Cancer Treatment and Infertility
Options for Having a Baby after Cancer Diagnosis and Treatment
Cancer is a life threatening diagnosis. Fortunately, life-saving treatments are available to increase the chance of survival in many patients. Unfortunately, many of these treatments are damaging to the reproductive organs and the patients’ fertility.
Cancer Treatments Associated with a High Risk of Infertility
Certain cancer treatments have a higher risk of infertility. In a review of nearly 20 years of literature, the Journal of Clinical Oncology reported that the greatest risk of infertility was caused by the chemotherapy group called alkylating agents, which includes
- Cyclophosphamide
- Ifosfamide
- Nitrosoureas
- Chlorambucil
- Melphalan
- Busulfan
- Procarbazine
Total body irradiation may also present a high risk to fertility. The procedure may be used in combination with chemotherapy to kill diseased cells or suppress the body’s immune system in preparation for a transplant of stem cells or marrow.
Oncofertility: Providing Fertility Treatment Options to Cancer Patients
Doctors’ primary concern is curing cancer in patients. However, they are increasingly aware of the patients’ desires to preserve fertility, giving rise to the field of oncofertility. Doctors may try to decrease the risk of infertility with lower doses of treatment or more localized radiation, or they may suggest fertility treatment options before cancer treatment.
Fertility Preservation Options for Males
Men have long been able to successfully reproduce via sperm cryopreservation. Even though some cancers cause a reduction in the quality of the sperm, patients who are open to IVF procedures have a good chance of having children after treatment. There are also procedures for retrieving sperm in males who are unable to produce a semen sample.
Unfortunately, sperm cryopreservation is not available to prepubescent males. However, an experimental procedure may be available in the future to cryopreserve testicular tissue for later transplantation.
Fertility Preservation Options for Females
For women, the most established fertility treatment is embryo cryopreservation. This procedure involves fertilization of harvested eggs. Time involved with harvesting eggs may require a delay in the cancer treatment, and the hormone stimulation could cause a problem if the cancer is hormone sensitive. The doctor and patient will need to openly discuss the risks versus the benefits of this treatment.
Embryo cryopreservation may also create a series of situational dilemmas for the cancer patient. Creating and freezing embryos requires a partner’s sperm. Therefore, a single patient would have to use donor sperm. Additionally, some patients will have an ethical objection to the creation and cryopreservation of the embryos.
There are other experimental treatments available to patients for whom embryo cryopreservation is not an option. One of the most promising is the cryopreservation of ovarian tissue, in which part of the ovary is removed and frozen for transplantation at a later date. In the future, freezing ovarian tissue may be an established ethical method of fertility preservation.
Research in the field of oncofertility is promising. Along with their increased chance of survival, cancer patients are now facing more options for preserving their future generations. Additional research is necessary to establish safe and efficient methods of fertility preservation; for now, the future looks hopeful.
