Cancer is a disease of high impact worldwide since it affects a high percentage of the population. Until recently, cancer was considered an incurable disease, but due to new techniques of chemotherapy, radiotherapy and immunological therapy, survival has improved dramatically. Doctors and patients are currently focused not only on treating the disease but on the quality of life of cancer survivors. This includes fertility preservation. One example is breast cancer. In the United States, the case of women under 40 years of age who have this disease has increased.
Of these, approximately 70% survive cancer, but 42% develop premature ovarian failure resulting in infertility. This is because chemotherapy and radiotherapy treatments have a negative impact on eggs and sperm.
What can be done during cancer diagnosis and treatment?
Fertility preservation, which is an area of expertise in reproductive medicine, allows people during the process of diagnosis and initial treatment of cancer, to have an option to preserve their eggs, ovarian tissue or sperm and to have children who are the product of their own gametes.
There are different types of fertility preservation treatments. The most common and effective techniques are:
- Freezing (cryo-preservation) of eggs in case of not having a stable partner or being single or of embryos in case of having a stable partner. Freezing semen is also used.
- A second technique is the freezing of ovarian tissue. This technique is very useful in women who have not started sexual life or girls who have not started their menstruation. Until recently it was an experimental technique, but it is currently proposed as an innovative and effective technique to achieve fertility preservation.
Cancer treatment should not be delayed, even for fertility preservation. For this reason, there are different treatment options according to the time you have before starting cancer treatment as follows:
- For patients who are less than 1 week old, ovarian tissue preservation should be performed laparoscopically.
- For patients who are between 2-4 weeks old, emergency ovarian hyperstimulation can be performed, which does not depend on the day of the menstrual cycle.
- For patients who are more than 4 weeks old, a conventional controlled ovarian hyperstimulation can be performed that begins on the day the period arrives.
What can be done after surviving cancer?
In general, all the fertility treatments we currently have can be done, taking into account two points. One of them is that the treatment may have destroyed the sperm and eggs as well. If this is the case and they had not been previously frozen, donor eggs or sperm can be used. Second, in some cancers that are sensitive to sex hormones (breast cancer is one of them), it is not recommended to use hormone-boosting drugs. For example, ovarian hyperstimulation, which is used for in vitro fertilization, produces an increase in estrogen levels about 15 times their normal value. In these cases, selective estrogen receptor blockers such as tamoxifen or aromatase inhibitors such as letrozole can be used to prevent the elevation of estrogen levels. In the most common cases in the world that are secondary to breast cancer, the results of the studies carried out so far do not show any difference between the survival and recurrence rates in patients who underwent fertility treatment versus those who did not.
Author: Dr. Iván Montes
