Fertility preservation – A boon for breast cancer survivors
Onco-fertility bridges the specialties of oncology and reproductive endocrinology with the purpose of maximising the reproductive potential of cancer patients and survivors
KOLKATA, India – October 25, 2017 – It was in the year 2014 that Shalini (name changed), aged 27 years, noticed an unusual lump on one of her breasts. Medical tests showed an early stage breast cancer. A partial mastectomy, and the usual cancer treatment involving chemotherapy and hormonal therapy were advised. Aware of the side effects of chemotherapy, newly married Shalini and her husband were concerned about their chances of having a family of their own after the treatment. On consulting the experts at Nova IVI Fertility, Shalini was advised to freeze her eggs so that she could prevent the loss of healthy eggs during the phase of her cancer treatment.
Cancer is a disease which can come as an uncalled surprise in one’s life. With no specific reason for cancer to occur, anyone at any age can be affected. An unhealthy lifestyle, a family history of cancer, over-exposure to environmental pollution, etc. are a few of the factors which could lead to cancer. However, it is alarming to know that there are a large number of young cancer survivors who face quality-of-life issues, including the likelihood of conceiving post cancer treatment.
The Indian Council of Medical Research (ICMR), in one of its studies, stated that in the year 2016, the total number of cancer cases was expected to be 14.5 lakh, and the figure is likely to reach nearly 17.3 lakh new cases in 2020. It was estimated that around 1.5 lakh new cases of breast cancer were diagnosed in 2016, which is 10% of all types of cancer cases in India.
Dr. Rohit Gutgutia, Fertility Consultant at Nova IVI Fertility, Kolkata says, “Cancer is increasingly affecting the lives of several young men and women posing as a life changing threat. While cancer largely affects normal functioning of the body, it does not have direct impact on the fertility of men and women, unless it is testicular or ovarian cancer. However, it is the usage of anti-cancer drugs that can lead to a drop in the quality and quantity of sperms and eggs, negatively impacting the reproductive capacity of men and women.”
Cancer treatment and infertility
Chemotherapy and radiotherapy involve certain drugs and exposure to radiations which can effectively kill cancer cells and prevent relapses, but also cause damage to the gametes i.e. eggs and sperms. This can lead to depletion of cells, and hence effect fertility. Women are born with a finite number of eggs and in some, the treatment with chemotherapy and radiotherapy may lead to a partial or complete loss of fertility potential.
Some women may immediately reach menopause after chemotherapy, resulting in complete cessation of their monthly cycles. While others, whose menstrual cycles resume after cancer treatments, can conceive naturally only if their ovarian reserve is good both before and after the treatment. The effects of chemotherapy or radiotherapy in men include compromised sperm count, motility, morphology and DNA integrity.
Fertility preservation gives hope to cancer survivors
Infertility resulting from cancer treatment can lead to great psychosocial stress. Cancer survivors who are completely cured typically view themselves as healthy enough to be good parents, and view their experience of illness as one that can enrich their parental role. Young women in their child bearing years diagnosed with cancer should be prescribed with techniques such as oocyte (women who do not have a partner) or embryo (married women) freezing. Post their cancer treatment, if infertility happens, they can conceive through IVF.
While sperm production in men usually returns to normal after cancer treatment, there have been cases where the quality of sperms has reduced. Hence, in such cases, freezing a sperm sample before cancer treatment helps, and it is not very expensive either. Fertility preservation is not restricted to only those undergoing cancer treatments. Career-oriented women too can opt for fertility preservation when they know that they will not start a family until much later in life.
“Creating awareness amongst cancer patients on the possibilities of conceiving post cancer is essential. Considering that oncologists are usually the first point of contact for cancer patients, it is ideal that they brief the patients on how cancer treatment can affect fertility and also discuss the options of fertility preservation. With October being observed as breast cancer awareness month, we would like spread the word on the prospect of starting a family post cancer treatment,” Dr. Gutgutia adds.
Like Shalini, not every cancer patient will have the opportunity to preserve their fertility before chemotherapy or radiation treatment. There are many instances where it becomes too late for a cancer patient to take the decision of preserving the oocytes or embryos. For those not fortunate to have frozen eggs or embryos prior to cancer treatment and whose gametes have been completely depleted, IVF with donor eggs or sperms is a common solution.