Oncofertility is an interdisciplinary field that focuses on the reproductive concerns of individuals facing a cancer diagnosis and its subsequent treatments. It is essential for several reasons:
- Preserving fertility: Cancer treatments such as chemotherapy, radiation, and surgery can often damage or destroy reproductive organs, leading to infertility. Oncofertility techniques, such as egg freezing, sperm banking, or embryo cryopreservation, allow cancer patients to preserve their fertility before undergoing treatments. This gives them the option to have biological children in the future, even if their reproductive organs are affected by cancer therapies.
- Quality of life: Infertility can have profound psychological and emotional effects on cancer survivors. Preserving fertility gives them the chance to maintain their sense of identity, hope for the future, and overall well-being during and after cancer treatment.
- Improved patient outcomes: Oncofertility practices can positively impact treatment decisions. When patients know they have options to preserve fertility, they may be more willing to undergo aggressive cancer treatments, leading to potentially better long-term outcomes.
- Empowerment and choice: Oncofertility empowers cancer patients to make informed decisions about their reproductive options. By providing them with information and access to fertility preservation methods, they can take control of their reproductive health and make choices that align with their values and desires.
- Ethical considerations: Fertility preservation is an important aspect of respecting patient autonomy and individual rights. Offering oncofertility services ensures that patients have access to comprehensive care that considers not just their cancer treatment but also their reproductive desires and aspirations.
- Research and advancements: Oncofertility research drives advancements in reproductive technologies and techniques. The knowledge gained from studying the impact of cancer treatments on fertility and finding ways to preserve it can have broader implications for other infertility cases and reproductive medicine.
- Family planning: Oncofertility allows cancer patients to consider family planning beyond their cancer diagnosis and treatment. It provides them with options to have biological children when they are physically and emotionally ready, even if that time is after cancer remission.
Methods of preservation
The choice of method depends on factors such as the patient’s age, gender, type of cancer, treatment plan, and individual circumstances. Here are some commonly used oncofertility preservation methods:
- Sperm Banking: This method is applicable to males. Prior to cancer treatment, sperm samples are collected and frozen for future use in assisted reproductive techniques such as in vitro fertilization (IVF) or intrauterine insemination (IUI). Semen samples can be banked at an IVF centre for long durations without any degradation in their quality
- Egg Freezing (Oocyte Cryopreservation): This method is suitable for females who do not have partners. Eggs are retrieved from the ovaries using hormonal stimulation, and they are then frozen and stored for later use. When the individual is ready to conceive, the eggs can be thawed, fertilized with sperm (either from a partner or a donor), and transferred to the uterus.
- Embryo Cryopreservation: This method is applicable to couples or individuals with a partner. Eggs are retrieved and fertilized with sperm in the laboratory, creating embryos with help of IVF. These embryos are then frozen and stored. Later, when desired, the embryos can be thawed and transferred to the uterus for pregnancy.
- Ovarian Tissue Cryopreservation: This method is suitable for prepubertal girls, women with certain types of cancer, or those who cannot undergo ovarian stimulation. Ovarian tissue is surgically removed and frozen for future transplantation. After cancer treatment, the tissue can be transplanted back into the body, where it may resume normal ovarian function and enable natural conception or assist with assisted reproductive techniques.
- GnRH Agonist (GnRHa) Therapy: In some cases, administering a gonadotropin-releasing hormone agonist (GnRHa) before and during chemotherapy can help protect the ovaries from damage. This method may reduce the risk of ovarian failure and preserve fertility. It’s important to note that each oncofertility preservation method has its own considerations, limitations, and success rates. The choice of method should be discussed with a reproductive specialist or oncofertility expert who can provide guidance based on the individual’s unique circumstances and treatment plan. But it’s important to know that these treatment options can be availed at any point of time regardless of which phase of menstrual cycle is going on. Also freezing of gametes for long durations do not degrade their quality nor degenerate them. They will come out in the same condition as they were at the time of freezing.
Oncofertility is essential because it addresses the unique reproductive needs and concerns of cancer patients, preserves fertility, enhances quality of life, empowers patients, and fosters ethical considerations and research in the field of reproductive medicine. It represents a holistic approach to cancer care that considers not only survival but also the patients’ long-term well-being and life goals.
Dr Anshika Lekhi
Senior IVF and Infertility specialist
Co Director IVF
Cloudnine hospital GCR, Gurgaon