Doctor, will I be able to have a baby ? Fertility after cancer
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Transcript of Doctor, will I be able to have a baby ? Fertility after cancer
Doctor, will I be able to Doctor, will I be able to have a baby ?have a baby ?
Life after cancerLife after cancer
Dr Aniruddha Malpaniwww.drmalpani.com
The child with cancerThe child with cancer
Early diagnosis, because of better awareness and better imaging techniques, means the diagnosis is being made more often
Newer treatment protocols translates into more effective treatment and better survival rates
OncofertilityOncofertility
The new specialtyExploring and expanding options for the reproductive future of cancer survivors
IVF specialists are seeing IVF specialists are seeing two types of childhood two types of childhood cancer patients:cancer patients:
Newly diagnosed patients ;
and Long-term survivors.
Doctor, why didn’t you tell me to Doctor, why didn’t you tell me to freeze my eggs / sperm ?freeze my eggs / sperm ?This is a question your survivors
will ask you when their cancer is treated and they come for a 5-year followup
How will you answer ?You will have wasted their
golden opportunity
Think of the future as well !Think of the future as well !Many young cancer survivors feel they received inadequate information on their fertility preservation options.
Fertility preservation gives patients hope for a high quality life after cancer
Please discuss this proactively
Newly diagnosed patientsNewly diagnosed patientsNeed to cope with diagnosis of a
life-threatening disease. Significant shock and emotional
distressShortened “window of
opportunity” for treatment. Time is of the essence.
Please refer as soon as possible !
Newly diagnosed patientNewly diagnosed patientYour major focus is to design
the best treatment plan. You have lots of things to do
Establish a diagnosisStage the diseaseSelect the best protocolRefer to a medical oncologistRefer to a radiation therapistRefer to a support groupsDiscuss costs
Refer to Refer to Specialty multi-disciplinary clinic for
a second opinion ?Surgical oncologist for staging?Medical oncologist for
chemotherapy ?Radiation therapist ?Please also refer to IVF specialist for
fertility preservation !
You have cancer !You have cancer !You need to discuss many
emotionally-charged topicsCancer-related infertility and
fertility preservation also need to be discussed because you can take proactive steps toward preserving their fertility
Their future ability to have children will significantly improve their quality of life.
Having babies enhances quality Having babies enhances quality of life for survivorsof life for survivors
Many cancer survivors have a strong urge to have a family.
Their brush with death makes them better parents
Cancer-related InfertilityCancer-related InfertilityChemotherapy and pelvic radiation
compromise future fertilityMore powerful drugs = better
survival and more infertilityInfertility is a source of long-term
distress in survivors – especially if this could have been prevented !
The two things every pediatric The two things every pediatric oncologist needs to know oncologist needs to know
about fertility about fertility Chemotherapy and pelvic radiotherapy damages gonadal reserve and can cause infertility
Fertility preservation techniques can help to mitigate this damage
Dramatic improvements in Dramatic improvements in preserving fertilitypreserving fertilityTake proactive steps to preserve
fertility before initiating cytotoxic therapy. Decisions should be made as early as possible. Even one dose of chemo can impair fertility
We can freeze◦ Eggs◦ Sperm◦Ovarian tissue◦Testicular tissue
Sperm preservationSperm preservationShould be routine for all
postpubertal boysTouchy topic. Needs to be discussed
proactivelyEasy to freeze spermMajor expense is the storage cost
( over many years)Sperm can only be used for ICSI –
they are worth their weight in gold !
Testicular tissue preservationTesticular tissue preservation
Option for prepubertal boysStill experimentalIn vitro sperm maturation –
hope for the futureTechnology will evolve and
improve over time
Egg preservationEgg preservation
Option for postpubertal girlsComplex and expensiveNeed to do egg collection to collect eggs
Ovarian tissue preservationOvarian tissue preservation
Ovarian tissue freezing for prepubertal girls
Much more complex and expensive
Still experimentalRefer to specialty center
Following hormonal stimulation, oocytes are aspirated directly from the ovaries, using ultrasound guidance.
About 10-15 oocytes are retrieved (which typically produces 5-6 high quality embryos)
VitrificationVitrification
New technology- fast freezing of vitrification. Much better results
• Fast freezing prevents ice crystal formation that can damage DNA
No increase in congenital anomalies compared with naturally conceived infants.
Cryopreservation of Ovarian Cryopreservation of Ovarian Cortical TissueCortical Tissue
Experimental. May be only option for prepubertal patients
Summary of procedure:◦ Retrieve ovarian tissue by
laproscopy◦ Freeze strips of ovarian cortical
tissue ( contains primordial follicles)◦ Later, reimplant tissue; hip, arm◦ Or graft ovarian tissue onto
the remaining ovary
Cryopreservation of Ovarian Cryopreservation of Ovarian Cortical TissueCortical Tissue
Advantages: no hormonal stimulation, no time delay
Disadvantages: ◦ Experimental procedure; few live births◦ 25% follicles die because of initial ischemia◦Concern for reimplantation of cancer cells with ovarian tissue implantation (not suitable if there may be metastases in the ovaries)
Retrieval and In Vitro Maturation Retrieval and In Vitro Maturation ( IVM) of Immature Oocytes( IVM) of Immature Oocytes
Another option might include aspiration of immature oocytes from the small “antral” follicles of the ovary with maturation of these oocytes in a laboratory setting in the future.
Referrals to IVF specialistReferrals to IVF specialistOncologists should refer interested
patients to reproductive specialists as soon as possible
Pretreatment fertility counseling and fertility preservation improves quality of life.
“ Losing my hair would be temporary, but losing my ability to have children would be permanent and devastating.”
Hope for the futureHope for the future
In vitro gametogenesisUsing stem cells for generating gametes in vitro
Additional online educational Additional online educational resourcesresources
www.savemyfertility.orgwww.fertilehope.orgwww.myoncofertility.org
FAQsFAQsShould survivors be tested for their
fertility once they become adults ?Should they tell their prospective
spouses about the possibility of their fertility being reduced ?
Does pregnancy increase the risk of cancer recurrence?
FAQs FAQs Is it safe to delay the chemo ? Does egg/tissue freezing really work?
What are the success rates of each treatment? How many babies have been born?
What is the safety of fertility treatments (especially for hormone sensitive cancers)?
FAQsFAQsHow long can the eggs/ sperm be
stored ? What happens if the patient dies? How much do the treatments cost?
Insurance coverage? Financial assistance?
What is the birth defect rate of children born to cancer survivors?