Treatment of cancers can adversely impact reproductive function and while patients have a strong desire to be informed of existing options to preserve their fertility, not all doctors bring up this topic. Though in such scenarios, a family member or parents of the cancer patient may need to initiate this conversation, we got some doctors on board to spill the beans on how to preserve fertility in patients since cancers of the genital organs i.e. testicular and prostate in males and uterine, ovarian, cervical, vaginal or vulvar in females have a direct impact on infertility.
According to Dr Samar Gupte, Consultant Gynaecologic Oncosurgery at PD Hinduja Hospital and Medical Research Centre in Khar, “Cancer can affect fertility in 2 broad ways. One, the effect of the cancer itself in destroying the potential of the organ to be functional.”
He added, “In women, for example, its genital cancers i.e. cancers of the uterus or ovaries. Uterine or cervical cancer can essentially destroy the uterus to be able to hold a pregnancy. Or ovarian cancer can by the growth itself destroy the ovaries’ ability to produce healthy eggs.”
Causes of infertility in cancer patients:
“Standard surgery for uterine or ovarian cancer involves removal of these organs and that by itself can cause infertility,” Dr Samar Gupte pointed out. He further revealed, “Chemotherapy has the potential to destroy the eggs in the ovary and similarly radiation i.e. high dose X-rays can also permanently damage the ovaries. In patients who suffer from non-genital cancers but need chemotherapy or even radiation to the pelvis, can have infertility.”
Echoing the same, Dr Kshitiz Murdia, CEO and Co-Founder of Indira IVF, elaborated, “A number of cancer treatment options exist that include chemotherapy, radiation therapy, hormone therapy, and immunotherapy among others. They help by effectively killing cancer cells or by blocking cellular pathways that lead to the formation of such cells however, some of these treatments can damage healthy, normal cells required for the body’s daily functioning in addition to the cancer cells. When these treatments are used for cancers in or around the pelvic region of the patient, it can also lead to damage of reproductive tissue, causing infertility.”
Tips on preserving fertility in cancer patients:
Dr Kshitiz recommended, “Genital organs are involved in different processes of the reproductive function such as production of viable sperms, development of mature eggs, and conception. Treatment options for these genital cancers can include removal of parts or whole organs, making an unassisted pregnancy improbable in the future. These individuals may have to opt for donor gametes, donor embryos or pregnancy via surrogacy.”
Offering another solution, Dr Kshitiz said that after proper consultation with their oncologist and fertility doctor, patients may opt for egg and/or sperm freezing before embarking on cancer treatments since some of these patients may be young – in their late 20s or early 30s – and would like to start a family in the near future. He said, “At least 15 eggs are ideally extracted from females, and semen samples from males are collected. These samples are then stored in vials at -196˚C in liquid nitrogen, preserving their viability. Gametes thus frozen can be thawed till 10 years later and patients may use them when they are physically, mentally, and financially ready to have children. Assisted reproductive technology, such as, in vitro fertilisation is a boon for the same.”
Highlighting that the success of this exercise is determined by the age of the person and the number of gametes that were stored, since a few may be discarded after every step of a fertility treatment cycle, Dr Kshitiz simplified, “For instance, a research performed on egg freezing found that 90-97% eggs survive after thawing, 71-79% eggs fertilise with a sperm, and about 41% eggs implant in the uterus. For cancer survivors who would like to become parents in the future, this technique ensures that they do not have to face added complications with fertility after conquering the disease.”
Talking about women with genital cancers i.e. cancers of uterus, ovaries, fallopian tubes, vulva, vagina and pregnancy cancers, Dr Samar Gupte shared that the criteria where some form of fertility preservation is possible includes young women desirous of having children with early stage and less aggressive cancers. “These are patients where limited surgery is possible and maybe one ovary and/or the uterus can be preserved or chemotherapy used may be relatively non toxic or ovary sparing radiation can be done,” he said.
Dr Samar Gupte added, “There are some situations where with the help of fertility experts, one can harvest the patient’s eggs before starting cancer treatment. These eggs can be cryopreserved or if patient has a partner then an embryo can be created (using invitro fertilization techniques) and the embryo can be cryopreserved. These can then be later be used for the same woman if her uterus still exists for a pregnancy of for surrogacy.”
He said that the patient selection criteria are extremely important and at no point does one want to compromise on the young woman’s life in deference to a potential future fertility which may or may not happen. Hence, the decisions to treat young women with cancers and for fertility sparing, is a complex process and involves a team effort.
The gynae-oncologist along with radiation experts, chemotherapy specialists and infertility specialists have to sit together and discuss with the patients and their well-wishers to arrive at a plan of action that is medically most sound and acceptable.