Fertility Preservation in Cancer Patients

Submitted by PatientsEngage on 13 August 2017

Dr Shruti Mohanka, a fertility specialist and gynaecologist at Global hospital in Mumbai helps us understand how fertility preservation should addressed for all young male and female patients undergoing cancer treatment.

Fertility preservation is a critical element of improving quality of life in cancer survivors. Young children and young adults often survive cancer and may wish to have families in the future. They and their families need to be aware that preserving fertility is an option. Too often they are either too overwhelmed or too embarrassed to discuss this with their doctor. This is a discussion they must have with their medical team BEFORE the treatment begins.   

1.    Is fertility discussed with all cancer patients undergoing treatment? When is such a discussion essential?

Fertility should be discussed with all patients undergoing cancer treatment. It is imperative that fertility preservation be performed prior to initiation of cancer therapy.

2.    Which treatments and which cancers affect fertility?

Any cancer treatment that requires radiation therapy can affect a woman’s fertility. In case of reproductive cancers like ovarian and uterine cancers, surgery in the affected area can also affect chances of reproduction. 

(Bladder, Rectal, Testicular cancers are some of the cancers that affect male fertility) 

3.    What age groups are excluded from such a discussion?

Post-menopausal women, and men who have completed their family are excluded from such a discussion. Even pre-pubertal children can have their ova and sperm retrieved and stored.

4.    What fertility preservation options are available for males?

For males, fertility preservation options include semen or sperm cryopreservation. Semen cryopreservation is commonly called sperm banking or freezing. It is a procedure in which sperm is deposited, frozen and stored for either a short term(less than a year) or long term (indefinitely). The sample is screened for certain infections such as HIV, Syphilis, HTLV-1 and Hepatitis. Sperm is usually mixed with liquid nitrogen and secured at temperature of less than -196oC. This sperm can then be used in the future for IVF, artificial insemination or fertility treatment procedures.

In men, who have reproductive cancers or are unable to ejaculate sperm, sperm retrieval may be required. Testicular sperm aspiration or TESA is done with a fine needle inserted into the testicle. A percutaneous biopsy may also be done for some patients which uses a large needle and extracts more sperm.

5.    What fertility preservation options are available for females?

Fertility preservation options for females include:

  1. Egg Freezing is a standard storage method for oocytes or ova. For breast cancer patients, a medication is used to lower the estrogen levels temporarily to stimulate egg collection.
  2. Embryo freezing requires a male partner or sperm donor and takes about 2-6 weeks. It has shown to have high pregnancy rates of 59%.
  3. Ovarian tissue freezing is done for pre-pubertal girls where primordial cells are retrieved and stored.
  4. Ovarian transposition is considered for patients receiving radiation therapy to the pelvis. To prevent the ovary from the effects of radiation, it is moved to the posterior fossa via surgery.
  5. Ovarian suppression involves blocking hormones that stimulate the ovaries so that egg maturation is prevented. This is done via a medication called leuprolide.
  6. Radical Trachelectomy is the removal of the cervix and not the uterus in patients with cervical cancer. This can however increase risk of pre-term birth in future pregnancies.

6.    What are future risks of fertility preservation?

In less than 1% of cases there may be a chance of tumor cells transmitted to the ovum or sperm. To avoid any such risks, a Preimplantation Genetic Test (PGT) is done on the embryo prior to implantation to detect any abnormality.

7.    What is the average length of time for storage of ovum and sperm?

Sperm and ova can be stored for either a short term(less than a year) or long term (indefinitely).
Embryo can be frozen for 10 years.

8.    Are spouses or patients provided with counselling options?

The complete counseling is done by the doctors themselves with in-depth explanation of fertility preservation options. Most consults are done with the spouse present. For underage children (below 18 years of age), parental consent is essential.

9.    How expensive are cold storage facilities or cyropreservation?

Charges for cryopreservation vary from lab to lab but approximately it is:

Rs 25,000 for ovum collection/retrieval,
Rs 5,000 per year for ovum preservation.
Rs 5,000 per year for sperm preservation and
Rs 10,000 per year for embryo preservation.

