Guest Columnist
Cancer Therapy and Women’s Fertility
By
Aug 17, 2010 - 12:42:27 PM

(HealthNewsDigest.com) - Each year, cancer is estimated to occur in 113 per 100,000 women under age 50 in the United States. Treatment of cancer has improved dramatically over the past several years, and it is estimated that 77% of patients under 45 survive at least 5 years. The trend toward delaying childbearing means that many patients will not have had children when they are diagnosed. While there is recognition that cancer therapy can affect a patient’s fertility, less than 25% of oncologists inform their patients about their risks and options.

Chemotherapy or radiation therapy for malignant and nonmalignant diseases
often results in premature ovarian failure and infertility. One of the
strongest predictors of emotional well being in cancer survivors, besides
sexual function, appearance, and employability, is feeling healthy enough to
be a good parent. Cancer survivors are often fearful that their history of
cancer or its treatment will have an adverse impact on their offspring by
placing them at risk for malignancy, congenital anomalies, or impaired
growth and development. They are also concerned about the risks of cancer
recurrence, infertility, miscarriage, and achieving a successful pregnancy
outcome.

Despite these concerns, surveys have reported that fewer than 60 percent of
respondents had received information about fertility after cancer treatment.
There are several methods to preserve fertility in women diagnosed with
cancer.

Fertility preservation requires individualization. The optimal approach
depends upon the type of cancer treatment (radiation versus chemotherapy),
time available, patient's age, type of cancer, and whether the patient has a
partner. However, there are no large randomized clinical trials evaluating
the majority of the interventions described below, nor are there long-term
follow-up studies assessing the possible impact of fertility treatment on
cancer survivors.

One option includes In Vitro Fertilization and embryo cryopreservation.
Women who must undergo chemotherapy or radiation therapy may go through
early menopause. In vitro fertilization and embryo freezing will allow a
woman to delay conception until she has completed her treatment, and deemed
in remission, even if treatment causes early menopause. There are several
steps to this including hormone therapy, egg retrieval, fertilization,
laboratory development of the embryo, and freezing. Frozen Embryos can
survive for many years and once the patient is in remission and ready to use
the embryos, the process of transferring the embryos can begin.

Any woman who has gone through normal puberty and still has regular
menstrual cycles may be a candidate for embryo freezing. Success rates
decline as women get older, and are best if women are under 38 years old.
Some women may have poor ovarian function even at a young age, but fertility
tests can predict success rates. Women who do not have a partner may have
the option to freeze eggs. This new technology has led to live births, but
is still considered experimental, and requires a specialized embryology
laboratory.

Egg Donation is also another option. Egg donation allows a woman who has
gone through menopause to carry a pregnancy. The process is similar to in
vitro fertilization, except that a fertile woman (a relative, friend, or
anonymous donor) is given fertility drugs to stimulate multiple eggs to
develop. Once the eggs are harvested, they are fertilized with the infertile
woman’s partner’s sperm (or donor sperm) and the embryos grown in the
laboratory for several days.

The infertile woman receives hormone therapy to develop a normal uterine
environment, and then the resulting embryos are placed in the infertile
woman’s uterus. Hormone therapy is maintained for several weeks and then
pregnancy progresses normally.

Cancer Therapy and Men’s Fertility
Male cancer patients have long been able to preserve their fertility by
freezing their sperm. Unfortunately, sperm quality is often affected by
cancer, and there may be poor sperm quality at the time of diagnosis. Sperm
Banking is a great option for men. Most large cities have sperm banks that
can freeze sperm. If a sperm bank is not located near your home, you can
find sperm banks across the country that can provide long term sperm
storage. The Internet is a great resource, and all reputable sperm banks
have detailed websites.

Options for fertility treatment depend on how cancer therapy has affected
the man’s fertility, and how normal the semen analysis is after treatment.
Options may include artificial insemination with washed sperm if the sperm
is relatively unaffected by cancer treatment, or if frozen sperm are
available from before cancer therapy.

Insemination with donor sperm can allow conception when there are no sperm
present after cancer treatment. If there are any sperm available, even very
poor quality or extremely low numbers of sperm, than in vitro fertilization
can allow conception. Once the eggs have been harvested from the patient’s
wife, the embryologist can pick up a single sperm and inject each egg to
ensure normal fertilization. Live birth rates are excellent with this
procedure, and are largely dependent on the age of the patient’s wife. In
addition, adoption remains an option for family building. There are local
and international adoption agencies, and private adoption through an
attorney may also be possible. Unfortunately, adoption can be very
expensive, and international adoption laws often change, causing frustration
for infertile patients.

All of the above are viable and real options for cancer survivors who wish
to have a family. As the oncology community becomes more aware of fertility
preservation options, these are offered to more patients. There are advocacy
organizations that can help, such as the Lance Armstrong Foundation, and
Fertile Hope, to assist patients as they negotiate treatment options in
their quest for a family.

Carolyn R. Kaplan, M.D. is Director of In Vitro Fertilization at Georgia Reproductive Specialists and specializes in the initial diagnosis of
infertility, egg donation, alternative approaches to the control of
menopause and the holistic approach to infertility treatment. Visit
www.ivf.com for more information.

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