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What is Oncofertility?
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, 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 that can lead to genetically damage oocytes (eggs), ovarian failure, early menopause, or other reproductive problems. For men, treatments can similarly cause damage to the testes that interfere with sperm production and testosterone secretion. As cancer treatments improve and survivorship increases, fertility preservation options in women, men, and children become an increasing important topic. Fortunately, multiple treatment options exist to maximize your future fertility potential. Consultation with the reproductive endocrinologists should be done as early as possible after the diagnosis of cancer, and optimally prior to chemotherapy or pelvic radiation.
Fertility Preservation Options
- Shielding of the genital and pelvic region with a lead apron during radiation therapy to minimize the damaging effects of ionizing radiation on the ovaries and testes.
- Ovarian Transposition to physically move the ovaries out of the pelvis through surgical techniques in cases where pelvic radiation is required in order to minimize the damaging effects of ionizing radiation on the ovaries.
- Gonadotropin Agonist injections will chemically down regulate the ovaries or testes and minimize their activity prior to receiving chemotherapy. The belief is that ovaries and testes with minimal metabolic activity will experience less damaging effects from the chemotherapy. However, there is controversy about the beneficial effects of gonadotropin agonist downregulation on future fertility.
- Egg Banking to cryopreserve (freeze) a woman’s eggs for future fertilization with sperm when she meets her future life partner. Hormonal stimulation of the ovaries result in the maturation of multiple eggs that can be harvested by ultrasound guided aspiration and frozen for future use. This process may require 2-6 weeks to complete.
- Embryo Banking to freeze embryos for future implantation. Hormonal stimulation of the ovaries result in the maturation of multiple eggs that can be harvested and fertilized immediately with her partner’s 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, where multiple immature eggs are harvested by ultrasound guided aspiration without prior hormone stimulation. These eggs will then be matured in the laboratory either before or after freezing. The main advantage 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 to freeze sperm 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 frozen for future use. This is only required when no sperm can be produced through ejaculation.
- Tissue banking where 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 with some success when the patient is ready to conceive. Scientists are currently developing methods to optimize this technique.
- Donor Egg is recommended when the ovaries are permanently damaged by cancer treatment and no longer able to produce eggs. A known or anonymous egg donor is hormonally stimulated to mature multiple eggs that can be harvested and fertilized with sperm from the patient’s male partner to form embryos. The embryos can then be transferred into the patient’s own uterus to carry the pregnancy.
- Donor Sperm is recommended when the testes are permanently damaged by cancer treatment and no longer able to produce sperm. The sperm from a known or anonymous donor is used to achieve a pregnancy with the patient’s female partner.
- Gestational Surrogate is required when cancer treatment damages the uterus and prevents a woman from carrying a pregnancy. Embryos created from a couple’s eggs and sperm are transferred into the uterus of the gestational surrogate in order to carry the pregnancy.
- Adoption is a legal transfer of all parental rights and responsibilities of a child from the biological parent.
At UCLA, we have a closely coordinated team of highly dedicated oncologists and reproductive endocrinologists to provide individualize treatment options to maximally preserve your future fertility.