Fertility Preservation Before Cancer Treatment
Fertility preservation at a glance
- Before undergoing cancer treatment, men and women can preserve their reproductive potential through cryopreservation: men may freeze a sample of their sperm, and women can preserve their eggs or create and freeze embryos.
- Women may also surgically reposition their ovaries to avoid radiation, depending on the area of the body being targeted.
- There are also fertility preservation options for children who will be going through cancer treatments.
Fertility preservation for men
Before beginning cancer treatments like chemotherapy or radiation, a man can have samples of his semen cryopreserved (frozen) at a fertility center or sperm bank for later use in assisted reproduction treatments. Sperm can be frozen for years then thawed for use in intrauterine insemination (IUI). If the existing cancer has caused sperm count to be low, the limited supply can be used in the future for in vitro fertilization (IVF) in conjunction with Intracytoplasmic sperm injection (ICSI).
Fertility preservation for women
If there is an adequate amount of time before cancer treatment begins, a woman can undergo IVF to retrieve as many viable eggs as possible to fertilize, and then freeze the resulting embryos. IVF embryos can be stored for years through cryopreservation. If the woman does not have a partner to fertilize the eggs, these can also be frozen. Timing of fertility and cancer treatments is important, since the duration of an IVF cycle may delay cancer treatment. The expense of IVF in conjunction with upcoming cancer treatment should also be considered.
If cancer in or near the pelvis will be treated by radiation, the woman’s ovaries may be surgically repositioned further away from the radiation target area, reducing risk to the eggs. Current experimental techniques also include removing and freezing the ovarian tissue to preserve fertility. However, according to the American Society for Reproductive Medicine, this technique may only be offered in an experimental study with proper oversight.
Cryopreservation keeps sperm and embryos viable by freezing them at a very low temperature. After cancer treatment, cryopreserved sperm can be used with the common assisted reproduction techniques of IUI, IVF or ICSI. If the sperm do not survive the freezing process, the man and his female partner may consider donor sperm.
Embryo cryopreservation (freezing fertilized eggs) is currently the best option to preserve a woman’s fertility after diagnosed with cancer or other disease that can cause infertility. Embryos frozen to use in future IVF procedures have high odds of implanting and creating a successful pregnancy, especially when compared to frozen eggs that are thawed then fertilized. However, freezing eggs without fertilization is now possible and increasingly successful. If a woman does not have a partner when diagnosed with cancer, she may opt to use donor sperm to fertilize her eggs or simply to freeze her eggs so that they may be thawed and fertilized in the future once she is cancer-free and wishes to conceive.
Post-mortem sperm or embryo use
If a couple chose to cryopreserve sperm or embryos, but the male partner battling cancer did not survive, the woman is left with the very hard decision of trying for a pregnancy using assisted reproduction, donating the frozen sperm or embryos, or disposing of them. If the female partner did not survive cancer, but she and her partner had embryos created and frozen, the man will also face a similar decision. This choice is difficult emotionally, and may require professional counseling in addition to legal consent.
Detailed instructions about what to do with stored sperm, eggs, or embryos should be given before undergoing cancer or other disease treatments. If the patient preserves reproductive tissue but passes away, his or her reproductive cells cannot be used to achieve a pregnancy unless he or she specifically gave permission for their use.
Fertility preservation for children
If a minor is diagnosed with cancer or other infertility-causing disease, the child’s parents may pursue fertility preservation for their child. This requires consulting with a doctor, oncologist, or reproductive specialist to ensure this would benefit the child. The minor must agree with the decision to move forward with fertility preservation procedures, which may include typical treatments if the minor is of reproductive age, or possible preservation of reproductive tissue.