Dr Shruti Mohanka is a fertility specialist and gynaecologist at Global hospital in Mumbai 

Community
Women's Health and Pregnancy
Cancer
Condition
Breast Cancer
Cancer
Ovarian Cancer

Stories

  • Connected by the thread of pain and love
    Breast cancer survivor and founder of RACE to rein-in-cancer, Rita Banik talks about how cancer changed her life and why she is passionate about helping others. Here, her thoughts on getting a second opinion, staying active, yoga… and more.  Please tell us a bit about your condition.  I am a breast cancer survivor.  I had a relapse of cancer in 2013, in the sternum bone.  So, I am also a cancer patient presently. When were you first diagnosed? March 2006 What…
  • Breast cancer at 31 and getting through Chemotherapy
    Rajita, now 42, looks back on her ‘shock’ diagnosis and treatment, and how she kept going through rough chemo sessions.  Please tell us a bit about your condition and your history.  I was diagnosed with breast cancer at the age of 31.  After I noticed a lump, I went to my gynaecologist as there’s a history of breast cancer in my family. I lost my mother to it at age 56. She suggested needle biopsy. The report of FNAC (fine-needle aspiration cytology) came out…
  • Cancer was just a part of my story
    “On paper, I am better: I no longer have cancer… But off paper, I feel far from being a healthy 26-year-old woman,” said Suleika Jaouad in a New York Times article Lost in transition after cancer, documenting her battered and traumatised state after cancer treatment. Minakshi Ray, who battled breast cancer, responds to that article and offers her take on life after cancer.   That I have got a second chance to live is good enough reason for me to live life more…
  • Breast Cancer
    Breast cancer is the most common cancer among women. Globally, breast cancer accounts for 25.4 per cent of all cancers in women. It can occur in men, but these cases are very rare. Breast cancer originates in the breast tissue, in the inner lining of milk ducts or lobules (milk producing glands) that supply the ducts with milk. Anatomy of the breast The breast lies over the chest or pectoral muscles. A tail of breast tissue extends up to the armpit. The breast is made up of fat, breast tissue,…
  • Management of Breast Cancer
    There are several treatment options for breast cancer.  Food and nutrition Eating right is a key part of cancer treatment. You need to keep your body as strong as possible before, during and after treatment, so you need to take in enough nutrients. Eating a diet rich in  proteins and calories will help your body deal with the treatment, recover faster and ward off infections. This may be easier said than done as some treatments play havoc with taste buds and the digestive system…
  • Breast Cancer Treatment
    There are several ways to treat breast cancer. Treatment depends on the type and stage of the cancer and other factors such as general health and age of the patient. Common methods of treatment are: Surgery: This is the most common form of breast cancer treatment. This involves the removal of the tumour and its nearby surrounding margins. There are many options in surgery such as: Lumpectomy or removal of the cancerous lump in the breast and a small amount of surrounding tissue Mastectomy…
  • Prevention of Breast Cancer
    Can breast cancer be prevented? The chance of developing breast cancer depends on genes, environment and lifestyle. Factors that increase one's chances are called risk factors, while those that decrease one's chances are termed protective factors. Here are some dos to improve your protective factors and don’ts to avoid risk factors: Risk factors Being overweight or obese Smoking Excessive alcohol intake Aging Peronal history of benign or malignant breat cancer Family history of breast cancer…
  • Breast Cancer Tests and Diagnosis
    What tests do you need to have done Early diagnosis of breast cancer significantly improves survival rates. Ninety per cent of women survive if the cancer is diagnosed early. Self-examination Women should examine their breasts once a month. If you are familiar with the feel of your breast, you can notify the doctor promptly about any changes in appearance or feel. According to the Johns Hopkins Medical Center, 40 per cent of diagnosed breast cancers are detected by women who feel a lump. The…
  • Breast Cancer Symptoms and Signs
    The usual symptoms are: Any change in the shape and size of the breast Swelling or lump in any part of the breast Breast pain other than the usual tenderness before periods Any unusual discharge or blood stained discharge from the nipple Redness or scaling of the nipple or breast skin Inverted nipple (turned in) Pitting of the skin over breast like the skin of an orange A lump or swelling in the armpit
  • Causes of Breast Cancer and Risks
    Are you at risk of developing breast cancer? You may be if you  Are female (risk is much more for women than men) Are a woman over 40  (risk increases with age) Have a history of a benign breast conditions such as atypical ductal hyperplasia and fibrocystic breast changes Have a history of breast cancer in one breast which increases your risk of getting cancer in the other breast Have family members (esp mother, aunt, daughter and maternal grandmother) who have had breast cancer…