Oncofertility is a relatively new term defined by Merriam-Webster as “a field of medicine concerned with minimizing the negative effects of cancer treatment (such as chemotherapy or radiation) on the reproductive system and fertility and with assisting individuals with reproductive impairments resulting from cancer therapy”. This includes freezing eggs, sperm, or embryos as well as the use of donor eggs or sperm following cancer treatment. Fertility preservation can help take a little pressure off and allow the patient to focus on the emotional and physical goal of getting well without having to worry about the impact on their future fertility.
Patients facing the devastating diagnosis of cancer are often missing crucial information about their reproductive options. Early detection and improved treatments allow cancer patients to live longer, fuller lives and consider quality of life issues including reproductive potential and family building. Many survivors are still in their child-bearing years and some might not have families yet or even be married but are facing treatments that might not allow them to take that journey. This is why it is vital for healthcare professionals to raise patient awareness of fertility preservation and if it is right for them so they have the chance for their own biological children once they’ve beaten their cancer diagnosis. While there are no guarantees, advances in reproductive technology have made it possible for women to preserve their fertility who do not have a partner or who simply prefer not to freeze embryos for personal reasons.
With proper education and understanding, fertility preservation is a valid option for women about to undergo treatments that may affect future fertility. Anyone interested in maintaining reproductive autonomy should have direct access to be counseled about their options and offered treatment if deemed appropriate. Choosing what reproductive options a woman wants for herself offers hope and a tiny semblance of control in a situation they otherwise have absolutely no control over. The key is strong and efficient communication between all healthcare providers to ensure the proper timing is available and there are no contraindications for fertility preservation in conjunction with vital, life-saving treatment.
Why Is Time So Important?
Unfortunately, patients with a cancer diagnosis don’t have the luxury of time, which is the most critical factor in seeking fertility preservation information. The entire medical care team needs to be on the same page about treatment but the sooner a patient speaks with a reproductive endocrinologist, the better. Both egg and embryo freezing are dependent upon the menstrual cycle for the timing to optimize response and there is typically only enough time for one chance before urgent cancer treatments must begin. If a cycle is missed and the patient has to wait a month, they may not have the time they need to complete a fertility preservation cycle.
Sometimes it’s not the treatment, but time itself that has the most effect on fertility. For example, a woman with breast cancer who undergoes surgery, chemotherapy, and follows with oral medication management for 5 - 10 years will have the effects of time on their fertility, in addition to any damage the cancer treatments may cause to their reproductive potential.
How It’s Done (in a nutshell)
Fertility preservation is the same process as an IVF cycle with the eggs or embryos being frozen following retrieval. It is not efficient to retrieve just one egg which is what matures in a typical monthly menstrual cycle. Ideally beginning on day 2 of the menstrual cycle, subcutaneous injections of fertility medications are taken for an average of 8 - 12 days to stimulate multiple follicles to grow and mature in the ovaries. The results are monitored closely with blood work to check hormone levels and transvaginal ultrasound to assess follicle growth. When the follicle sizes and hormone levels are appropriate, the egg retrieval is scheduled. The retrieval usually takes less than 30 minutes, not even enough time to get a pedicure. Overall, a cycle of fertility preservation can be completed in just 10 - 14 days from the time the cycle is initiated. Then the patient can be on their way to life-saving medical treatments knowing that their eggs or embryos are safe and sound until they’ve conquered their diagnosis and are ready to focus on growing their family. *Note: If elevated Estrogen levels are a concern, medication protocols are available to address this and proceed with treatment.
Biggest Regret: Not Knowing
One of the biggest regrets following a cancer diagnosis with successful treatment and remission - No one wants to say, “I wish I had known...” Information is power and in this stressful and overwhelming situation, giving someone the power to choose what they want for their reproductive future is priceless.
Questions to Ask
Is your oncologist and/or surgeon okay with you proceeding with a cycle of fertility preservation?
Is there a dedicated team just for fertility preservation care at the fertility clinic?
Are there clinic restrictions on cycle dates for monitoring and retrieval that may interfere with your treatment timing?
Does the clinic offer special pricing or programs for fertility preservation for medical reasons?
Is egg/embryo storage included in your cycle fee as it may be a while before you consider future family planning?
Is the clinic aware of any programs you qualify for with medication assistance?
What is the embryology lab’s experience of freezing and warming eggs (including statistics)?
As the field of oncofertility continues to evolve, oncologists, surgeons, and fertility specialists need to work together to provide the safest, most appropriate fertility treatment options available to their patients. Even if they don’t move forward with treatment, it is invaluable to have the information about how the cancer treatments and time, in general, may affect their future fertility potential so they can make an informed choice of what’s best for them.
Click here to learn more about Embrace Fertility’s Treatment Partner Program if you’re in this overwhelming situation and want someone with you every step of the way.