Some cancer treatment poses a risk to the fertility of both men and women, however there are fertility preservation techniques that can be accessed prior to the commencement of cancer treatment, which provides the opportunity for a pregnancy in the future.

Infertility after cancer treatment:

Infertility after cancer treatments may arise because:

• The ovaries are not able to produce mature eggs (ovarian failure), this can be temporary or permanent
• Hormonal signaling between the brain and ovaries has been disrupted
• There is damage to the uterus and/or the fallopian tubes from surgery or radiotherapy.

Fertility Preservation Treatments:

The type of fertility preservation treatment suitable for you, will depend on your individual circumstances such as:

• Desire for children in the future
• Current relationship situation
• Tumour type and hormone-sensitivity
• Particular cancer treatment type planned
• The time available before cancer therapy is to start

In 1996, Melbourne IVF and the Reproductive Biology Unit at the Royal Women's Hospital established an egg bank at the Royal Women's Hospital campus. The ability to cryopreserve (freeze) sperm and embryos has been technically feasible and a widely practised procedure for more than a decade. The ability to freeze eggs and ovarian tissue has been much more difficult for a wide range of physiological reasons and research is continuing into this area. Much scientific work has gone into exploring the techniques to successfully cryopreserve mature eggs and ovarian tissue. We now believe that with the advances made to date, we can offer such a treatment in selected cases.

Indications for freezing eggs/ovarian tissue:

An imminent premature menopause. Most often this is as a result of planned chemotherapy and /or radiotherapy for cancer treatment. Chemotherapy may also be used for patients who have a severe medical condition. Depending on the dosage and duration of treatment there is a variable probability that the patient will undergo a premature menopause. When the chance of premature menopause is high the option of storing eggs or ovarian tissue prior to chemotherapy is discussed.

Future premature menopause. Some women have approached us to freeze eggs for their daughters who have recently been diagnosed as having Turner's syndrome. This condition results in their daughters having a premature menopause before they ever have periods. If the women were to wait until their daughters were of an age to use donated eggs they themselves would have gone through the menopause. Therefore the question of storing eggs whilst they are still in the reproductive time of their life is considered.

Ethical and moral considerations. Some patients participating on an IVF program have moral or ethical beliefs against freezing supernumerary embryos. The ability to cryopreserve eggs prior to fertilisation means that if they are surplus to requirements, then in the future their disposal would not raise some of the moral or ethical dilemmas that the disposal of embryos may. 

Freezing of eggs
 
Mature eggs. These eggs are collected after an ovarian hyperstimulation cycle and cryopreserved as mature eggs.

Immature eggs. These eggs may be collected from ovarian tissue and frozen as immature eggs. Occasionally they may also come from aspiration of small cysts within the ovary.

Freezing of ovarian tissue. A laparoscopic technique is utilised to retrieve either a portion of one ovary or the complete ovary for freezing. After the ovarian tissue is sliced thinly into multiple sections the cryoprotectant is added so that the tissue can be frozen. There remains much research to be performed on the freezing of ovarian tissue. The big challenge in this area is to successfully mature invitro the ovarian tissue and immature eggs. There has not been a pregnancy achieved from such techniques to date. There have been a handful of cases reported in the literature following transplantation of the frozen tissue.

Current status of Egg Freezing. Most research has focused on the ability to cryopreserve mature eggs. Viable pregnancies have been obtained from the application of this technique. 

What is your risk?

Fertile Hope is a national American, nonprofit organisation dedicated to providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility.

Their website provides a wealth of information, including a Risk Calculator, to determine level of risk, using calculators based on a compilation of clinical experience and published research on common cancer treatments that may impact reproductive function. 

http://www.fertilehope.org/tool-bar/risk-calculator.cfm 

Where to get help
 
The Fertility Preservation Service at the Royal Women’s Hospital and Melbourne IVF is a service provided by the Reproductive Services Unit at the Royal Women’s Hospital and Melbourne IVF, in collaboration with cancer specialists from major oncology units.

The service is supported by:

• Doctors with experience in fertility preservation options
• Doctors with specialised experience in adolescent gynaecology issues
• Counselors with expertise in areas of cancer treatment and fertility
• Nurses and administrative staff who facilitate the service
• An internationally acknowledged scientific team who have pioneered several of the techniques now available in both research and clinical settings.  

Further Information:

Download:  “Can I still have children? Fertility options for young women having chemotherapy and radiotherapy”.

Download:  “Can I still have children? Information for men having chemotherapy and radiotherapy”.