Protecting Your Parenthood Dreams: Fertility and Cancer Treatment

A cancer diagnosis is overwhelming, and for many young adults, it brings an immediate concern: "Will I still be able to have children?"  Fertility is an often overlooked aspect of comprehensive cancer care. For patients to make well-informed decisions regarding their future, it is essential that they comprehend the possible effects of treatment and the preservation options that are accessible.

How Cancer Treatments Affect Fertility

Unfortunately, many life-saving cancer treatments can significantly affect fertility.  Chemotherapy is a popular treatment that targets cells that divide quickly, including healthy reproductive cells and cancer cells. Women who use certain chemotherapy medications, particularly alkylating agents, may develop primary ovarian insufficiency (POI), a condition in which the ovaries cease to produce mature eggs and hormones, which can occasionally cause early menopause. Chemotherapy can harm or stop sperm production in men.

Radiation therapy, particularly when delivered to the pelvic region or reproductive organs, can also cause irreversible damage to ovaries and testes, affecting egg and sperm production. The capacity to conceive or carry a pregnancy may be directly impacted by surgery for reproductive malignancies that may need the removal of organs like the ovaries or uterus. Depending on the patient's age, baseline fertility, therapy type and dosage, and other variables, the degree of fertility loss may be either temporary or permanent.

Fertility Preservation Options for Men and Women

The good news is that advancements in reproductive medicine offer various ways to preserve fertility before treatment begins.

• For Women:
• Egg Preservation (Oocyte Cryopreservation): Involves stimulating the ovaries to produce multiple eggs, which are then retrieved and frozen for future use.
• Embryo Cryopreservation: Option if a partner is available, involves freezing fertilized eggs. It often has slightly greater success rates than egg preservation.
• Ovarian Tissue Freezing: Though still considered experimental in some cases, involves removing and freezing a piece of ovarian tissue containing immature eggs, which can later be transplanted back to restore fertility.
• For Men:
• Sperm Banking (Sperm Cryopreservation): The primary technique for preserving male fertility is the collection and freezing of semen samples prior to chemotherapy or radiation therapy. Testicular Sperm Extraction (TESE): This technique can be used for men who have low sperm counts or have trouble supplying a sample.

Costs and Access to Services

Fertility preservation can have a significant cost impact. Without accounting for yearly storage fees, the typical cost of one egg freezing cycle in India can range from ₹1,40,000 to ₹2,00,000. Although certain insurance companies might give restricted coverage, this is typically not a feature of basic health insurance. But as awareness grows, certain facilities, such as Jindal IVF in North India, are providing oncofertility programs specifically designed to help cancer patients access and afford these therapies. Inquiring about expenses, payment schedules, and any financial aid programs is essential for patients.

Family Planning After Treatment

Recovery and future family planning are top priorities after successful cancer treatment. For those who had fertility preservation, the frozen eggs or sperm can be used through assisted reproductive technologies like IVF, but it's crucial to have reasonable expectations and realize that success rates vary.

Depending on the type of cancer and the treatment received, it is usually advised that cancer survivors wait a specific amount of time after treatment before trying to conceive. This period can range from six months to two to five years. This gives the body time to heal and lowers the possibility that any lingering effects of the treatment could harm a developing fetus. Some people can still start a family through surrogacy, adoption, or donation of eggs, sperm, or embryos if biological parenthood is not an option.

Talking to Your Oncologist About Fertility

The most important thing is to discuss fertility with your oncologist as soon as possible after receiving a diagnosis.  Don't assume they will raise the topic. Be proactive and ask:

• How is my specific cancer treatment likely to affect my fertility?
• What alternatives do I have for preserving my fertility, and when should I start?
• What are the dangers and success rates of these procedures?

It's critical to have early and honest contact with your medical team, which includes your oncologist and a reproductive specialist. This proactive strategy gives young adults with cancer the best chance to fulfill their aspirations of becoming parents following treatment by empowering them to make educated decisions.