Oncofertility: Offering parenthood hope to cancer survivors

In the book It’s Not About the Bike: My Journey back to Life, Lance Armstrong writes, “I wanted to be a father – quite badly – but I had always assumed it would happen when I was in love. I had no choice; …”[1] These were the innermost thoughts of the seven-time Tour de France winner before his first chemotherapy session. The concerns of then 25-year-old Armstrong[2] is no different from any other young person diagnosed with cancer, which oncofertility, an interdisciplinary field that bridges oncology and reproductive research to explore and expand options for the reproductive future of cancer survivors, can address.

The term, coined by Dr Teresa K Woodruff in 2006, refers to fertility preservation options as treatments for cancer, including chemotherapy, radiation, and surgery, may reduce or destroy the survivor’s ability to have children later. Cancer treatment can damage the testes that interfere with sperm production and testosterone secretion in men. In women, they can cause ovarian damage leading to genetically damaged oocytes (eggs), and medical complications such as ovarian failure or early menopause.

Alarming rise in cancer cases a cause for concern

With the rapidly increasing number of cancer cases in India, oncofertility is poised to become a trusted medical specialty that will offer hope and help at the same time. According to the Indian Cancer Registry, by 2026, India will have 9.34 lakh new cancer cases for females and 9.35 lakh in males. Considering that 65 per cent of India’s population is less than 35 years and 50 per cent is less than 25 years of age, an estimated 11 per cent and 25 per cent of cancer patients will be in their reproductive age.

With better cancer treatments, the number of survivors has increased over the years. However, in very few cases, fertility preservation options in women, men, and children assume the importance of an aspect to be addressed. Consultation with the reproductive endocrinologists should be part of psychosocial rehabilitation of cancer patients and done at the earliest after the diagnosis, ideally before chemotherapy or pelvic radiation begins.

Preserving the fertility of cancer patients

It is critical to recognise that the decision of cancer patients to preserve their fertility is not a single event but rather an emotional experience influenced by biological, social, and psychosocial forces interacting with modern medicine. As per estimates, as much as 40 to 80 per cent women face possible infertility and cannot get pregnant due to cancer treatments.[4] It is important to ensure that surviving cancer does not lead cancer patients out of the frying pan into the fire. Fertility preservation options for both men and women are available. Overarching options include:

Shielding of the genital and pelvic region with a lead apron during radiation therapy to reduce the damaging effects of ionizing radiation.
Ovarian transposition physically moves the ovaries out of the pelvis through surgical techniques in patients who require pelvic radiation.
Banking of eggs, sperm, and embryo are also viable options. Sperm banking is the easiest while the process of egg and embryo banking takes 2-6 weeks each to complete. Frozen eggs and oocytes can be used for up to 10 years from the date of freezing. Tissue banking is a relatively new process and methods are being developed to optimise it.[5]

The roadblocks in the field of oncofertility

In India, cancer survivors are often left rudderless in absence of structured survivorship programs prevalent in the developed countries. Fertility preservation options in India are yet to see a standardization, making the cost a deterrent. While there are several assisted reproductive technology (ART) banks that can offer frozen sperms, preserving options for women are costlier and hence, limited. Besides, though delivering a child is covered by insurance, there is no insurance coverage for fertility treatments. This makes the cost of preservation an out-of-pocket expense, the reason many may have dropped the idea even if they needed it. Besides, if the oncologist is reluctant or uninformed about these options, it can cost the patient an opportunity to choose one.

(This article is authored by Dr. Gauri Agarwal, Fertility Expert and Founder of Seeds of Innocence and Genestrings Lab)

[1] https://oncofertility.msu.edu/sites/oncofertility/files/legacy_files/uploadedfilecontent/onco_chapter_1.pdf

[2] https://www.independent.co.uk/news/world/americas/lance-armstrong-doping-testicular-cancer-espn-a9522606.html

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070400/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381379/

[5] https://www.uclahealth.org/obgyn/oncofertility

Source: | This article originally belongs to thehealthsite.com

Oncofertility: Offering parenthood hope to cancer survivors

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Oncofertility: Offering parenthood hope to cancer survivors

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