An Introduction to Oncofertility
A cancer diagnosis during a person’s reproductive years brings with it a unique set of challenges, one of the most significant being the potential impact of treatment on future fertility. Many life-saving cancer treatments, such as chemotherapy and radiation, can damage the reproductive organs and compromise a person’s ability to have biological children in the future.
Oncofertility is a specialized, collaborative field of medicine that sits at the intersection of oncology and reproductive endocrinology. Its primary goal is to address this issue by providing cancer patients with options to preserve their fertility before they begin their cancer therapy. In comprehensive Turkish cancer centers, a referral for an urgent fertility preservation consultation is considered a standard and essential part of the care plan for young patients who are about to undergo treatments that may affect their fertility.
How Cancer Treatment Can Affect Fertility
The impact of cancer treatment on fertility depends on several factors, including the type of cancer, the type of treatment, the doses of drugs or radiation used, and the patient’s age at the time of treatment.
- Chemotherapy: Many chemotherapy drugs work by attacking rapidly dividing cells. While this is effective against cancer, these drugs can also damage the cells in the ovaries and testicles that are responsible for producing eggs and sperm. This can lead to a decrease in the number and quality of eggs and sperm, or in some cases, complete and permanent infertility.
- Radiation Therapy: Radiation directed at or near the pelvis can destroy eggs in the ovaries and can damage the cells in the testicles that produce sperm. Radiation to the uterus can cause scarring and damage its blood supply, making it difficult to carry a pregnancy in the future. Radiation to the brain can also interfere with the hormonal signals needed for normal reproductive function.
- Surgery: Surgical removal of reproductive organs, such as the ovaries, uterus, or testicles, as part of the cancer treatment will directly impact fertility.
The Critical Importance of Timing
The key to successful fertility preservation is timing. The preservation procedures must be completed before the patient starts their systemic chemotherapy or pelvic radiation treatments. This means that once a young patient is diagnosed with cancer, there is a narrow and critical window of opportunity to act. The oncology team and the fertility specialists must work together quickly and efficiently to coordinate the preservation cycle without causing a harmful delay in the start of the life-saving cancer treatment.
The Oncofertility Multidisciplinary Team
Effective fertility preservation requires a close partnership between the oncology team and fertility experts.
- Oncologist (Medical, Surgical, or Radiation): The oncologist identifies that the planned cancer treatment poses a risk to the patient’s fertility and makes the urgent referral to the fertility specialist.
- Reproductive Endocrinologist (Fertility Specialist): This is the physician who specializes in fertility. They evaluate the patient, explain the available preservation options, and manage the entire preservation procedure.
- Embryologist: A highly skilled laboratory scientist who is responsible for handling the eggs, sperm, and embryos in the IVF laboratory.
- Oncology Nurse Navigator: Helps to coordinate the rapid scheduling of appointments between the oncology and fertility departments.
Fertility Preservation Options for Women
For female patients, the primary goal is to preserve eggs or embryos before treatment begins.
Egg Freezing (Oocyte Cryopreservation)
This is the most common and standard method of fertility preservation for women. The process is essentially the first half of an in-vitro fertilization (IVF) cycle.
- Ovarian Stimulation: The woman self-administers daily injections of fertility hormones for about 10-14 days. These hormones stimulate her ovaries to produce multiple mature eggs in a single cycle, rather than the single egg that would normally be produced.
- Monitoring: During this period, she is monitored closely with blood tests and ultrasound scans to track the growth of the egg follicles.
- Egg Retrieval: Once the eggs are mature, they are collected in a minor surgical procedure. While the patient is under light sedation, the doctor uses an ultrasound-guided needle passed through the vagina to retrieve the eggs from the follicles in the ovaries. The procedure itself is short, typically lasting about 20-30 minutes.
- Freezing: The mature eggs are immediately taken to the laboratory, where they are cryopreserved (frozen) using a technique called vitrification. These eggs can then be stored for many years.
