sperm cryopreservation is a method where a man's sperm is collected and frozen for later use. Prior to cancer treatment, the man provides a semen sample, which is then processed and preserved through a freezing process called cryopreservation. The frozen sperm can be stored for an extended period. When the man desires to have children in the future, the thawed sperm can be used for various assisted reproductive techniques, such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Embryo Cryopreservation: Embryo cryopreservation involves ovarian stimulation followed by removal of the eggs (oocytes) from the ovaries via an oocyte retrieval procedure performed under anesthesia. The mature eggs are then fertilized in the laboratory with sperm from a partner or a donor. Heterosexual couples with severe male factor infertility, single women or women in same sex couples can fertilize eggs with donor sperm for embryo cryopreservation. After fertilization occurs, the resulting embryos are monitored in the laboratory as they continue to develop over the next several days. The high-quality embryos are then frozen using the vitrification technique. In the future, when the individual or couple is prepared for pregnancy, the frozen embryos can be thawed and transferred to the uterus to attempt pregnancy.
Ovarian Tissue Freezing: In certain cases, women who cannot undergo ovarian stimulation or are not able to delay the start of their cancer treatment can opt to have a piece of their ovarian tissue removed and frozen. This tissue may be able to be used to help achieve pregnancy in the future.
Ovarian Suppression: A certain class of medications called GnRH agonists may help prevent ovarian damage related to chemotherapy by suppressing the menstrual cycle. This stops the ovarian cells from cycling rapidly and may allow them to “hide” from the chemotherapy. This medication is typically given throughout the chemotherapy treatment.
Factors to consider before undergoing Oncofertility Treatment
Before undergoing oncofertility treatment, there are several factors to consider that can impact the decision-making process and overall experience. These factors include:
Cost of Oncofertility Treatment:
Oncofertility treatments can involve significant financial implications. It is essential to understand the costs associated with each treatment option, including procedures, medications, laboratory services, and long-term storage fees. At Audubon Fertility we have special financial programs available to our Oncofertility patients which our financial team reviews with patients at their initial consultation.
Insurance Coverage for Oncofertility Treatment:
Reviewing your health insurance policy is crucial to determine if oncofertility treatments are covered and to what extent. Some insurance plans provide coverage for fertility preservation procedures, while others may have limited or no coverage at all.
Age and Fertility:
Age plays a significant role in fertility potential. Women's fertility declines with age, and the quality and quantity of eggs decrease over time. It is important to consider your age and ovarian reserve when deciding on the most appropriate oncofertility treatment option. At Audubon Fertility we will review your history, diagnosis, treatment plan, age, and ovarian reserve to inform a personalized discussion of fertility preservation options and develop a personalized fertility preservation plan that aligns with your specific needs and treatment timeline.
Timing of Oncofertility Treatment:
The timing of oncofertility treatment is crucial. Oocyte or embryo cryopreservation can often be accomplished in as little as 3 weeks if necessary. It is recommended to consult with a reproductive specialist as early as possible before initiating cancer treatment. Some cancer treatments can cause immediate or rapid fertility decline, making it important to discuss fertility preservation options before starting treatment.
Availability of Oncofertility Treatment:
Not all medical centers or fertility clinics offer oncofertility treatments. It is important to research and identify reputable clinics or centers with expertise in oncofertility. Consider factors such as the clinic's experience, success rates, and the availability of specialized services required for oncofertility treatment.
Challenges in Oncofertility
Oncofertility, the intersection of oncology and fertility preservation, presents several challenges that individuals may face when considering fertility preservation options. Some of the key challenges include:
Cost: Fertility preservation procedures, such as oocyte cryopreservation or embryo cryopreservation, can be costly. The expenses involved in consultations, medical procedures, medications, and long-term storage fees can add up. For individuals already facing the financial burdens of cancer treatment, the cost of oncofertility can present an additional challenge. At Audubon Fertility we have special financial programs available to our Oncofertility patients which our financial team reviews with patients at their initial consultation.
Time: The urgency and time sensitivity of cancer treatment can pose challenges for individuals considering fertility preservation. Cancer treatments often need to be initiated promptly, leaving limited time for fertility preservation procedures. Oocyte or embryo cryopreservation can often be accomplished in as little as 3 weeks if necessary. However, the need to coordinate cancer treatment and fertility preservation can create time constraints and add stress for patients. Additionally, some cancer treatments may not allow a 3 week delay for fertility preservation procedures. At Audubon Fertility we work with our Oncofertility patients and their oncology team to determine the most appropriate treatment plan for each individual clinical situation.
Limited Access: Access to oncofertility services can be limited, particularly in certain geographical areas or healthcare settings. Not all hospitals or fertility clinics may have the specialized expertise or resources required to offer comprehensive oncofertility care. This limited access may necessitate traveling to specialized centers or facing logistical challenges in seeking appropriate care.
Oncofertility plays a vital role in preserving fertility during cancer treatment, offering hope and options to individuals facing the challenging journey of cancer. Understanding the impact of cancer treatments on fertility and exploring oncofertility treatment options can provide a sense of control and a path toward building a future family.
It is crucial to have open and honest discussions with medical professionals who specialize in oncofertility, such as the experts at Audubon Fertility. They have the knowledge and expertise to guide you through the process, address your concerns, and develop a personalized fertility preservation plan that aligns with your specific needs and treatment timeline.