A specialty that bridges oncology and reproductive research to explore and expand options for the reproductive future of cancer survivors.
All cancer patients of reproductive age should receive fertility counseling as part of the treatment plan, irrespective of type and stage of disease.
Cancer treatments, such as chemotherapy, radiation, and surgery, may destroy a person’s ability to have children later in life, and oncofertility research focuses on increasing fertility preservation options.
As 10% of cancer patients are younger than age 40, this issue affects more than 135,000 people in the United States each year.
As cancer survivorship increases, the preservation of fertility in women, men, and children becomes increasing important.
for many, having children, after cancer is a component of psychological well-being and quality of life.
Oncofertility incorporates reproductive issues after cancer treatment, such as family planning, complex contraception, hormonal management throughout survivorship, surrogacy, and adoption.
Established fertility preservation options for men include sperm banking, and testicular sperm extraction.
Anti-cancer therapies in males cause infertility encompassing abnormal semen, anatomical, endocrine, genetic, functional, or immunologic abnormalities of the reproductive system along with chronic illness and sexual conditions incompatible with the ability to deposit semen in the vagina.
Spermatogonia is the most important target of cytotoxic treatments with damaging effects depending upon the drug concentration or radiotherapy dose.
Men who do not preserve their fertility prior to cancer treatment may have children through donor sperm using sperm from a known or anonymous donor.
Women’s options include embryo banking in which hormonal stimulation causes the production of multiple eggs, which are removed, fertilized by sperm, and frozen for future use, and egg banking in which hormonal stimulation causes the production of multiple eggs, which are removed and frozen for storage and future use, ovarian transposition and ovarian shielding.
After sterilizing cancer treatment, a woman can also choose surrogate pregnancy or adoption.
Prepubescent children have fewer options to preserve fertility than adults, but include testicular sperm extraction for males and ovarian tissue banking for females.
Ovarian tissue cryopreservation is appropriate when the time is available before starting anti-cancer treatment is too short for ovarian stimulation, and oocyte or embryo cryopreservation.
PROMISE-GIMS Trial using LHRH triptorelin for women with early stage breast cancer and randomized to a control group that received adjuvant, or neoadjuvant chemo therapy alone or to an interventional group that received triptorelin with an intervention group: The rates of premature menopause were approximally 9% for the group of women treated with triptorelin, compared with 26% for those in the control group.
Cancer treatments, such as chemotherapy, radiation, and surgery, may destroy a person’s ability to have children later in life, and oncofertility research focuses on increasing fertility preservation options.
As 10% of cancer patients are younger than age 40, this issue affects more than 135,000 people in the United States each year.
As cancer survivorship increases, the preservation of fertility in women, men, and children becomes increasing important.
Oncofertility incorporates reproductive issues after cancer treatment, such as family planning, complex contraception, hormonal management throughout survivorship, surrogacy, and adoption.
Established fertility preservation options for men include sperm banking, and testicular sperm extraction.
Men who do not preserve their fertility prior to cancer treatment may have children through donor sperm using sperm from a known or anonymous donor.
Women’s options include embryo banking in which hormonal stimulation causes the production of multiple eggs, which are removed, fertilized by sperm, and frozen for future use, and egg banking in which hormonal stimulation causes the production of multiple eggs, which are removed and frozen for storage and future use, ovarian transposition and ovarian shielding.
After sterilizing cancer treatment, a woman can also choose surrogate pregnancy or adoption.
Prepubescent children have fewer options to preserve fertility than adults, but include testicular sperm extraction for males and ovarian tissue banking for females.
PROMISE-GIMS Trial using LHRH triptorelin for women with early stage breast cancer and randomized to a control group that received adjuvant, or neoadjuvant chemo therapy alone or to an interventional group that received triptorelin with an intervention group: The rates of premature menopause were approximally 9% for the group of women treated with triptorelin, compared with 26% for those in the control group.
Low doses of chemotherapy reduce the pool of actively dividing spermatogonia.
