Fertility preservation before cancer treatment

As we have discussed previously in this blog, after a cancer diagnosis a lot of things come to your mind. Fortunately the vast majority of people with a cancer diagnosis survive and the rates are increasing every year. This is why you also need to take long-term decisions, such as preserving your fertility. Thankfully, oncology treatments are increasing their success rate, but they will most likely impact your future fertility.

Fertility preservation for men

In males, freezing some sperm samples should be enough. The number of samples will depend on the quality of the sperm and your reproductive desires. If you don’t recover your spermatogenesis, these samples will be of a great value, so probably they won’t be used for intrauterine insemination and an IVF with ICSI will be required.

Fertility preservation for women

Egg cryopreservation (vitrification)

Before eggs can be vitrified you need to undergo an ovarian stimulation and egg retrieval. Hence, you need to differ your oncology treatment and sometimes this is not possible. Furthermore, in some kinds of cancer it is not possible to undergo an ovarian stimulation.

If there is no contraindication, you would start with ovarian stimulation the first days of a period. Tipically, this process lasts between 11 and 13 days, and at the end of it the eggs are retrieved under anaesthesia in a simple procedure. The mature eggs obtained are frozen following a protocol called vitrification, and they are stored in an egg bank until you want to use them.

Ovarian tissue preservation

When egg cryopreservation is not an option, a small biopsy of ovarian tissue obtained by laparoscopy can be frozen.

Ovarian tissue freezing is still experimental, and the success rates are much lower than egg cryopreservation, and has produced only a small number of live births so far.

After cancer treatment, the ovarian tissue can be thawed and placed close to the fallopian tubes or in another part of the body, like the abdomen or forearm. Once the transplanted tissue starts to function again, the eggs could be collected and fertilized in the lab.

Alternatively, the tissue could be thawed and cultivated in a specific egg maturation media to obtain viable eggs to be used in an in-vitro fertilisation process. Unfortunately, this process is highly inefficient today, although several research lines are studying how to improve it.

Sometimes it is not possible to perform any of the treatments above. Unfortunately, sometimes not enough eggs are obtained or the IVF procedure is not successful. In these cases, you must keep a positive attitude. Egg donation is always possible as long as you can conceive, and it is one of the most common assisted reproductive treatments these days.