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Unfortunately in India, fertility preservation services are rarely discussed with the patient before starting cancer therapy.
Cancer is a dreaded word, which can have life-altering and heartbreaking consequences. For people who are planning to start a family, a cancer diagnosis can be a major roadblock. Dr Sneha Sathe, fertility consultant at Nova IVF Fertility, Chembur calls it an "immense emotional burden". "Certain types of cancers are predominantly diagnosed among women of reproductive age, and a small proportion of cancers originating in the reproductive tract are also detected in this age group. For young patients, the diagnosis is a shock and then comes another: the risk of infertility," she says.
The doctor points out that unfortunately in India, fertility preservation services are rarely discussed with the patient before starting cancer therapy. "After successfully completing treatment, patients are often confronted with the realisation of loss of fertility. They consider the negative impact of cancer on their fertility as the most traumatic part of their diagnosis," she says.
According to Dr Sathe, cancer surgery or treatments, and sometimes the cancer itself can interfere with some parts of the reproductive process and affect the ability to have children. "The effects might be temporary or permanent. The risk that the cancer treatment will harm fertility depends on the patient's age, the type and stage of cancer and the type of cancer treatment," she says.
For instance,
Surgery: Surgical removal of the testicles (orchidectomy), uterus (hysterectomy) or ovaries (oophorectomy) have a negative impact on fertility. Cancer surgery for other tumors in the abdomen or pelvis can cause scarring in and around the reproductive organs. These may block the fallopian tubes, preventing the egg from traveling to the sperm or preventing the implantation and growth of a fertilised egg.
Chemotherapy: The effect of chemotherapy on fertility depends on the drug and the dose. Alkylating agents and the drug cisplatin are known to cause the maximum damage. Women requiring higher doses, combination regimens or both chemo and radiation therapy to the abdomen or pelvis are at higher risk of permanent damage to fertility.
Radiation: The damage depends on the location and size of the radiation field and the dose. High doses of radiation can destroy many or all of the eggs in the ovaries leading to infertility and early menopause. Radiation damage to the uterus can increase the risk of miscarriage, preterm birth and low birth weight babies.
Other cancer medications: Hormone therapies used to treat certain cancers including breast cancer in women, can affect fertility. The effects are often reversible and fertility may be restored.
"It means preserving the ability of a person, or a couple, to start a family at a time of their choosing. Onco-fertility is a term coined for fertility preservation in cancer patients. Current data suggests that for most tumors, pregnancy after cancer treatment does not increase the risk of cancer progression or of poor obstetric neonatal outcome. The emphasis has moved from providing life to providing quality of life," Dr Sathe explained.
Embryo cryopreservation: The patient needs to undergo an IVF cycle, followed by freezing of the embryos, which are transferred to the womb at a later date.
Oocyte cryopreservation (egg freezing): Eggs are retrieved after ovarian stimulation and the unfertilized eggs are frozen. This is the standard method for preserving fertility for young single women with cancer. Egg or embryo freezing procedures require controlled ovarian stimulation (COS) which takes approximately 2 weeks. The usual ovarian stimulation protocols for routine IVF begin from the second day of the menstrual cycle.
Oophoropexy (ovarian transposition): For women requiring radiation therapy to the pelvic area, the ovaries are surgically repositioned in the pelvis so that they are out of the radiation field.
Radiation shielding: Small lead shields are placed to reduce the amount of radiation exposure to the ovaries.
Fertility sparing surgery: FSS is the technique to retain the patient's uterus and ovarian tissue enough to allow future conception. This may be an option for young women with early-stage cervical cancer and some types of ovarian and endometrial tumors.
Sperm cryopreservation (semen freezing): This procedure involves freezing and storing sperm at a fertility clinic or sperm bank for use at a later date.
Radiation shielding: Small lead shields are placed over the testicles to reduce the amount of radiation exposure.
