|Year : 2018 | Volume
| Issue : 2 | Page : 86-88
Strategies for fertility preservation in young patients with cancer
Devika Gunasheela, Jyothi Menon, N Ashwin
Gunasheela Fertility Centre, Bengaluru, Karnataka, India
|Date of Web Publication||22-Feb-2019|
No. 1, Dewan N Madhava Rao Road, Basavanagudi, Bengaluru - 560 004, Karnataka
Source of Support: None, Conflict of Interest: None
Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.
Keywords: Cortical tissue cryopreservation, embryo preservation, fertility preservation, Oocyte preservation, semen preservation
|How to cite this article:|
Gunasheela D, Menon J, Ashwin N. Strategies for fertility preservation in young patients with cancer. Onco Fertil J 2018;1:86-8
| Introduction|| |
Cancers most frequently diagnosed in adults aged 25–49 years include breast, colorectal, and cervical cancers and malignant melanoma (Cancer Research UK, 2009). Five-year survival rates of over 90% for many malignancies are now reported in young people. Advances in cancer therapy have given a chance for a good percentage of patients suffering from malignancies to avoid or at least extend their span of enjoyable and productive life. The diagnosis and treatment of cancer often poses a threat to fertility. Methods of fertility preservation are evolving quickly, and awareness needs to grow in the medical community regarding these methods. The possible future effects of chemotherapy or radiotherapy on fertility should be discussed with all cancer patients who have reproductive potential. Maximum attempts should be made to preserve the gonadal function of young men and women treated with cancer drug therapy. This article covers the various methods of fertility-preserving options in young men and women.
| Cancer Scenario in India|| |
There are around 30 lakh cases of cancer at any time in India. Eleven lakh new cases of cancer are diagnosed every year. Death rates are 6 lakh/year. Two-third of cases are at advanced stage at the time of diagnosis. The Indian Council of Medical Research predicts that figures of new cancer patients are likely to reach 17.3 lakhs in 2020. In Karnataka alone, there could be nearly 1.5 lakh cancer cases at any given time, and about 35,000 new cancer cases are added to this pool each year. One in eight Indians is likely to develop cancer in their lifetime. Five-year survival for breast cancer is approaching 90%. Over a period of 20 years between 1976 and 1996, the survival rate of childhood cancers has risen from 56% to 75%.
| Effects Of Cancer And Its Treatment On Fertility|| |
Male reproductive system
Spermatogenesis is a highly prolific process. The germinal epithelium is extremely sensitive to the effects of chemotherapy and radiotherapy. Radiation doses of only 0.1–1.2 Gy can impair spermatogenesis and doses of >4 Gy may cause permanent damage to both stem cells and differentiating spermatogonia. Spermatogenesis declines during the 3–6 months following treatment for testicular cancer, but steadily recovers thereafter.,
Female reproductive system
The mechanism of injury in the female reproductive system is not entirely understood. There is atrophy with a marked loss of primordial follicles and oocyte depletion. There could be injury to blood vessels and ovarian cortical fibrosis as a result of radiotherapy. The greatest threat is a combination of intensive chemotherapy and total body irradiation. The type of therapy is important – alkylating agents cause amenorrhea in 77%. Total body irradiation causes amenorrhea in 100%.,
Fertility preservation strategies for females include the following:
- Pharmacological protection
- Ovarian transposition
- Oocyte cryopreservation
- In vitro fertilization (IVF) and cryopreservation of preimplantation embryos
- Cryopreservation and transplantation of ovarian tissue.
Fertility preservation strategies for males involve cryopreservation of semen.
Semen can be stored indefinitely in liquid nitrogen. The inherent risks of freezing and thawing sperm include damage to sperm and reduced capacity to fertilize. Sperm concentration and motility may already be compromised because of the patient's health. It is the depositor's responsibility to remain in contact with the facility.
| What Can Be Done With Frozen Semen Samples?|| |
- Requires at least 10 million motile sperm per insemination
- Almost always requires multiple samples.
