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According to the World Health Organisation, cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. However, advances in cancer treatment have also increased the chances of survival for this deadly disease. Today, young women diagnosed with cancer have a greater chance of long-term survival than before. Successful survivorship for female patients includes maintaining a high quality of life after a cancer diagnosis and treatment. Future fertility is a valid concern for many women diagnosed with cancer, but sometimes the physician’s knowledge and attitudinal barriers can prevent them from receiving the required care.
Depending upon the area affected by the disease, the type of cancer, patient’s age, and grade of cancer, the treatment technique for this disease varies. Cancer treatments, including surgery, chemotherapy, and radiation, can affect fertility by impacting several biologic systems, especially for women.
Chemotherapy treatment can stop your ovaries from working, which can cause infertility. Absence of periods is common during chemotherapy and does not always mean onset of infertility. Many women may resume periods after a few months of stopping chemotherapy. It can also bring on the early onset of menopause. Radiation to brain can affect the function of pituitary gland, leading to hormonal imbalance which can be corrected easily with supplements. Radiation to the pelvic area can result is permanent damage to the ovaries, leading to infertility.
It is essential to understand the fertility preservation options available to women before starting cancer treatment. The first step for any female cancer patient under the age of 45 years is to understand the treatment and her options, or chance at preserving fertility by talking to her treating oncologist. The physician and the patient can then undertake a future course of action that is acceptable to everyone involved.
Counselling is essential for such patients, even if they are unmarried and are not looking at pregnancy in the near future. One of the most widely available and well-established fertility preservation is embryo in vitro fertilization (IVF). During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by a sperm in a lab. If the patients are younger, embryo freezing is another alternative.
Embryo freezing is a procedure that allows people to store embryos for later use. A person can also freeze eggs that are not fertilized. Another method to prevent fertility issues in women during cancer treatments is ovarian tissue freezing, which has its own limitations and is not 100% effective. Oophoroplexy involves surgical transposition of ovaries out of the field of radiation, when it is being given to the pelvis.
While it is essential to consider the impact of cancer treatments on fertility, it is equally important to ensure that there is no compromise on the patient’s life in order to save potential future fertility. Hence, the decision to treat young women with cancer and fertility-sparing is complex and involves a team effort.
A gynecologist-oncologist team, along with radiation experts, chemotherapy and infertility specialists, should meet and discuss with the patients and their families to arrive at a plan of action that is medically most sound and acceptable. It is important to monitor reproductive capacity after treatment, and work with cancer survivors to explore potential avenues to parenthood.
(This article is co-authored by Dr Uma Dangi, Consultant Medical Oncology, Fortis Hospital Mulund and Fortis Hiranandani Hospital, Vashi and Dr Sushma Tomar, Obstetrician and Gynecologist, Fortis Hospital, Kalyan)
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