Being diagnosed with cancer can be a daunting experience in itself. The 'c' word is one that we all fear and wish to avoid. However with increasing lifespans and stressful lifestyles, cancer has become more prevalent in the population. Indiviuduals at high risk for cancer need to take be proactive action and perform regular checkups to ensure that if cancer develops, it is diagnosed at an early stage.
Cancer treatment options have advanced greatly and the prognosis of a wide range of cancers has increased substantially throughout the years. When it comes to fertility, cancer treatment may have negative impacts on the fertility of the patient. The type of treatment and location of the cancer can directly impact the side effects it may have on the patient's fertility. In men, the effects of the cancer treatment may be seen as a loss of spermatogonial stem cells (cells responsible for producing sperm) and or altering the function of sertoli and leydig cells (cells responsible for hormonal response and support of sperm production). It is now widely accepted that fertility perservation options should be discussed with patients who are diagnosed with cancer, specially those who may wish to have children later on in life. If options are not discussed, patients should seek advice as to what steps they should take. There are a variety of options for both men and women which need to be considered before proceeding with cancer treatments.
If a male patient is diagnosed with cancer, they may have multiple options for fertility perservation to increase their chances of fatherhood after their cancer is treated. For post-pubertal males, the easiest option would be semen/sperm freezing. If the patient chooses this option, they will be referred to an institution equipped for freezing semen samples. The patient's semen will be analysed to make sure it is of good quality (similar to sperm analysis for infertility treatment). If this is the case, the sample will be frozen and stored in liquid nitrogen for future use. Depending on the volume of the ejaculate, multiple vials may be frozen from a single ejaculate or the patient may be asked to produce more than one sample to freeze multiple vials. Each vial can be thawed at a later date and used for a single procedure (whether IUI or IVF). If the sample is not of good quality or there are no sperm present, surgical removal may be suggested straight from the testes. Samples can be frozen for a long period of time until the patient has recovered from cancer treatment and is ready for parenthood. It is worth noting that some times after cancer treatment, fertility may not be affected and the patient may be able to conceive naturally.
The situation is a bit more challenging when it comes to pre-pubertal boys as they are not able to produce sperm until they undergo puberty. However, a method known as testicular tissue cryopreservation has been developed but this is still considered to be an experimental procedure. Many of these patients may not become infertile in the future so it is important to discuss options with the oncologist/radiologist for the best course of action. There are no standardised protocols in place at the moment but the testicular tissue is usually cut into small fragments and stored in vials which have a cryoprotective medium and is frozen in liquid nitrogen. The crypreserved tissue can be transplanted back at a later time with the hopes of reinstating natural fertility. Another option would be to process the tissue in-vitro and extract sperm directly which could be used for infertility treatment. For this treatment, attention has to be on ensuring the safety of the transplantation (potential for infection or re-introducing malignancy). Another important aspect is ensuring the integrity of the gametes produced for a generation of normal offspring. Other possible options would be testicular shielding during radiotherapy, and modifying cancer treatment regimens with chemo-protective agents.
It is important for clinicians to offer appropriate counselling and options for any patient undergoing cancer treatment who is either not aware of the possible negative impacts on fertility or who wishes to preserve their fertility for the future. There is no one treatment that is suitable for all patients. Each individual needs to be given the appropriate options describing all the different aspects of fertility perservation with possible chances of failure to provide the best possible care. Counselling and support is crucial for patients to ensure they understand all of their options. Cancer can take a great toll on individuals both emotionally and physically which is why continued support is needed for patients even after their treatment is complete. There may be options for fertility perservation which I have not mentioned in this post. Please discuss with your clinician for more details on each treatment type and which option is suitable for you.
