Fertility preservation in cancer patients
Women diagnosed with cancer can experience the unique journey of pregnancy and become mothers!
Each year in Greece, nearly twenty thousand cases of cancer are recorded in women. About 10% of these women are under 40 years old, and therefore of reproductive age. Unfortunately, most women mistakenly believe that their dream of motherhood is lost forever upon diagnosis.
Previously, fertility was often a collateral loss of cancer treatments. Damage to reproductive organs from chemotherapy or radiation significantly reduces or eliminates the chances of conception if no fertility preservation method is applied.
Today, patients have multiple options for preserving fertility and do not need to worry about their reproductive health, provided they are informed and follow one of these options.
The most important factor patients need to know is that timing is crucial. For the best results, patients are counseled before the start of any chemotherapy or radiotherapy. Key factors are assessed, including the patient’s age, type of malignancy, treatment plan, and medication doses.
For male patients, options are relatively simple. Sperm freezing is the most common procedure, but in rare cases, testicular tissue cryopreservation is used. Frozen sperm, even in small quantities, can later be used with in vitro fertilization (IVF).
If a female patient’s cancer treatment can be delayed for two weeks, the two most common fertility preservation procedures can be applied: egg freezing or embryo freezing.
Significant progress has been made in the field of fertility. Previously, a four- to five-week cycle was needed for ovarian stimulation and egg retrieval. Now, the same results can be achieved in just two weeks, regardless of where a woman is in her menstrual cycle. In addition, over the past three years, egg freezing techniques have improved significantly. Thanks to a new technique called vitrification, outcomes are much better in terms of egg survival, fertilization, and the possibility of a future pregnancy.
The presence of a partner influences which of these two procedures is the best choice. If the patient is not in a stable relationship, egg freezing is recommended. For women with a stable partner, embryo freezing is preferred. Even in such cases, some couples still choose egg freezing.
If treatment cannot be delayed, an alternative option is laparoscopic removal and freezing of ovarian tissue. Once the patient recovers from treatment, the removed tissue can be re-implanted to restore ovarian function and egg production. For women with gynecologic cancers or cancers requiring pelvic radiotherapy, ovarian transposition is an option. In this procedure, the ovaries are moved out of the radiation field to minimize damage and preserve ovarian function.
Fertility preservation is a new collaborative field between Oncology and Reproductive Medicine. As survival rates after treatment for malignancies continue to increase, it is essential to focus on aspects related to the quality of life of survivors. Fertility is clearly one such aspect.
Collaboration between fertility preservation programs and oncology or breast clinics ensures immediate referral and timely, accurate information. Patients should be informed early about their options to preserve fertility so that no opportunities are missed.