Female fertility preservation

Dr Chris Venter educates us on the fertility preservation options for female cancer patients.

When someone is confronted with the devastating diagnosis of cancer, the immediate goal is to survive the cancer. In the past decades, there has been a sharp increase of survivors of cancer. This is due to advancements in cancer therapy and earlier detection of cancer. 

Many cancer survivors are in their reproductive years, and survivorship issues, such as family planning, become a real need. Evidence has shown that the desire to one day have a family is a strong motivational factor for patients fighting cancer. Unfortunately, effective cancer treatments come with a cost; many cancer treatments can damage young eggs, and, subsequently, impact negatively on future fertility.

What is female fertility?

Females are born with a limited number of eggs. At the age of 12, most females will have around three hundred thousand eggs. The number and quality of eggs gradually reduces over time.Cancer or radiation may accelerate this loss of eggs, resulting in a permanent damage to egg reserve. 

How can you save your fertility?

Your desires and concerns regarding your fertility must be discussed with your oncologist, who will refer you to a reproductive specialist, if appropriate. There should be no time delay in seeing a reproductive specialist as most oncotherapy has strict timelines.

What fertility preservation options are available?

• Pre-pubertal females

Since the ovarian function has not matured, these young patients can’t produce mature eggs. Ovarian tissue cryopreservation (OTC) remains the only option. This is where part or all of an ovary is removed, and the tissue that contains the eggs is cut into thin slices and frozen. The tissue may later be thawed and placed back into the woman’s body, usually on the remaining ovary. 

Though, in South Africa OTC is still regarded as experimental and should only be performed under strict guidelines as part of a research protocol.

• Post-pubertal females

The most established method remains embryo cryopreservation. This remains the method of choice in women in an established relationship. The process involves, ovarian stimulation which takes 10 to 15 days, followed by egg retrieval and fertilisation with the male partner’s sperm. After five days of incubation, embryos are stored for future use. Embryo cryopreservation has the added advantage of genetic testing of the embryo for gene mutations in hereditary breast cancer patients.

Oocyte cryopreservation is the option of choice in post-pubertal women not in an established relationship. Ovarian stimulation, followed by oocyte (egg cell) aspiration and cryopreserving mature oocytes.

Ovarian transposition is for the patient receiving pelvic radiation therapy. Ovarian oocytes are more sensitive to radiation than chemotherapeutic drugs. The procedure involves the laparoscopic re-positioning of the ovaries, higher up in the pelvic area, out of the radiation field. 

General facts 

• Fertility preservation should not delay the start of cancer therapy by more than 10 to 15 days.
• There is no evidence to show that fertility preservation will worsen or increase relapse of breast cancer.
• Some medical aids will cover surgical fertility preservation options, such as ovarian transposition, but won’t cover medical preservation options, such as egg and embryo cryopreservation.
• There is no risk of the cancer being transferred to your offspring by storing eggs or embryos.
• Freezing of eggs or embryos is safe and doesn’t lead to an increase in birth defects.
• Fertility preservation doesn’t guarantee a future pregnancy, but it gives the patient the assurance that she did  everything to give herself a fair chance to one day have a family.

For more info, visit www.savemyfertility.com 

MEET OUR EXPERT  – DR CHRIS VENTER

Dr Chris Venter works as a reproductive medical specialist in Johannesburg. He has a keen interest in treating couples with reproductive failure and raising awareness amongst cancer patients about the importance of fertility preservation. Through collaboration with the Oncofertility Consortium Network, his goal is to unify oncofertility care in South Africa.