There are more cancer survivors today than ever before, with survival rates jumping nearly 10 per cent since the 1990s. With the emergence of the oncofertility specialty, a medical field that merges oncology with reproductive medicine, more focus has been placed on helping people preserve their ability to have children following cancer treatment. Dr. Shu Foong, medical director at the Regional Fertility Program and clinical assistant professor at the University of Calgary, explains how this is done and why it’s so vital.
Q: What cancer treatments have the biggest effect on fertility?
Cancers involving the reproductive system that require surgical removal of the organ, such as ovarian or testicular cancer, would usually pose the biggest risk. However, cancer therapies, like systemic chemotherapy or radiation, could also affect a person’s fertility. Such treatment could damage the finite number of eggs in women, or destroy the germ cells from which men grow sperm, resulting in the inability to make sperm. The oncology team will select the best treatment protocol for the specific cancer, but it is important to note that not all radiation protocols or chemotherapeutic agents will affect fertility in the same way.
Q: What are the options for preserving fertility in women?
The main option for fertility preservation in women is cryopreservation of eggs or embryos. This is commonly referred to as “freezing,” but the science is more advanced and does not involve traditional freezing techniques. These procedures take approximately two weeks and are preceded by ovarian stimulation that can be started at any time in a woman’s menstrual cycle. In certain radiation protocols, a surgical procedure can be done to move the ovary out of the field of radiation. There may also be medications that can be taken to protect fertility during the course of chemotherapy, but the efficacy of these medications are more limited.
Q: What are the options for preserving fertility in men?
Sperm cryopreservation (freezing) can be performed on ejaculated or surgically obtained samples. This is widely available and can easily be arranged by self-referral. Sperm cryopreservation does not require medications to be taken ahead of time.
Q: Are there other factors that affect fertility?
We need to consider all factors in a patient’s medical history that can lead to an increased risk of infertility, such as the age of the patient, family history of early menopause and other co-existing medical conditions. We also need to consider the delay in conception from the time needed to complete cancer treatment and the recommended cancer-free period before an individual should consider having a baby. It is very important to get an early referral to a fertility specialist to allow for a complete evaluation of your individual situation and have all options presented. There needs to be hope.