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Before the cancer patient goes to the oncology consultation, she comes to the infertility treatment center to start the oncofertility procedure. There is no grace period between the oncofertility procedures and the commencement of oncological treatment – writes the drug. med. Jarosław Kaczyński, obstetrician-gynecologist, endocrinologist and doctor in charge of couples treatment at InviMed Warsaw.
- Oncofertility is a method of preserving the fertility of patients undergoing cancer therapy
- In the case of women, it consists in the production of eggs for later fertilization or the production of embryos and freezing them until transfer
- In men, oncofertility is collecting semen and freezing it for use later in the IVF procedure
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The extent to which cancer treatment negatively affects female fertility depends on the age of the woman, as the older she is, the more sensitive she is to chemotherapy; and on the value of AMH, i.e. the ovarian reserve index. Women who have a high AMH value are more likely to maintain an ovarian reserve. On the other hand, with a low ovarian reserve, there is a greater risk of losing it as a result of chemotherapy. The problem is complex, however, because drugs have different effects on the body – there are substances that completely destroy the ovarian reserve, but there are also drugs that do not carry a high risk of damaging the eggs.
New technologies – work in progress
Currently, as part of oncofertility, i.e. securing fertility in the case of cancer, in the case of women, we only have the production of eggs for later fertilization, or the production of embryos and freezing them until transfer. These two procedures are based on the principle of in vitro fertilization. We can also collect and freeze a piece of ovarian tissue to use this material for transplantation into a woman after the completion of oncological treatment. For men, we only have one method, which is to collect semen and freeze it for use later in the IVF procedure.
In recent years, no new technologies have been introduced, but work on them is ongoing. These methods are currently in the laboratory phase and it is not possible to use them in cancer patients. An example is the work of an American professor, Monika Laronda, who collected ovarian tissue from a patient who was only two years old before oncological treatment. Oocytes were isolated from this ovary, which were then placed in an artificially produced ovary by 3D printing and made mature and ready for fertilization. So Professor Laronda obtained a mature oocyte in a pre-pubertal baby, something that seems unrealistic when viewed through the prism of the principles of developmental biology.
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Of course, there have already been individual scientific reports of transplantation of ovarian tissue taken from a child and placed in the body of an adult woman who has undergone oncological therapy. The woman later became pregnant spontaneously. However, in Professor Larondy’s experiment, progress is made in using an artificial ovary obtained by 3D printing to reach maturity by the egg – which is of great importance for those women who need to have their ovaries removed in the course of an oncological disease.
Onkofertility before or during oncological treatment?
There is no unequivocal answer to this question. If we consider chemotherapy treatment, it must be remembered that it affects not only cancer cells, but also all structures of the body. We also know that chemotherapy stimulates cells to apoptosis, or programmed death. There are therefore many mechanisms that this type of treatment triggers and may harm fertility.
Irradiation treatment also harms fertility, because although targeted radiation therapy is used and the radiation beam is aimed precisely at the tumor cells, some rays are nevertheless dispersed. The results of new research confirm that even very small doses of irradiation reduce the ovarian reserve by 50%, while stronger irradiation practically leads to its loss. It therefore seems logically justified to protect oocytes from initiating oncological treatment.
There is also no clear answer because a method of treating patients with leukemias has been developed. Leukemia is a very difficult disease because cancerous cells are found in the blood. A technology has been developed in Israel where five courses of chemotherapy are given to kill the cancer cells circulating in the blood, and then the ovarian tissue is removed for transplant at a later time. The patient undergoes treatment with the use of bone marrow transplantation, and after its completion, her own ovarian tissue collected earlier is implanted. However, before this transplant is performed, the collected tissues are transferred to an animal model – a scrap of the removed ovary is implanted into mice. If the mice survive for six months and do not develop cancer, the patient’s tissue is considered oncologically clean and suitable for implantation in the female.
Oncofertility in practice
Our center is visited by patients who have undergone a tumor biopsy and have diagnosed the tumor on the basis of microscopic examination. The oncofertility procedure takes place on an outpatient basis. The patient comes to the office, a medical interview is made, and medications are prescribed. After a few days, the patient returns for tests, drugs are prescribed again and the date of puncture is set for the collection of oocytes or the production of embryos. Only the collection of ovarian tissue requires a hospital procedure. However, it is a quick procedure, so the patient can be admitted to the ward on the same day and leave the same day. If I proceed with the collection of ovarian tissue, the woman may start the oncological procedure the next day. Some oncologists believe that it takes a woman about 7 days to start chemotherapy, as this treatment may affect the healing of a surgical wound. However, all operations in our center are performed in the laparoscopic mode, so there is practically no scar. As for ovulation stimulation, one day I can collect oocytes, and the next patient can start chemotherapy.
A patient who comes to me for oncofertility advice should have a certain AMH (Ovarian Reserve Index) value. This is due to the fact that in the Masovian co-financing program, reimbursement is possible provided that there is a proper ovarian reserve. If the patient comes for consultation and there is no AMH result, this test must be performed, which means 1-2 days of waiting for the result. However, without the result of this examination, no reimbursement can be granted for either the drugs or the procedure itself
The article comes from the “Diagnosis: Cancer” campaign prepared by Warsaw Press and the media partner of which is the medTvoiLokony portal. All materials can be found at http://www.warsawpress.com/
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