In Poland, as many as 1,5 million couples unsuccessfully try to get pregnant. If the cause of the problem is on the side of a woman, it may be the result of ovulation disorders, endometriosis, as well as previous treatments, e.g. in oncological diseases. Patients who have undergone this type of treatment often do not realize for many years that they have lost their fertility. Until they dream of a baby.
- Treatment of some diseases – mainly oncological ones – damages a woman’s fertility, but the need for prompt treatment makes this issue a secondary issue.
- The relatively young branch of medicine – oncofertility, deals with restoring the lost fertility in this way
- One of the methods of oncofertility is cryopreservation – after completing the treatment, the patient is implanted with a healthy, previously obtained fragment of the ovary, which should start working. This sometimes allows you to get pregnant naturally. Thanks to this, already 160 children were born in the world, three in Poland
Impaired fertility is the most common side effect of treatment. It is about the so-called gonadotoxic therapies, which are used in oncological and rheumatic diseases, connective tissue diseases, as well as in the case of fibroids or endometriosis. Especially when it comes to neoplastic diseases – the time to start the therapy matters. Then fertility takes a back seat. In fact, it was going down until recently, because today there are more ways to preserve it. With patients undergoing this type of therapy in mind, a section of medicine was established – oncofertility. What exactly is it? In what situations is it helpful? We talk about it with prof. dr. hab. n. med. Robert Jachem, head of the Clinical Department of Gynecological Endocrinology and Gynecology at the University Hospital in Krakow.
Justyna Wydra: What is oncofertility?
Prof. Dr. have. n.med. Robert Jach: Oncofertility is a field on the border of gynecology, oncology, reproductive medicine and gynecological endocrinology. In short, it consists in preserving fertility and restoring it after the end of the oncological treatment cycle, or any other treatment that uses cytotoxic drugs. The term was created in 2005, but has been functioning as a medical procedure since 2010. The concept was introduced to medicine by an American researcher – prof. Teresa K. Woodruff from the University of Northwestern in Chicago. Since January this year, in the United States, according to the position of the American Society for Reproductive Medicine ASRM, freezing ovarian tissue, one of the methods used in oncofertility, is no longer considered experimental. In Europe, including Poland, work is currently underway on its official recognition.
What methods are used in this field?
In the first instance, if possible, reproductive organ sparing surgical procedures are used. Instead of removing the uterus and ovaries, surgery is performed to preserve these organs. However, the essence of the entire procedure are assisted reproductive techniques that ensure reproductive functions during treatment.
These types of techniques include: egg freezing for women, sperm for men, in vitro procedure (embryo freezing), as well as freezing (cryopreservation) of a fragment of ovarian tissue collected during laparoscopy, even before chemotherapy or radiotherapy is implemented. After completion of such gonadotoxic treatment, the patient is implanted with a healthy, previously removed fragment of the ovary, which should then assume its essential function, both endocrine and germline. As a result, it sometimes results in the possibility of natural pregnancy, without the need to interfere in the form of assisted reproductive procedures, which are often unacceptable for a couple for various reasons.
What are the advantages of this method?
First of all, the method of cryopreservation of laparoscopically collected ovarian tissue is shorter than the in vitro procedure. It can be done in just one day. A patient who learns that, for example, in two weeks he will start oncological treatment, after meeting the appropriate criteria, should be qualified for a minimally invasive laparoscopic procedure. It takes about 45 minutes. During this time, a fragment of the ovary (approx. 1 cm) is collected2) and by oncofertility techniques, this tissue section is preserved. The patient may return home on the same or the next day. After a short convalescence, she is ready for the main treatment, usually oncological. These types of treatments often cause infertility. After their completion, the woman can return to the center, where the previously collected and frostbitten tissue is implanted into the ovary by laparoscopy. Usually the organ then takes up its lost function. As a result of oncofertility procedures, such a patient may even become pregnant naturally. The ovaries are restored to their germinal function for about two years. In some cases, this time is significantly extended.
Why can a patient lose fertility after radiotherapy or chemotherapy?
To explain this mechanism, you need to know how cancer grows. It is a rapid, uncontrolled division of cells by the body’s natural defenses. Cells multiply uncheckedly, forming a tumor that infiltrates adjacent tissues, also resulting in the formation of lymphatic and blood vessel metastases. Colloquially speaking, cancer can be described as a parasite that destroys its host. In turn, chemotherapy or radiotherapy, i.e. gonadotoxic treatment, is designed to destroy these rapidly dividing cells. In addition to blocking cancer cells, it also stops other rapidly dividing cells in the body from dividing. This group includes hair follicles (hence hair loss characteristic of chemotherapy), bone marrow cells (which can cause anemia and leukopenia) and the digestive tract (which causes nausea and vomiting), and finally, reproductive cells – which lead to infertility.
- The success of French doctors. A patient who lost her fertility after chemotherapy had a baby thanks to the IVM method
How many babies have been born so far thanks to the cryopreservation method we talked about earlier?
About 160 children were born in the world, thanks to the method of cryopreservation and re-implantation of healthy ovarian tissue into the body of patients after gonadotoxic therapy. Considering the fact that in our country the procedure is still considered experimental and is not reimbursed by the National Health Fund, we now know about three children born in this way in Poland. Two of them gave birth to patients in the center where I work.
It is also worth mentioning that there are about several dozen collected and frozen ovarian tissues from patients who have not yet decided to undergo this procedure. Some of them are still undergoing oncological treatment, and the rest have simply not decided to procreate yet.
Are patients who are to undergo gonadotoxic therapies informed about the possibilities of oncofertility methods? Doctors know about this technique?
Unfortunately, we do not have representative data on the awareness of doctors, but as part of the work of the working group on preserving fertility in oncological patients of the Polish Society of Oncological Gynecology, we conducted our own questionnaire research. They show that in the broadly understood target group of oncologists, gynecologists, oncologists, clinical oncologists and radiotherapists, there is awareness of this issue (over 50% of respondents have heard about the method), but only less than 20%. doctors have ever discussed this with a patient.
Coming back to the first part of the question, members of various patient organizations are fully aware of both the problem and its potential complications, as well as possible solutions. However, this is also not a representative group. Unfortunately, women who are not affiliated with this type of group usually do not have such extensive knowledge. That is why we conduct various types of training all the time, and the subject matter appears during numerous conferences and webinars. Thanks to this, the awareness of patients on this topic is still growing, but in my opinion it is still happening too slowly.
Information about the specialist:
Prof. dr hab. n.med. Robert Jach is a specialist in obstetrics and gynecology, specialist in gynecological oncology, specialist in gynecological endocrinology and reproductive medicine. President of the Polish Society of Cervical Colposcopy and Pathophysiology, provincial consultant in the field of gynecological endocrinology and reproduction. He is the head of the Clinical Department of Gynecological Endocrinology and Gynecology at the University Hospital in Krakow. He also treats at the Superior Medical Center in Krakow.
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- Postpartum depression after IVF. A problem that is hardly talked about
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- Ten Sins Against Fertility