Preserving Fertility in Cancer Patients
A man and woman’s fertility can be damaged by some cancer treatments. Not all cancer treatments lead to infertility, but many do. Fakih IVF offers some methods for preserving fertility in men and women so they can have children after completing cancer treatment. Be sure that you understand the risks and chances of success of any fertility option you are interested in.
Egg freezing means removing mature eggs and freezing them for later. This process may also be called egg banking.
Treatment typically starts on the second or third day of menstruation and consists of a regimen of fertility medications to stimulate the development of multiple follicles in the ovaries. Depending on the treatment protocol, this may mean anywhere from 1 to 2 shots every day, for about 7 to 10 days. During this time, the patient would be assessed through ultrasound tests to analyse the development of the follicles and blood tests to check the hormone levels.
The eggs are retrieved from the patient using a transvaginal technique involving a very thin ultrasound-guided needle to reach the ovaries. The number of eggs retrieved depends on how the patient has reacted to the fertility medication. The procedure takes about 15 minutes and is done under sedation. The collected eggs are then frozen using the latest flash-freeze method called vitrification. This process does very little damage to the eggs, and can keep the eggs in storage for years until the woman decides to use them for conception.
The patient will need to undergo in-vitro fertilization (IVF) in order to use those eggs. Therefore, once the patient is ready to get pregnant, the eggs are thawed and then fertilized using ICSI, an assisted reproductive technology that injects one sperm directly into the egg. The embryos (fertilized eggs) will then be transferred into the woman’s uterus (womb) in order to achieve a pregnancy.
Egg freezing may be an option for women who have no partner at the time of cancer diagnosis.
Embryo Freezing (except in the UAE until further notice from the health authorities)
Embryo freezing (also called Embryo Vitrification or Embryo Cryopreservation) is the most successful method of preserving fertility because frozen embryos can remain in storage for up to 10 years and have a high chance of survival and pregnancy. So they have the highest success rate compared to any other treatment. The process is the same as Egg Freezing, except the eggs are passed on to an embryologist who fertilizes them using the husband’s sperm. Once fertilized, the embryos (fertilized eggs) grow in the laboratory for 3-5 days until they are suitable for freezing. They are then frozen for future use after cancer treatment.
But some women who have fast-growing cancers cannot wait 2 to 3 weeks to begin treatment. And women with breast cancer may risk some growth of their tumors during IVF cycles because of the high levels of estrogen that result from the hormone shots. In cases like these, it is recommended to opt for "Natural Cycle IVF" in which ultrasounds are used to follow the progress of normal ovulation, and 1 or sometimes 2 eggs can be collected.
This surgical treatment can be used in some women with ovarian cancer in only one ovary. The cancer must be one of the less aggressive types. A surgeon will try to remove the ovary with cancer, leaving the healthy ovary and uterus in place. If there is a risk of the cancer coming back, the unaffected ovary may be removed once the woman has finished having children.
Sperm Freezing is an effective way for men who have gone through puberty to store sperm for future use. Many men can store sperm (either from natural ejaculate or from a TESA sample), even if they have reduced sperm quality or quantity.
The method is very simple and is usually done in a private room at the clinic. The man ejaculates through masturbation or with the help of a partner. The semen is collected in a sterile cup that can be obtained from the clinic. The sample can also be collected at home and brought to the clinic within an hour, keeping it at room temperature during that time.
Once the sample is received, it is tested to see how many sperm cells it contains (sperm count), what percentage of them are able to swim (motility), and how many have a normal shape (morphology). The sperm cells are then frozen using Vitrification (a new flash-freeze technique) and stored for future use.
The success rates of infertility treatments using frozen sperm vary and depend on the quality of the sperm after it is thawed. Babies born from frozen sperm don’t have any unusual rates of birth defects or health problems. Once sperm is stored, it is good for many years.
When the couple decides to have a child, the sperm is thawed and used for intrauterine insemination (IUI) where the thawed sperm are washed and concentrated, and placed in a sterile solution. When the woman is at her most fertile time of the month, the small amount of this fluid is placed in her uterus by a doctor or nurse who threads a tiny tube (called a catheter) through the small opening in her cervix. This usually takes only a few minutes in a doctor's office.
Even a few sperm cells that survive freezing and thawing may be enough to conceive if the sperm is actually injected into the egg. This injection technique is called IVF-ICSI, which stands for in vitro fertilization with intracytoplasmic sperm injection (ICSI for short).