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OncoFertility – refers to the medical field that bridges the specialties of oncology and reproductive endocrinology with the purpose of maximizing the reproductive potential of cancer patients and survivors.

Cancer treatments can negatively affect an individual’s ability to reproduce. Namely, cancer treatments can impact an individual’s reproductive cells (sperm or eggs) and hence their future ability to have children. With cancer survival rates increasing, fertility preservation has become a relevant consideration for individuals receiving cancer therapies. For many younger cancer survivors, this means talking about fertility preservation upfront so that they will have the option to create a family in the future. As with all medical care, it is important to discuss your options with your doctor and make a fertility preservation plan. There are many options, but cryopreservation is often the most common.

Infertility and Cancer Treatment

Cancer and its treatments can damage the reproductive system, causing fertility problems for both men and women. This includes:

  • Radiation and chemotherapy can damage women’s eggs, causing irregular periods, which affects her ability to become or stay pregnant.
  • For men, cancer treatments can affect the process of sperm production, also known as spermatogenesis.
  • Specific surgical procedures can also cause infertility. Surgery has the ability to disturb the balance of hormones required for an adequate reproductive function, which may cause reproductive problems. Specific surgeries such as a hysterectomy, or removal of the uterus, call for the removal of reproductive organs required for fertility.
  • The removal of tumors or tissue in or around reproductive organs, abdominal surgeries, and surgeries of the brain and nervous system all have the ability to negatively influence someone’s fertility.

When talking to your doctor, key things to understand are your prognosis, and if you are a woman, how safe it is for you to become pregnant. There are many ways to have a child post cancer treatment, including fertility treatments, adoption, surrogacy, donations of eggs or sperm, embryo donation, and cryopreservation.

What is Cryopreservation?

Cryo comes from the Greek word krýos, which means “icy” or “frost”. In assisted reproductive technologies (ARTs), cryopreservation is the freezing of sperm, eggs, or embryos for later use. This is a safe and effective way for individuals to preserve their fertility after cancer treatments. It is important to note that cryopreservation must happen before starting cancer treatments.

Sperm Cryopreservation

Sperm cryopreservation has been used since the mid 1900s. In male patients, sperm cryopreservation is noninvasive and currently, the most effective option for men to maintain fertility after cancer treatment. The amount of sperm cryopreserved can vary among individuals based on age, the number of previous children, and semen quality. Men who have cryopreserved sperm have high chances of fathering a future child, especially when used in conjunction with intracytoplasmic sperm injection (ICSI). ICSI, a specialized form of in vitro fertilization (IVF), involves injecting one sperm directly into an egg followed by the transfer of the embryo. Other fertility treatments such as intrauterine insemination (IUI), putting sperm directly in the uterus, are applicable if the individual’s thawed sperm has high motility.

Embryo cryopreservation

Embryo cryopreservation is the process of freezing embryos created using IVF and storing them for later use. Embryos that are cryopreserved can be stored for many years. It is important to note that sperm is required for the production of embryos; hence this process requires a willing partner or donor sperm. The steps include:

  • Egg retrieval and IVF are required to produce an embryo.
  • The embryo then gets treated with cryoprotectants and stored.
  • When the woman has completed cancer treatment and is ready to carry a baby, the embryo will be thawed along with implantation procedures.
Egg (Oocyte) Cryopreservation

Egg freezing is the most recent advancement compared to more established methods such as sperm and embryo cryopreservation. Although this method is not as established, it comes with many benefits. Oocyte cryopreservation may appeal to female patients who do not have a partner, do not wish to use donor sperm, or have ethical/religious disagreement with embryo cryopreservation. Eggs are very susceptible to cryopreservation’s physical and chemical damage, but as research improves, it is becoming a very viable option. This article discusses the first female cancer patient to give birth with the use of cryopreserved eggs.

Did you know?

It has been shown that 70% of thawed embryos
survive and have a pregnancy rate of 60%.

Fertility preservation funding options

In Ontario, OHIP covers the freezing of eggs and sperm for a medical reason, like cancer treatment. Eligibility for cryopreservation coverage also requires the individual to be an Ontario resident with a valid health card. However, the cost of storing the cryopreserved specimens (storage fees) and fertility drugs that may be required are not included.

The take-home message

Cancer patients have more options to preserve their fertility than ever before. Life after cancer can be rich and fulfilling and can include building a family of your own. Cryopreservation is an important option of fertility protection for cancer patients. The freezing of eggs, sperm, and embryos are all possible with cryopreservation techniques, but these options must be discussed with healthcare professionals prior to starting the cancer treatments. 

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References:
1. Williams D. H. (2010). Sperm banking and the cancer patient. Therapeutic advances in urology, 2(1), 19–34. https://doi.org/10.1177/1756287210368279
2. Sinha S. (2009). Role of Cryopreservation in Assisted Reproductive Technology (ART). Apollo Medicine (6)3, 212-221. https://doi.org/10.1016/S0976-0016
3. How Cancer and Cancer Treatment Can Affect Fertility in Females. (n.d.). Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html
4. Fertility Issues: A Side Effect of Treatment. (2020, July 22). Retrieved from https://www.breastcancer.org/treatment/side_effects/fertility_issues
5. Fu, L., Zhou, F., An, Q., Zhang, K., Wang, X., Xu, J., Guo, Y., Lu, W., Liang, X., & Gu, Y. (2019). Sperm Cryopreservation for Male Cancer Patients: More than 10 Years of Experience, in Beijing China. Medical science monitor : international medical journal of experimental and clinical research, 25, 3256–3261. https://doi.org/10.12659/MSM.913513
6. What is intracytoplasmic sperm injection (ICSI)? (n.d.). Retrieved from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-intracytoplasmic-sperm-injection-icsi/
7. What is IUI? (n.d.) Retrieved from https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-iui
8. Embryo Cryopreservation. (n.d.). Retrieved from https://my.clevelandclinic.org/health/treatments/15464-embryo-cryopreservation
9. Johnston K.T., & Potter J. (2011). Fertility assessment and preservation. Supportive Oncology. 617-623. https://doi.org/10.1016/B978-1-4377-1015-1.00058-8
10. Iussig, B, Maggiulli, R, Fabozzi, G, et al. A brief history of oocyte cryopreservation: Arguments and facts. Acta Obstet Gynecol Scand. 2019; 98: 550‐ 558. https://doi.org/10.1111/aogs.13569
11. Akasha A.M. & Woodruff T.K. (2019). Chapter 31 – Oncofertility: Preservation of ovarian function after a cancer diagnosis. The Ovary. 3. 501-508. https://doi.org/10.1016/B978-0-12-813209-8.00031-5
12. Get Fertility Treatments. (n.d.). Retrieved from https://www.ontario.ca/page/get-fertility-treatments


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