Every woman of childbearing age should consider before oncological treatment oncofertility. It is not only securing her reproductive capacity, but also postponing premature menopause resulting from radio- or chemotherapy.
How do chemotherapy and radiation therapy affect fertility?
Both chemotherapy and radiotherapy damage reproductive capacity. Until recently, we believed that a dose of 4 Gy (gray) of total body irradiation was safe. Now we know that a dose below 2 Gy damages the reproductive capacity. If we add chemotherapy to it, we lead to premature extinction of ovarian function and to menopause, i.e. we deprive a woman of the chance to have her own children.
What are the possibilities of preserving fertility in the period after diagnosis and before starting cancer therapy?
There are several such methods. In the past, we used surgical treatment to move the ovaries beyond the radiation area. We now know that this is not an effective method as the ovaries often return to their original location. In addition, the stretching of the fallopian tubes often leads to their damage and rupture, becoming a mechanical factor of infertility. In addition, the blood supply to the ovarian tissue deteriorates, which results in a greater risk of ischemia and an additional reduction in the ovarian reserve.
A very interesting topic and a bit controversial is the use of GnRH agonists. Until recently, we believed that these drugs protect against the effects of chemotherapy by preventing the growth of follicles in the ovary. This was to protect the cells from damage. However, there are many mechanisms that lead to ovum damage as a result of chemotherapy. These mechanisms are so extensive that the use of GnRH agonists cannot protect the eggs. Therefore, currently, according to the current American recommendations, the use of a GnRH agonist cannot be the only method of procreation protection. It can be used as an adjunctive therapy, but not the only one.
In fact, at the moment, cryopreservation reigns supreme, i.e. freezing gametes (eggs / sperm) or gonads (ovarian tissue). In this procedure, I can:
– collect gametes, i.e. sperm from a man or ova from a woman.
– after prior stimulation, collect the mature ova in order to fertilize them and then freeze the resulting embryos.
– finally, I can take a piece of ovarian tissue and freeze it. There are several technologies. All of them are highly effective and can be widely used.
What is the effectiveness of these methods?
The effectiveness of in vitro fertilization depends on the center and, of course, the couple’s reproductive abilities, because it must be remembered that infertility treatment involves not only treating the woman, but also the partner, and is estimated at 40-50%. The freezing of eggs in new technologies practically does not affect their quality.
Are frozen cells thawed at the request of a woman or a couple?
This is not done on request. Treatment of cancer patients must be safe for them. Return to procreation can only take place in consultation with the attending oncologist. So if the oncologist did not complete the therapy, did not tell the patient that she could return to reproduction, we cannot treat her, because we would in fact stop the oncological treatment.
We do not have Polish data, but we know from the American data that over 50 percent. women undergoing chemotherapy or radiation want to be mothers. It is possible after the end of oncological treatment.
Do oncologists inform their patients about the possibility
oncofertility, that is, securing fertility before oncological treatment?
It depends on the resort. Not all oncologists know about oncofertility. In the Oncology Center in Warsaw, it looks like this that a patient who is diagnosed, for example a breast tumor on the basis of an aspiration biopsy, it goes to me. Although she had not yet had any council, she had not yet been discussed about a form of cancer therapy. Before this patient comes under the care of oncologists, her reproductive ability is already secured. Sometimes treatment to maintain reproductive capacity overlaps with the initiation of chemotherapy. Oncologists do not have any problems with postponing oncological treatment, e.g. by a week.
Should a woman’s reproductive capacity be secured in every oncological disease? How does it work for men?
For men, we don’t have any treatments to keep them fertile. All we can do for these patients is to collect the semen before starting the oncological treatment. Such a man shows up at the infertility clinic to deposit sperm.
However, when it comes to women, every patient of childbearing age should consider before oncological treatment oncofertility. Patients live longer and longer after oncological treatment and even if they do not think about having children, they should definitely be interested in postponing menopause as long as possible. It must be remembered that the ovaries are used not only for procreation, but also for the production of hormones.
Menopause is heart failure, heart attacks, osteoporosis and dementia. All these situations are related to the function of the ovaries. So, securing the reproductive capacity for the future also means delaying complications related to menopause. Every woman should remember this and be referred to specialized centers.
Are there many such centers in Poland?
Preparation of the patient and collection of eggs for cryopreservation can be performed by any IVF center (In vitro fertilization – in vitro fertilization). However, when it comes to collecting ovarian tissue, according to my knowledge, we do it at the Oncology Center in Warsaw, if not the only one in the country, then as a few. Of course, this procedure does not end with the surgical removal of ovarian tissue. The ovarian tissue is transported to the infertility treatment clinic – in our conditions it is InviMed in Warsaw, with whom we cooperate practically from the very beginning of the application of this therapeutic technique in Poland. At InviMed, the ovarian tissue is processed. As a result of this process, tissue sections 1 mm thick are obtained, which are subjected to cryopreservation. After the completion of oncological treatment, the sections protected in this way are thawed and autotransplanted into the body of the already oncologically cured patient.
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