Fertility preservation in the face of a positive cancer diagnosis is stressful, but often these fast decisions are ones that we will be so grateful for down the track. Dr. Raewyn is here to help with fertility preservation in oncology and has guided and supported endless couples along this journey. And, as a breast cancer survivor herself, she is acutely aware of the emotions and fears you may be experiencing.
Dr Raewyn can discuss the myriad of fertility preservation options available based on your personalised treatment plan. This will ensure you have plenty of options in the future, should you wish to start a family.
The ‘wait and see’ approach
You may wish to go ahead with your cancer treatment and assess how and if your fertility is affected afterwards. There is no right or wrong choice here, but it may lead to disappointment down the track if you decide to have a baby. This is an option that should be discussed with your oncologist at length before commencing treatment.
Egg Freezing
“We frequently freeze eggs for women who have received a cancer diagnosis and are about to undergo chemotherapy, as chemotherapy can trigger menopause,” explains Dr. Raewyn.
At such a stressful time, egg freezing provides the hope and a chance that they may be able to have a healthy, happy baby later on.
“The harvest and egg freezing procedure involves an IVF cycle and can be expedited within 24 to 48 hours after they receive their diagnosis,” says Dr. Raewyn.
“Their oncologist will refer the woman to our clinic, where we have methods in place to fast-track the procedure for these cases. Out of pocket expenses are also usually minimised for fertility preservation treatments.”
Ovarian tissue freezing (Cryopreservation)
This involves a laparoscopic operation to remove some ovarian tissue. In younger patients, this usually results in the removal of a large number of immature eggs.
Following removal, the tissue is frozen and stored until it can safely be returned to the patient. It is believed that new blood vessels will start to grow and establish once the transplanted tissue is returned, producing hormones that will help ripen the eggs.
If this happens, the IVF process may be used to help mature, collect and fertilise the eggs, or alternatively it may be possible to mature the ovarian tissue itself in the laboratory to produce mature eggs for IVF.
Freezing ovarian tissue has similar implications to egg freezing with some tissue dying during the thawing process. It is also important to note that there may be an increased risk of transmitting cancer cells back into the body and that removing some of the ovary may reduce fertility outcomes should it return naturally following cancer treatments.
Ovarian suppression during treatment
Ovarian suppression during chemotherapy for hormone receptor negative breast cancer (HER negative) is thought to help protect the ovaries and improve the chances of protecting fertility during treatment.
It involves using a drug known as GnRHa – gonadotropin-releasing hormone analog, such as Zoladex, or goserelin. This drug blocks the hormone signals the ovaries to develop and release the eggs.
Research indicates that in pre-menopausal women, this option in combination with chemotherapy may in fact protect fertility. GnRHA used throughout chemotherapy is also thought to reduce the chance of the cancer returning, therefore improve the survival of patients with this type of breast cancer.
Ovarian suppression does not impact the commencement of cancer treatments; however, it can be costly, and it is important to discuss the benefits and risks to you based on your personal situation.
Options for Men
Some men may face infertility in certain cancer treatment programs. Because of this, we have treatments in place to preserve the sperm for use down the track. These include obviously harvesting a sperm sample and keeping the sperm or sperm tissue frozen until it is ready for use.
If radiation treatment is necessary, the risk of infertility will vary depending on the area treated, the dose and the number of treatments. Again, freezing sperm is your best bet here. It’s also important to note that some chemotherapy and radiation treatments have been linked to birth defects in children, so it is best to use contraception if you are sexually active during your cancer treatment.
Some male surgeries, such as removal of testicles or prostate, can lead to infertility. Again, harvesting and storing sperm or sperm tissue can help improve your chances of becoming a father later in life.
