On April 1st, I wrote about the impact of cancer treatments on fertility. I discussed the many ways in which the way we treat cancer can affect the patient’s ability to have kids in the future. Fortunately, there are many things we can do to try to preserve fertility.
Part 2: What can be done to preserve fertility?
Some fertility preservation techniques are well-known. One option for boys who are old enough is sperm banking (freezing and storing their sperm for possible future use). Ideally, this should begin prior to treatment and multiple samples should be preserved. Unfortunately, in some cases this is not possible, due to the urgency of beginning treatment, especially in leukemia patients who are often quite sick at the time of diagnosis. Despite the common use of sperm banking, the use of frozen sperm seems to be rare (for example, only 7% of testicular cancer patients used their stored sperm in one study).
What about children who are too young for standard sperm banking techniques? Although the testes of younger boys may be relatively spared from the effects of chemotherapy, this point is debated. In younger boys, sperm can be obtained by “electroejaculation” or by testicular sperm extraction (both under general anesthesia, of course).
These approaches work for boys whose infertility risk comes from systemic chemotherapy. As I discussed before, newer surgical techniques have made male infertility as a consequence of retroperitoneal lymph node dissection quite rare. What about radiation therapy? If the radiation must be directed at the testes, nothing can be done other than sperm banking. However, if only one testis must be irradiated, the other can be moved out of harm’s way surgically, and put back where it belongs when the radiation treatment has been completed.
A similar approach, called oophoropexy, can be used to move ovaries our of the radiation field in girls or women who need pelvic radiation. This can be done by a minimally invasive approach, using a scope. Unfortunately, damage to the uterus from radiation may still make pregnancy difficult or impossible.
Eggs (oocytes) can also be frozen and stored, just like sperm. Unfortunately, this is not as easily accomplished as it is in boys, and is not as successful. Oocytes can be retrieved directly (this requires drugs to stimulate their production and a minimally invasive procedure to harvest them), or ovarian tissue containing the oocytes can be extracted surgically and frozen. During cancer treatment, suppression of ovary function with medicines such as Lupron is probably also effective at preserving fertility, though this is not yet conclusively proven.
And what of the babies?
Given the number of options available to try to protect fertility, as well as the active research that will hopefully improve things in the future, we also have to give thought to the children who are born to survivors of childhood cancer. Chemotherapy and radiation therapy are mutagenic. Does that mean children born to people who receive these treatments are at increased risk of birth defects? Apparently not. A very large epidemiologic study published in 1995 failed to show a link between cancer therapy and developmental problems.
Hopefully, future therapies will have less impact on fertility than the treatments we have now, and we doctors will be able to look back on this time and be grateful our patients no longer have to add “Will I be able to have a baby?” to their list of worries when they are diagnosed.
Cancer and Fertility: How Can Treatment Impact Fertility? (Part 1)