Dr RichaSharma & Dr Samit Sekhar
Dear readers in continuity of regularly updating you about what’s all we need to be aware, here are we with another concern which a segment of patients have. Though in metro cities, as facilities are there under one roof so general awareness of is better as compared to towns and smaller cities.So as doctors its our responsibility to bring forth to you basics you all should be aware as if we are aware we can take right decisions at right time with mind open.We will go stepwise in each article and you are open to send us queries which we will try to solve or at least guide you in the right direction.
Topic today is cancer and its impact on fertility and can there be ways to protect it. Its still hidden under covers of hesitation and communication gap presenting lots of challenges and unmet needs of the society.We will start with a clinical situation we came across in our practice to make it more lucid to understand the gravity of situation and how important it is !!
Crux- Act Now Or Its Never !
THE PATIENT’S DILEMMA: BALANCING CANCER AND FERTILITY
Mr Aman (name changed) 18 years aged reported to oncology department in some hospital in Delhi and he was diagnosed as having cancer bilateral testes .Cancer was a crisis of life not only for the gentleman but for whole family.It was like a nightmare .Main focus definitely was on how to save the life and cure it. He underwent surgery and chemoradiation later but nothing was done for preserving fertility or they were not in that situation !!. Now that guy is 35 years age , he is married for 10 years with no kids as he has zero sperms .When we took history we came to know as what all happened- had the family taken decision or discussed options to preserve fertility, things would have been different than now regretting.Timely decisions would have worked.
Unmet Needs –
Many womenof childbearing age who have been diagnosed with cancer think that preserving their fertility is important and want information about their options but still there is a hitch.
* Patients may not feel comfortable bringing up fertility issues.
* Patients may not be aware of their options for preserving fertility.
* Patients may be focused on their cancer diagnosis and unable to think about fertility or the possibility of having a future family.
Women may later regret not considering fertility issues prior to starting cancer treatment.
Understanding that there are fertility preservation options available and referring at-risk patients to specialists can improve patients’ emotional outlook and future quality of life.
Even women with a poor prognosis may want to consider fertility preservation.
Same is applicable to men
Options available-
ASCO recommendations-
Fertility preservation options for women diagnosed with cancer
Option Definition
Embryo Banking To get eggs , form embryos and freeze to be used later
Egg Banking
Harvesting and freezing of unfertilized eggs for IVF and implantation after cancer treatment
Ovarian Tissue
Banking
(Experimental) Freezing of ovarian tissue and reimplantation of tissue or in vitro maturation of follicles and fertilization of eggs after cancer treatment
Radiation
Shielding Use of shielding to reduce scatter radiation to the ovaries
Ovarian Transposition Surgical repositioning of ovaries away from the radiation field
Radical Trachelectomy Surgical removal of the cervix with preservation of the uterus
Ovarian Suppression
(Experimental) GnRHanalogs or antagonists used to suppress ovaries
Donor Embryos Embryos donated by a couple
Donor Eggs Eggs donated by a woman
Gestational Surrogacy Woman carries a pregnancy for another woman or couple
Adoption Process that creates a legal parent-child relationship
For men-
* Sperm cryopreservation
* Gonadal shielding
* Testicular tissue cryopreservation/suppression
Source of Information-
Fertile Hope also provides an online risk calculator.
For patients who wish to try for a pregnancy, it is important to take into account the patient’s age when planning their cancer treatment. Patients who are over the age of 35 may have reduced fertility preservation options.
(The authors are Senior IVF Consultant Gurgaon Fertility Centre GFC, and executive Director Gurgaon Fertility Centre, GFC)
Email id- drricha @gurgaonfertilitycentre.com
info@gurgaonfertilitycentre.com
Follow our WhatsApp channel
