When a young person hears the word cancer, the mind runs to survival first, but for many in their twenties and thirties another silent fear springs almost immediately: will I still be able to have children someday? Better answers than ever are now emerging through the science of oncofertility. Cancer treatments like chemotherapy, radiation and some operations can destroy eggs and sperm or damage the organs that produce them. Going through change of hormones and putting stress on organs can also be risky.
In the old days, patients had a dilemma of beginning treatment fast or saving the chance of having children. Some of that dilemma is being taken away now as doctors and scientists offer more choices more quickly. Both egg and embryo freezing are still the most well established options for many women.
It takes still around two weeks of hormone injections, though time frames have been shortened ever since clinics have managed to start stimulation within a day from diagnosis instead of waiting for a whole menstrual cycle. Extracted eggs can be stored for years. Men have a much easier option in many cases: sperm can be frozen and stored for yearssometimes immediately after providing a sample (or extraction in case of ejaculation issues). Options are more varied but still developing for un-pubertal children and youths. Ovarian tissue freezing involves surgical removal and freezing of a small piece of ovary before treatment commences. The ovarian tissue can be then transplanted on return to the body. This can potentially establish functioning hormones and fertility.
More experimental work is progressing for boys. In a pioneering study, scientists recently demonstrated that supporting cells from cryopreserved testicular tissue from young cancer patients can be reprogrammed into primitive germ cells.1 The science remains in its infancy, but offers future regenerative aid for those with no mature sperm to cryopreserve at the time of their cancer discovery. Another useful procedure is ovarian transposition, which is often performed when pelvic irradiation is planned.
An expert surgeon will move the ovaries from within the irradiation field so that they tend to be spared. In one recent series, two young girls who had ovarian transposition went on to have normal pubertal development and good ovarian function several years later. This highlights how early partnership with the fertility service can Much alter long-term results.
Recommendations of leading cancer organizations incorporate this information into the pre-treatment discussion with all reproductive aged individuals. There are expedited referral pathways in many institutions so that urgent counseling can occur within days of diagnosis. A woman can now freeze her eggs without a partner at a relatively young age, allowing her to have more control over reproductive choices in later life.
Financial support through grants and advocacy organizations has grown although insurance reimbursement remains inconsistent across many states and is a significant obstacle for some. Such stories, like that of Jenilee Crowley, illustrate what these technological advances mean in practice. When diagnosed with early breast cancer on the day after her wedding, Crowley took a break from hormone treatment and froze her embryos in careful consultation with her obstetrician.