In vitro fertilization
- Best for limited number of samples
- Good success rates
Intracytoplasmic sperm insemination
- Can be used for low sperm numbers
- Good success rates even with low numbers
- Slightly more expensive than IVF.
| Gunasheela Institute Of Research In Cancer And Fertility (Charitable Trust)|| |
Gunasheela Institute of Research in Cancer and Fertility found its inception in 2010 with a noble purpose of helping patients suffering from various cancers in the reproductive age group to preserve fertility despite their ongoing cancer therapies.
Patients referred for fertility preservation are evaluated, given thorough counseling on the impact of cancer therapies on fertility and the importance of fertility preservation prior to cancer therapy.
This program is an ongoing social initiative by Gunasheela Institute of Research in Cancer and Fertility, and fertility preservation has been offered and continued as a charitable program from 2010 till date for all male and female patients.
Statistics of fertility preservation program in Gunasheela Institute of Research in Cancer and Fertility
285 male patients have undergone fertility preservation from December 2010 to April 2018 in Gunasheela Institute of Research in Cancer & Fertility. Patients belong to age group of 15 to 40 years with 62% of patients belonging to age group of 21 to 30 years.
Distribution of cancers is as follows.
31 female patients have undergone fertility preservation from December 2010 to April 2018 in Gunasheela Institute of Research in Cancer & Fertility.
Distribution of various cancers among female patients include:
Fertility preservation stratergy distribution among female patients:
| Conclusion|| |
Fertility preservation in cancer patients can only be approached with a multidisciplinary setting. Increasing long-term survival rates along with advances in fertility treatment mean that it is now perpetual that fertility preservation should be offered to these patients. However, patients must be willing to take the gamble and the surgeon must be anxious to offer the treatment available. There are many obvious challenges and ethical issues that still need to be resolved, especially in the area of fertility preservation in prepubertal patients.
ASCO guidelines and recommendations
As part of education and informed consent before cancer therapy, health-care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists.
Although patients may be focused initially on their cancer diagnosis, the update panel encourages providers to advice patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation.
The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available.
Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Waring AB, Wallace WH. Subfertility following treatment for childhood cancer. Hosp Med 2000;61:550-7.
Nandakumar A, et al.
National Centre Disease Informatics and Research, ICMR Annual report 2016-2017: 26-33.
Thomson AB, Critchley HO, Kelnar CJ, Wallace WH. Late reproductive sequelae following treatment of childhood cancer and options for fertility preservation. Best Pract Res Clin Endocrinol Metab 2002;16:311-34.
Bahadur G, Ralph D. Gonadal tissue cryopreservation in boys with paediatric cancers. Hum Reprod 1999;14:11-7.
Warne GL, Fairley KF, Hobbs JB, Martin FI. Cyclophosphamide-induced ovarian failure. N Engl J Med 1973;289:1159-62.
Richardson SJ, Senikas V, Nelson JF. Follicular depletion during the menopausal transition: Evidence for accelerated loss and ultimate exhaustion. J Clin Endocrinol Metab 1987;65:1231-7.
Williams RS, Little RD, Mendenhall NP. Laparoscopic oophoropexy and ovarian function in the treatment of Hodgkin disease. Cancer 1999;86:2138-42.
Tulandi T, Al-Took S. Laparoscopic ovarian suspension before irradiation. Fertil Steril 1998;70:381-3.
Homburg R, van der Veen F, Silber SJ. Oocyte vitrification – Women's emancipation set in stone. Fertil Steril 2009;91:1319-20.
Silber S. Ovarian Transplantation: New Technique gives Greatly Improved Results in this Delicate Operation. Abstract No: O-037. 25th
Annual Conference of the European Society of Human Reproduction and Embryology. Amsterdam, The Netherlands; 2009.
Aslam I, Fishel S, Moore H, Dowell K, Thornton S. Fertility preservation of boys undergoing anti-cancer therapy: A review of the existing situation and prospects for the future. Hum Reprod 2000;15:2154-9.
Rosenlund B, Sjöblom P, Törnblom M, Hultling C, Hillensjö T.In vitro
fertilization and intracytoplasmic sperm injection in the treatment of infertility after testicular cancer. Hum Reprod 1998;13:414-8.
Lee SJ, Schover LR, Partridge AH, Patrizio P, Wallace WH, Hagerty K, et al.
American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006;24:2917-31.
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