World Cancer Day: Doctors share tips to preserve fertility in cancer patients | Health

Cancer treatment can have a negative impact on reproductive function and although patients are keen to be informed of the options available to preserve their fertility, not all physicians address this topic. Although in such scenarios, a family member or relatives of the cancer patient may need to initiate this conversation, we have doctors on board to talk about how to preserve fertility in patients since cancers genitals, i.e. the testicles and the prostate in men. and uterine, ovarian, cervical, vaginal or vulvar in women have a direct impact on infertility.

According to Dr. Samar Gupte, Consultant in Gynecological Oncosurgery at PD Hinduja Hospital and Khar Medical Research Centre, “Cancer can affect fertility in 2 major ways. First, the effect of cancer itself on destroying the organ’s potential to be functional.”

He added: “In women, for example, her genital cancers, i.e. cancers of the uterus or ovaries. Cancer of the uterus or cervix can essentially destroy the uterus to be able to hold a pregnancy. Or ovarian cancer can, through the growth itself, destroy the ovaries’ ability to produce healthy eggs.

Causes of Infertility in Cancer Patients:

“Standard surgery for cancer of the uterus or ovary involves the removal of these organs and that in itself can lead to infertility,” Dr. Samar Gupte pointed out. He further revealed, “Chemotherapy has the potential to destroy the eggs in the ovary and similarly radiation i.e. high dose x-rays can also permanently damage the ovaries. In patients who have non-genital cancers but need chemotherapy or even radiation therapy to the pelvis, they may be infertile.”

Echoing the same, Dr. Kshitiz Murdia, CEO and Co-Founder of Indira IVF, explained, “There are a number of cancer treatment options which include chemotherapy, radiotherapy, hormone therapy and immunotherapy, among others. They help by effectively killing cancer cells or blocking cellular pathways that lead to the formation of such cells. However, some of these treatments can damage healthy, normal cells needed for the daily functioning of the body in addition to cancer cells. When these treatments are used for cancers in or around the patient’s pelvic region, it can also lead to damage to reproductive tissues, resulting in infertility.

Tips for preserving fertility in cancer patients:

Dr. Kshitiz recommended: “The genitals are involved in different processes of reproductive function such as the production of viable sperm, the development of mature eggs and conception. Treatment options for these genital cancers may include removal of parts or entire organs, making an unassisted pregnancy unlikely in the future. These people may need to opt for donor gametes, donor embryos, or a surrogacy pregnancy.

Offering an alternative, Dr. Kshitiz said that after proper consultation with their oncologist and fertility doctor, patients can opt for egg and/or sperm freezing before embarking on treatments for the disease. cancer, as some of these patients may be young – in their late twenties or early thirties – and wish to start a family in the near future. He said: “At least 15 eggs are ideally extracted from females and sperm samples from males are collected. These samples are then stored in vials at -196˚C in liquid nitrogen, preserving their viability. Frozen gametes can be thawed up to 10 years later and patients can use them when they are physically, mentally and financially ready to have children. Assisted reproductive technology, such as in vitro fertilization, is a boon for the same.

Emphasizing that the success of this exercise is determined by the person’s age and the number of gametes that have been stored, since a few may be discarded after each stage of a fertility treatment cycle, Dr. Kshitiz said. simplified: “For example, research done on egg freezing found that 90-97% of eggs survive after thawing, 71-79% of eggs fertilize with sperm, and about 41% of eggs implant in the uterus . For cancer survivors who want to become parents in the future, this technique ensures that they won’t have to deal with additional fertility-related complications after beating the disease.

Talking about women with genital cancers i.e. cancers of the uterus, ovaries, fallopian tubes, vulva, vagina and pregnancy, Dr. Samar Gupte shared that the criteria where some form of fertility preservation is possible include young women wishing to have children at an early stage and less aggressive cancers. “These are patients for whom limited surgery is possible and perhaps an ovary and/or uterus can be preserved or the chemotherapy used can be relatively non-toxic or ovary-sparing radiation therapy can be done,” he said.

Dr. Samar Gupte added: “In some situations, with the help of fertility experts, the patient’s eggs can be harvested before starting cancer treatment. These eggs can be cryopreserved or if the patient has a partner, an embryo can be created (using in vitro fertilization techniques) and the embryo can be cryopreserved. These can then be used later for the same woman if her uterus still exists for pregnancy or surrogacy.

He said the patient selection criteria are extremely important and at no point is one willing to compromise the life of the young woman in deference to potential future fertility which may or may not occur. Therefore, the decision to treat young women with cancers and preserve fertility is a complex process and involves teamwork.

The gyne-oncologist along with radiation therapy experts, chemotherapy specialists and infertility specialists should sit down together and discuss with patients and their supporters to come up with a plan of action that is medically the most sound and acceptable.

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