Multidisciplinary fertility management
Certain cancer therapies will have negative effects on the patient's future fertility.
Treatment such as chemotherapy and radiotherapy can have toxic effects on the ovarian reserve (the stock of gametes contained in the ovaries).
Age at the time of diagnosis and when starting cancer treatment are therefore critical when the fertility specialists, together in consultation with the oncology team, decide in which direction to guide their patients to preserve their fertility.
Multidisciplinary fertility management at the time of a cancer diagnosis can be defined as oncofertility.
There are several techniques available according to the anti-cancer therapies used
Cryopreservation of ovarian tissue:
This technique uses a laparoscope to remove a fragment of ovary under general anaesthesia.
This technique can only be used in patients under the age of 36 when urgent chemotherapy is required.
It is the only way of preserving fertility in pre-pubescent patients.
Part of the ovarian tissue sampled is analysed to ensure the absence of malignant cells. The rest is frozen.
After chemotherapy, if the patient does not recover a normal cycle, the previously frozen tissue can be grafted on using the same laparoscopic technique.
Freezing of eggs and embryos
At the time of a cancer diagnosis, the patient will not necessarily have met the father of her future children yet.
In this case, it is possible to cryopreserve eggs for a legal duration of 10 years.
If a couple who are already together wish to have children in the future, it is possible to freeze embryos. In this case, the timeframe for preservation is 5 years.
The eggs are collected in the same way as standard in vitro fertilisation, under local or general anaesthesia (with or without stimulation).
In the case of egg freezing, after the patient has healed and when she decides so, the eggs will be thawed and fertilised using the sperm of a partner or the sperm of a donor.
In the case of embryo freezing, after the patient has healed and when the couple decides so, the embryos will be thawed and transferred to the uterus (legal maximum of 2 embryos transferred at a time).
In vitro maturation
This technique makes it possible to collect the eggs when they are still immatur, similarly to standard egg retrieval but with the modification of specific techniques.
The eggs are then matured in the laboratory until a certain stage where they can be frozen or fertilised with sperm.
As in the case of frozen eggs and embryos, they can be used after the patient has healed.
During all of these treatments, the ovaries can be stimulated in the same way as for in vitro fertilisation.
Given that certain cancers are sensitive to hormones, anti-oestrogen medications may be combined to avoid limiting the use of different fertility preservation techniques.
The choice of therapy will be decided together with the patient or couple; in consultation with a multidisciplinary team of oncologists, radiotherapists, psychologists, and fertility specialists.
What about male patients?
In the case of a male patient, one or more samples of sperm will be produced by masturbation, and then processed in the laboratory, to be frozen in vials.