Fertility Options And The Impact Of Cancer Therapy On Patients' Fertility Prior To Initiating Therapy

Main Category: Fertility
Also Included In: Cancer / Oncology
Article Date: 24 May 2006 - 18:00 PDT


UroToday.com - Dr Schover, Professor or Behavioral Sciences, MD Anderson Cancer Center presented highlighted the importance of discussing fertility options and the impact of cancer therapy on patients' fertility prior to initiating therapy.

She emphasized the strong desire of cancer survivors to be parents and the infertility represents a major loss. Recent guidelines from the President's Cancer council urge oral and written discussion about the risks of treatment on fertility and options for fertility preservation. ASRM ethics committee and ASCO panel on fertility preservation also address this issue. 30-50% of patients do not recall being told that cancer treatment could damage their fertility.

All men should be offered sperm cryopreservation prior to treatment since ART techniques provide fertility potential even when semen parameters are severely abnormal. In the US, 25% of men crypopreserve sperm prior to treatment for testes cancer. 20-30% have poor analysis at presentation. 10% are azoospermic.

Only 10% ever utilize cryopreserved specimens. With more aggressive screening for prostate cancer, younger men who may continue to have interest in parenthood are being treated with surgery or some form of radiotherapy. These patients should also be offered cryopreservation. Brachytherapy may preserve spermatogenesis. The average ERT exposure to the testes is 1.2 Gy and most men will become azoospermic.

Since young boys may also produce specimens successfully, cryopreservation must be discussed with families of you boys being treated (surgically with radiation or with systemic therapy) for malignancies.

Women may also be affected by malignancies and may want to preserve fertility. Although embryo freezing is well established, the success of ovarian or ovum cryopreservation is less reliable.

There is no clear evidence of decreased healthy births after chemo or radiation therapy. DNA repair may take 2 years. Patients should avoid conception for at least 6-12 months after treatment.

By Harris Nagler, MD

Leslie R. Schover, PhD.
Parenthood after Chemotherapy

EDITORIAL COMMENT:

The issue of fertility and fertility preservation must be discussed prior to any individual receiving therapy for a malignancy. Cryopreservation of sperm is reliable and durable. Even a few sperm may allow for conception with IVF and ICSI. The techniques of cryopreservation of ovum and ovaries are likely to continue to advance.

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