oncofertility

Oncofertility: Fertility Preservation for Cancer Patients and Survivors

Oncofertility is a medical field that bridges oncology and reproductive endocrinology. Oncofertility aims to maximize the chances that cancer patients and survivors can have a family despite their illness.

Cancer treatments—including chemotherapy, radiation, and surgery—may impair or destroy a person's ability to have children later in life. For women, these therapies can cause ovarian damage, early menopause, or other reproductive problems. For men, treatments can cause damage to the testes, which interferes with sperm production.

Oncofertility: Fertility Preservation for Cancer Patients and Survivors

Fertility Preservation Options

As cancer treatments improve and more patients survive, fertility preservation options for women, men, and children become increasingly important. Fortunately, there are many treatment options available. Cancer patients or survivors can consult with our reproductive endocrinologists as early as possible following diagnosis, particularly prior to chemotherapy or pelvic radiation.

Fertility preservation treatment options include:
  • Shielding—if possible, the genital and pelvic region is protected with a lead apron during radiation therapy to minimize radiation damage to ovaries and testes.
  • Ovarian Transposition, in which the ovaries are surgically moved out of the pelvis prior to pelvic radiation in efforts to minimize radiation damage.
  • Gonadotropin Agonist Injections, which minimize ovary or testes activity prior to chemotherapy. It is believed that ovaries and testes with lower metabolic activity will face fewer damaging effects from chemotherapy, although that view remains controversial.
  • Egg Banking allows unfertilized eggs to be retrieved and frozen for future fertilization, once cancer treatments are complete. During egg banking, ovaries are stimulated with hormones, resulting in the maturation of multiple eggs that can be harvested by ultrasound-guided aspiration, and then frozen for future use. This process may require 2-6 weeks to complete.
  • Embryo Banking allows fertilized embryos to be frozen for future implantation. Ovaries are stimulated with hormones, resulting in the release of multiple eggs that can be harvested by ultrasound-guided aspiration. These eggs are immediately fertilized with sperm to create embryos, which are then frozen for future use. This process may require 2-6 weeks to complete.
  • In Vitro Maturation (IVM) of Oocytes (immature female egg cells that mature into eggs). In this treatment, multiple oocytes are harvested by ultrasound-guided aspiration without prior hormone stimulation. Oocytes are matured in the laboratory, either before or after freezing. The advantage of this process is the relatively short time period required to obtain immature eggs, which minimizes any delay before cancer treatment. Scientists are currently developing methods to optimize the maturation process of eggs in the laboratory.
  • Sperm Banking allows sperm to be frozen for future use. Multiple semen samples can be collected and frozen over a period of several days.
  • Testicular Sperm Aspiration or Extraction is a minor surgical procedure where sperm is retrieved directly from the epididymis or testes, which can then be frozen for future use. This is only required when sperm cannot be produced through ejaculation.
  • Tissue Banking, in which ovarian cortex or testicular tissue is surgically removed and frozen. This tissue can later be transplanted back into the body and hormonally stimulated to produce eggs and sperm when you are ready to conceive. This procedure yields some success, but scientists are currently developing methods to optimize the technique.