Introduction:
Cancers and their treatments can affect the fertility of female patients. Many cancer treatments lead to the removal of the organs required for pregnancy, like fallopian tubes, uterus, or ovaries, and changes in hormone levels, and can even damage the eggs. So, the steps taken to treat cancer can affect fertility permanently or temporarily, depending upon the treatment. However, some women wish to preserve their fertility to have children after the treatment. The steps for the preservation of fertility take place before the treatment starts.
What Is the Necessity of Preserving the Fertility of Women?
Women fertile before treatment can naturally become pregnant, but post-treatment, some patients cannot become pregnant. So, if these patients want to get pregnant, they need to preserve their fertile eggs before treatment; if they want to have children after the cancer treatment. Before starting the cancer treatment, the steps taken can provide chances for women to get pregnant post-treatment. But all this should be under the supervision of the doctor. Therefore, consulting the doctor before getting pregnant after the cancer treatment is essential.
How Does Cancer Treatment Affect the Fertility Of Women?
Sometimes, cancers like adenocarcinoma can lead to the removal of the uterus. And some treatments may include the removal of ovaries or fallopian tubes also. In contrast, other cancers are treated by chemotherapy or radiation. Women who have undergone chemotherapy or radiation therapy to the pelvis are usually at risk of early menopause, although they start having menstrual cycles again. They can have menopause 5 to 20 years earlier than before treatment. If these women have to conceive, they have to wait at least two years after the treatment, as the risk of getting cancer back or recurrence can occur.
How to Preserve Fertility in Cancer Patients?
Preservation of fertility in cancer-treated women includes the following procedures:
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Cryopreservation (Freezing Embryos or Eggs) - It is a step in which the patient opts for freezing embryos or eggs. Freezing eggs is a process that includes collecting the eggs and freezing them. Cryopreservation for collecting eggs for embryos takes several days or weeks, depending on the woman's menstrual cycle. Then, with the help of injectable hormone medications, they are safely given. Cryopreservation for eggs during the menstrual cycle is not required to count. The procedure is performed by inserting the catheter through the upper part of the vagina into the ovaries to collect the eggs. However, the fertility specialist charges the patient for the storage of these eggs.
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Embryo Freezing - It is an effective way to help preserve women's fertility. The process involves the removal of the mature egg from the female body and inserting it in a sterile laboratory dish with several thousand sperm to fertilize the egg by any one sperm, hence calling it in-vitro fertilization (IVF). In-vitro intracytoplasmic sperm injection (IVF-ICSI) involves a single sperm injection directly inserted into an egg to fertilize it. In both these processes, after fertilization, the embryo is frozen. Then after the treatment ends and the woman is ready for pregnancy, the embryo is thawed and put into the woman's uterus. But along with this, age and menopause factors play an important role in pregnancy. The embryo quality, survival rates in the uterus, and many other factors like not getting implanted are all involved in the women's pregnancy.
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Egg (Oocyte) Freezing - It is also an effective way to preserve the fertility of women who have not chosen a partner or who do not have a sperm donor to fertilize the egg. The process involves the removal of the mature eggs from the female and freezing them without fertilizing them. It is also called egg banking. Whenever the woman is ready to get pregnant, then the eggs are thawed, fertilized, and implanted in the uterus for becoming pregnant.
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Ovarian Tissue Freezing - It is a process in which part of one ovary is removed by laparoscopy. Laparoscopy is a minor surgery with the flexible tube reaching the pelvis through the navel cut. The ovarian tissue is cut into small strips, then stored frozen. Then, when the treatment is over, the tissues are transplanted again into the pelvis. And soon, the tissues start functioning again, and then the eggs get collected so fertility attempts can be performed in the laboratory.
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Ovarian Transposition - It is the process of moving the ovaries from the target zone of the treatment area. It is one of the favorable options for women undergoing pelvic radiation treatment. It is used before puberty or after puberty. It is a kind of outpatient surgery done by a doctor by placing the ovaries in the central pelvis before the treatment and by the time the ovaries fall to their position back. It is not always a successful technique, as ovaries are not always protected.
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Fertility-Sparing Surgery - The procedure is required in cases related to early-stage cervical cancer; in this, the surgeons have to remove the cervix. And for ovarian cancer, the surgeon removes the affected ovary while the other unaffected ones remain. Both of these can preserve fertility.
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Ovarian Suppression - Gonadotropin-releasing hormone agonists are long-acting hormonal drugs used to make women go through menopause for a short period, called ovarian suppression. The main objective of ovarian suppression is to close the process of the ovaries during cancer treatment to protect them from damage. But there are more trusted ways of preserving the fertility of women.
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Progesterone Therapy for Early-Stage Uterine Cancers - Women with early-stage, slow-growing cancers (adenocarcinoma) are usually treated by the removal of the uterus (hysterectomy). So, in stage 1 endometrial cancers, the women can be treated with progesterone hormone instead of removal of the uterus or other fallopian tubes, or ovaries.
Conclusion:
The women who are cancer treated are sometimes unable to conceive and become pregnant. There are a few methods mentioned above that preserve the fertility of women post-treatment. Some of the methods involve cryopreservation, ovarian transposition, and fertility-sparing surgery. Cryopreservation involves embryo freezing, egg freezing, and ovarian tissue freezing methods. Ovarian transposition is a procedure to displace the ovaries towards the central pelvis, and fertility-sparing surgery involves the procedure that suppresses the menstrual cycle for a short period so that no preservation by removing the eggs is done.
