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There are several specific types of cancer treatment that can significantly impact the patient's fertility, therefore it is important to inquire about the methods of fertility preservation prior to the treatment. It is highly important to preserve genetic material prior to starting any kind of cancer treatment, as it negatively affects the reproductive function.
There are several available fertility preservation methods, which are used for females, males and prepubescent children:
- Oocyte cryopreservation
- Semen cryopreservation
- Embryo cryopreservation
- Ovarian tissue cryopreservation (the tissue contains primary follicles)
- Testicular tissue cryopreservation (the tissue contains sperm producing cells)
- Organ preservation surgeries
- Ovarian transposition
- Use of GnRH agonists during chemotherapy
In case of childhood cancer, it is highly important to consider fertility, as the child's body continues to develop and various cancer treatment methods can have an irreversible effect on fertility in the future. It is possible to use ovarian or testicular tissue cryopreservation in order to preserve fertility for prepubescent children. It is possible to use semen cryopreservation, TESA sample cryopreservation or testicular tissue cryopreservation in order to preserve fertility for men. Spermatogenesis is restored right after the transplantation of testicular tissue.
Women, who are diagnosed with breast cancer, uterine cancer, cervical cancer, sarcoma, Hodgkin's and other types of lymphomas must pay attention to fertility preservation. In case of other oncological diseases, each case has to be evaluated individually. Ovarian tissue cryopreservation is advised in case of such diseases as sickle cell anemia, thalassemia, aplastic anemia, as well as for women with autoimmune diseases, who have undergone unsuccessful immunosuppressive therapy or have genetic mutations that present a high risk of premature ovarian failure. Female patients, who are advised not to undergo hormonal stimulation, can undergo ovarian tissue cryopreservation in order to have more oocytes or embryos for vitrification. When planning a pregnancy, ovarian tissues are transplanted back into the ovaries or any other part of the body - for example, the upper arm or the wall of the abdomen. After the transplantation, the reproductive functions are restored - hormones are released and ovarian follicles start to mature.
The most common malignant tumors, which increase the chance of fertility loss are:
- Breast cancer
- Uterine cancer
- Cervical cancer
- Hodgkin's lymphoma
- Non-Hodgkin's lymphoma
- Sarcoma (osteosarcoma, liposarcoma, Ewing's sarcoma, rhabdomyosarcoma)
These malignant tumors commonly occur in the reproductive age and they respond well to treatment. Nowadays combined cancer therapy has a high therapeutic efficacy, which increases the survival rate. Therefore oncology patients often choose to lead a healthy and full life. Patients with a positive treatment prognosis are increasingly more interested in fertility preservation and recovery of the reproductive function.
Types of cancer treatments:
Most commonly, there are three types of cancer treatments - surgery, radiation therapy and chemotherapy (together with cytostatics, hormones and immunotherapy).
After undergoing radiation therapy and chemotherapy, the chance of spontaneous ovarian function renewal and subsequent pregnancy for female patients, who are over 25 years old, does not exceed 5%.
If the treatment plan includes radical surgeries, abdominal or pelvic radiotherapy, high-dose chemotherapy with bone marrow transplant or systemic antitumor therapy, the patient needs to be informed about potential loss of fertility.
Radiation therapy effects:
Abdominal or pelvic radiotherapy can cause deterioration of reproductive tissues: severe ovarian stromal changes, ovarian follicular failure, germinal epithelial damage as well as changes in uterine tissue.
Solution: use of external shields, ovarian transposition, oocyte, embryo, semen, ovarian or testicular tissue cryopreservation.
Effects depend on the age of the patient, duration of the treatment and types of prescribed pharmaceuticals (alkylating agents have the most notable cytotoxic effect on the gonadal function).
Solution: oocyte, embryo, semen, ovarian or testicular tissue cryopreservation, use of GnRH agonists during chemotherapy.
Basic conditions for preserving fertility in cancer patients:
- Female patients under the age of 37, male patients with no age restrictions
- Malignant tumor has been diagnosed for the first time
- Therapy plan, which decreases the chance of fertility loss
- Favourable illness prognosis
- Patient's willingness to preserve fertility
- The decision has been made after consulting other doctors, who are involved in the treatment process
Consultation with an oncologist and reproductologist is necessary in order to choose the most optimal method of fertility preservation.
Oncologist's task: in case of a first-time diagnosis of a morphologically verified malignant tumor, the specialist has to inform the patient, who has reached the reproductive age, about the possible loss of fertility and methods of fertility preservation prior the start of the treatment.
Reproductologist's task: to choose the most optimal method of preserving fertility for the cancer patient.
6 steps to take in case of an oncology diagnosis:
- Histology analysis
- Appointment with a reproductologist in iVF Riga clinic
- Development of a fertility preservation plan with a reproductologist
- Meeting of specialists in reproduction, oncology and chemotherapy
- Participation in a fertility preservation programme