Chemotherapy related to gonadal toxicity can cause depletion and impairment of Sertoli and Leydig cells.
The most severe damage to spermatogonia and germinal epithelium is induced by: alkylating agents, platinum drugs and long-term hydroxyurea.
Spermatogonia is sensitive to radiation, leading to cessation of spermatogenesis.
Cancer and anti-cancer treatments may affect post treatment ovarian function by reducing ovarian reserve, disturbing hormonal balance, or by anatomical functional changes to the ovaries, uterus, cervix, or vagina.
Chemotherapy related amenorrhea is mainly due to damaged growing follicles that occur within weeks after chemotherapy initiation and is often transient.
Depending on the patient’s age, pre-treatment ovarian reserve, type of agent, exhaustion of the primordial follicles pool may occur with subsequent premature ovarian insufficiency.
Alkylating agents induce the greatest damage because of their cell cycle nonspecific mode of action, not only to growing follicles but also to oocytes resulting in a reduction of the primordial follicle pool.
Radiation exposure reduces the number of ovarian follicles and has an adverse effect on uterine and endometrial function.
The gonado toxic effects of radiation depends on the field, dose, fractionation schedule, with single doses more toxic than multiple fractions.
Radiation related ovarian follicle loss occurs at doses of less than 2Gy and effective sterilizing dose is at which 97 1/2% of patients develop immediate premature ovarian insufficiency decreases with increasing age is the time of treatment ranging from 16 Gy at 20 years to 14 Gy at 30 years.
Radiation interferes with uterine distention throughout pregnancy.
All cancer patients of reproductive age should receive oncofertility counseling as early as possible.
Fertility preservation for males includes: sperm cryopreservation, gonadal shielding during radiation, medical gonadal protection with hormone suppression treatments, with or without androgens, antiandrogens, or progestins.
Fertility preservation for females includes: oocytes and embryos can be safely and efficiently cryopreserved before the initiation of anti-cancer treatments; ovarian tissue cryopreservation, ovarian transposition and Gonadal shielding during radiation, and medical gonadoprotection.
Oocytesand embryos can be safely and efficiently cryopreserved before the initiation of anti-cancer treatments.
Unlike embryos, oocyte cryopreservation can be carried out without a partner and is the preferred option for most post pubertal women.
There are two options for protecting ovaries from radiation: transposition of the ovaries before radiation therapy and gonadal shielding during radiation therapy.
Ovarian, transposition and Gonadal shielding are indicated for women 40 years or less scheduled to receive pelvic radiation for cervical, vaginal, rectal, or anal cancers, Hodgkin’s or non-Hodgkin’s lymphoma in the pelvis or Ewing sarcoma of the pelvis.
Medical gonadoprotection during chemotherapy reduces the risk of ovarian failure and its associated fertility and endocrine related consequences.
male and female cancer survivors have significantly reduced chances of post treatment pregnancies compared with the general population.
Post treatment pregnancy rates are highly dependent on the type of cancer: the lowest rates reported for men with a history of acute leukemia, or non-Hodgkin’s lymphoma and for women with the history of breast with cervical cancer.
There is an increased risk of developing obstetric and birth complications for female cancer survivors, in terms of increased risk of prematurity, low birthweight, emergency cesarean section, assisted vaginal delivery, and postpartum hemorrhage.
The risk of such complications is higher when the interval between the end of treatment and conception is short.
An interval of at least one year following completion of chemotherapy is recommended in cancer survivors.
A washout period is considered before conception for tamoxifen-three months, and seven months for anti-HER2 monoclonal antibody trastuzumab.
Neonatal outcomes of pregnancies for men and women with prior exposure to anti-cancer treatments appear to be comparable to those of the general population.
Studies, however, suggest a slight increase in risk of congenital abnormalities in offspring of male cancer survivors when either cryopreserved sperm or fresh posttreatment sperm was used.
Slightly increase risk of congenital abnormalities has been described in female patients, as well,, but this is likely to be artifactual.