You Can Become Mother After Cancer Treatment.
Story 1: Rupa, a 27-years-old woman has been trying to conceive for two years. When she consulted the doctor, it was found that she had very few eggs inside her ovaries. Further inquiry revealed that she received chemotherapy for leukaemia (“blood cancer”) when she was nine years-old. However, she is completely cured of her cancer right now.
Story 2: Salma, a 32-years-old woman lost her both ovaries because of ovarian cancer three years ago. Now she desperately wants to become a mother. But the doctor told that only option remaining for her is the egg-donation and IVF.
What is Fertility Preservation?
Increasing number of cancers are diagnosed in young individuals, who are yet to start their family. Many a times, these cancers are detected at early stage and therefore, are potentially curable with proper cancer treatment. That means, these patients are able to survive for long time.
But often, as a result of the cancer treatment, they are losing their ability to have their own children in future. The question is, can we save both the sides- that is can we cure their cancer without compromising their ability to become the parents. The answer is something called “Fertility Preservation in Cancer Patients”.
How cancer affects the ability to become the parents (fertility)?
Cancers affecting the reproductive organs (ovaries, uterus,cervix etc) can directly compromise the fertility by affecting the functions of these organs. Surgical removal of these organs will also impair the fertility.
Radiotherapy is very effective mode of treatment of many cancers. But if radiation is applied particularly in the tummy (abdomen), lower part of the tummy (pelvis) or rectum, it can damage the ovaries (reduces the number of the eggs) and the uterus. Chemotherapy for cancer in any parts of the body can damage the ovaries. Remember, the function of the ovaries depend on the age of the patient and pre-existing number of eggs. Therefore, whether the radiation or chemotherapy will damage the ovaries, depends on the age of the patient, the dose and duration of the treatment and the type of the medicines used. Again, in some cases, the ovaries can recover their functions completely or partially.
Which patients are eligible for “Fertility Preservation”?
Before fertility preservation, we have to ensure that the cancer is in early stage, that means there is good chance that the patient will survive after cancer-treatment. Secondly, the fertility preservation techniques should not affect the progression of the cancer. Importantly, there should be sufficient time available for fertility preservation, before starting the cancer treatment.
How fertility preservation is done in the cancers of the ovaries or uterus?
If these cancers are detected in early stage, in many cases, partial removal of these organs is possible, keeping their functions intact, as far as possible. In some cases, the ovaries can be moved away from the radiation field by operation. In some cases of the cancer of the uterus, hormone therapy can be used, instead of the surgery. Your oncologist will discuss with you, if these are feasible in your case.
How fertility preservation is done before radiation or chemotherapy?
Your ovaries can be stimulated by hormone injections. The response of the ovaries is monitored by ultrasound and sometimes with blood test. It takes 10-14 days of time for the eggs to mature after the injections. Then the eggs can be collected under anaesthesia, using a fine needle inserted through the vagina into the ovaries (without any cut). This procedure, called “Ovum Pick Up” (OPU- egg collection) takes around half an hour time. You do not need any hospital admission for OPU and can return back home within 3-4 hours.
How these eggs will be preserved, depends on whether you have partner (married) or not.
- If you are married, your eggs will be fertilized (“mixed”) with your partner’s sperms to produce the embryos. This is called in vitro fertilization (IVF). These embryos can be frozen for long time. When you become cancer free, these embryos can be transferred inside your uterus to give you the pregnancy.
- If you are not married, your eggs can be frozen. When you get your partner, your eggs can be used for IVF, using your partner’s sperms and the embryos can be transferred.
In some cases, the whole or part of the ovary can be taken out and frozen and can be transferred back inside your tummy when you will be cancer free. This is called “Ovarian Cryopreservation”. The eggs can also be collected from your frozen ovaries inside the laboratories and can be grown further.
How much time does this fertility preservation take?
With advent of new technologies, the hormonal stimulation and OPU takes hardly one month time. After OPU, your cancer treatment can be started.
What is the success rate of these fertility preservation techniques?
In general, the success rate of IVF is 40% per transfer. That means, if embryos are transferred in 100 women, only 40 can conceive after one month. The frozen embryos have very good chance of survival, if they are of good quality. The chance of survival of frozen eggs was little smaller. However, with the advent of new “vitrification” techniques, reasonably good number of eggs survive after freezing. “Ovarian cryopreservation” is still considered “experimental”.
Will the babies born by these procedures be normal?
There is no evidence that freezing and IVF increases the risk of abnormalities of the baby.
How long the frozen eggs or embryos be kept?
These can be preserved for at least five years. If you want to preserve them for long time, you need to talk with your laboratory.
If I freeze my eggs or embryos, can’t I get pregnant naturally?
If you are freezing your eggs/embryos, you are keeping them as “back up support”. In many cases, ovarian function can return, at least partially after cancer treatment and you can conceive naturally. But in case,your ovaries fail to resume their activities, you can use the frozen materials.
Whom should I contact for fertility preservation?
You must discuss with your oncologist, if fertility preservation applies to you. You also need to consult fertility specialist, who will conduct the procedures like hormonal stimulation and OPU. The procedure must be done in the laboratory, equipped with all ultra modern facilities.
Cancer does not mean the end of the world. Motherhood is still possible after cancer treatment. Before cancer treatment, please do not hesitate to discuss with your oncologist about the fertility preservation. Please consult fertility Specialist if you want to preserve your fertility.