Health Beat fertility preservation
therefore, the American Society of Clinical Oncology and the American Society for Reproductive Medicine recommend that options for fertility preservation be discussed as early as possible during cancer treatment planning. Sarah decided to go forward with fertility preservation. During the fertility preservation process, I clearly remember her telling me that this process of preserving her fertility, which was one of many of her medical journeys at that time, gave her the most hope for the future. The risk of infertility after cancer treatment depends on many factors, including the patient’s age, type of cancer, type of treatment and underlying fertility potential. Treatments such as high dose radiation to the abdomen and pelvis, and chemotherapy with alkylating agents such as cyclophosphamide and procarbazine are associated with a high risk of losing regular periods or causing early menopause. Non-alkylating chemotherapy poses less chance of these possibilities. The risk of less abrupt changes in ovarian function that ultimately affect fertility is not certain, but is likely greater than the risk of losing periods. In Sarah’s case, she did not regain her menses after her cancer treatment. Fortunately, we had already talked through her options and Sarah had chosen a course of action that was right for her. Other Reasons for Female Fertility Preservation Women who are undergoing cancer treatment are not the only women who should consider taking steps to preserve their fertility. There are several other conditions and treatments that can result in compromised fertility in which fertility preservation is a viable option. These include autoimmune and rheumatologic diseases, severe endometriosis, risk of premature ovarian failure and significant genetic risk of breast or ovarian cancer with prophylactic removal of the ovaries. Women with anticipated advancing reproductive age are also candidates for fertility preservation. 134
spokanecda.com • october • 2015
Fertility Preservation Options Standard fertility preservation techniques include protection of the ovaries from radiation by surgical transposition of the ovaries (oophoropexy) and/or gonadal shielding. For some cancers, like cancer of the ovaries, removal of minimal tissue is also possible depending on the type, grade and stage of cancer. With the type of cancer that Sarah had, these measures were not an option. Other experimental methods of female fertility preservation exist including ovarian tissue cryopreservation, ovarian suppression with specific medication to hope to minimize the toxic effects of chemotherapy, and collection of immature eggs with the goal to mature them outside of the body. Sarah was not interested in trying these experimental protocols due to their investigational nature. There are some cancer treatments that are associated with a high likelihood that women will lose most if not all of their eggs (oocytes) and effectively be in menopause after they survive their cancer. Sarah was set up to use a regimen of chemotherapy which was in this highrisk category of chemotherapies. In order to conserve fertility in these women it is necessary to preserve eggs or embryos prior to cancer treatment. For women in a committed relationship, embryo freezing is an established fertility preservation technique. To freeze embryos a woman must undergo in vitro fertilization (IVF). IVF is the process whereby a woman’s ovaries are stimulated to produce multiple follicles, eggs are retrieved and fertilized with sperm, the fertilized eggs (embryos) are cultured in the laboratory, and then the embryo(s) are frozen until the woman is ready to conceive. At this time the frozen embryos are thawed and transferred into the woman’s uterus. The IVF process takes two to three weeks to complete, depending on the woman’s menstrual cycle. Embryos may be cryopreserved for many years; there is no identified time limit. This, however, requires the use of sperm. Sarah was not in