When the patient is cured of her cancer and is ready to start a family, the eggs can be thawed, fertilized with sperm in the lab to create embryos, and then one or more embryos can be transferred to her uterus to attempt a pregnancy.
Embryo Freezing (Embryo Cryopreservation)
This process is very similar to egg freezing, but it involves an extra step. After the eggs are retrieved, they are immediately fertilized with sperm from a partner or a sperm donor in the laboratory. The resulting embryos are then allowed to grow for several days before they are frozen and stored. For women who have a male partner, embryo freezing has historically been considered the most established method with very high success rates.
Fertility Preservation Options for Men
For post-pubertal male patients, fertility preservation is a much more straightforward process.
Sperm Banking (Sperm Cryopreservation)
The standard method is sperm banking. The patient provides one or more semen samples through masturbation. In the laboratory, the sperm is analyzed, mixed with a cryoprotectant fluid, and frozen in vials, where it can be stored indefinitely. This should ideally be done before any chemotherapy or pelvic radiation begins. For men who are unable to produce a sample through masturbation, sperm can sometimes be collected through other methods, including surgical extraction from the testicles.
The Patient Consultation: What to Expect
The oncofertility consultation is a detailed discussion with a reproductive endocrinologist. They will review the planned cancer treatment and explain its specific risks to fertility. They will then outline the available preservation options, including the step-by-step process, the timeline, success rates, and any associated risks or costs. This consultation is designed to provide the patient with all the information they need to make a timely and informed decision about whether to proceed with fertility preservation before starting their cancer therapy.
Frequently Asked Questions
1. How long does the egg freezing process take? Will it delay my cancer treatment?
The entire process of ovarian stimulation and egg retrieval typically takes about two weeks from the start of the hormone injections. Oncofertility teams are highly experienced in working efficiently with the oncology team to complete this process within the narrow window of time available, usually without causing any significant or harmful delay to the start of the planned cancer treatment.
2. Is it safe to use fertility hormones if I have a hormone-sensitive cancer like breast cancer?
This is a very important question. Specialized protocols have been developed for patients with hormone-sensitive cancers. For example, during the ovarian stimulation process for a breast cancer patient, a medication called letrozole is often given alongside the standard fertility hormones. This helps to keep the woman’s estrogen levels low throughout the process, making it a safe option.
3. What is the difference between egg freezing and embryo freezing?
In egg freezing, only the woman’s unfertilized eggs are frozen. In embryo freezing, the retrieved eggs are fertilized with sperm from a partner or donor, and the resulting embryos are what get frozen. Embryo freezing requires a male partner or the use of donor sperm at the time of the procedure. Egg freezing preserves the woman’s future options independently.
4. I am already starting chemotherapy next week. Is it too late for fertility preservation?
The ideal time for fertility preservation is before any chemotherapy is administered. If you have already started treatment, the options become more limited, but you should still ask for an urgent consultation with a fertility specialist. Depending on the drugs you have received, there may still be possibilities.
5. What options are available for young children who have not gone through puberty?
This is a more complex and experimental area of oncofertility. For pre-pubertal girls, the main option is ovarian tissue cryopreservation, where a piece of the ovary is surgically removed and frozen. For pre-pubertal boys, testicular tissue cryopreservation is an experimental option. The hope is that in the future, this tissue can be used to restore fertility. These are highly specialized procedures available at select academic centers.
6. Does having cancer treatment always cause infertility?
Not always. The risk depends on the specific treatments used. Some chemotherapy drugs have a low risk of affecting fertility, while others have a very high risk. The radiation dose and location are also key factors. Your oncologist will be able to give you an estimate of the level of risk associated with your particular treatment plan, which is what prompts the discussion about preservation.
7. Where can I find oncofertility services in Turkey?
Oncofertility services are provided by the Reproductive Endocrinology and Infertility (IVF) departments of major university hospitals and large private hospitals that have comprehensive cancer centers. A referral for a consultation is typically made by a patient’s oncologist as soon as a cancer diagnosis is made in a young person.
