When fertility is threatened by cancer and other conditions
Nowadays, many people suddenly come face to face with the reality of cancer. Moreover, the rate of adult patients below the age of 40 as well as the rate of adolescent patients is sadly increasing at a very fast pace. Given the fact that this population consists of individuals of reproductive age, the problem at hand is quite significant.
Treatment of any type of malignancy includes chemotherapy and/or radiotherapy that destroys reproductive tissues in both genders (ovarian – testicular tissue) leading to a loss of reproductive capacity after the treatment is over, although the malignancy has been successfully managed.
Although men suffering from cancer are offered a simple solution to the problem of infertility through sperm freezing prior to treatment, women are still faced with a much more complicated problem. Until recently, the only hope these women had for having children in the future was through egg donation.
However, these past few years have seen the development of two new techniques in IVF: a) egg cryopreservation and b) ovarian tissue cryopreservation. These new techniques give hope to women of reproductive age who haven’t had children yet and want to preserve their fertility.
Egg cryopreservation
Method
The ovum (egg) is the largest cell in the human body and contains a significant quantity of water. When an egg freezes, the ice crystals that are formed within it may jeopardize the cell’s integrity. To prevent this, eggs must be dehydrated before the freezing process. Water is then replaced by a special cryopreservation agent that suspends ice crystal formation.
Eggs are frozen either with the Slow Freezing method or the newly-introduced technique of vitrification. Slow freezing is the most popular technique for embryos. Vitrification is a new fast freezing procedure in which the cryopreservation agent is used in high concentration levels. The result is a cell that is compact as glass, without ice crystals.
Preparation & time constraints
The entire egg collection process when preparing for cryopreservation is carried out within one IVF cycle, during which a woman takes drugs for ovarian simulation. Egg retrieval is then performed and immediately followed by egg freezing.
The duration of the ovarian simulation phase varies depending on the protocol used in each case. This phase may last from 2 to 4 weeks.
This is when some women come to terms with the lack of time. Therefore, as soon as she is diagnosed with malignancy, the patient needs to come into contact with an IVF specialist and start the relevant procedure so that she may also start her cancer treatments immediately after that.
Ovarian tissue cryopreservation
Similar to egg cryopreservation, an ovarian tissue cryopreservation procedure can start right before chemotherapy or radiotherapy. Cryopreservation requires the removal of the ovarian tissue, i.e. the section that contains follicles in different stages of development. This section undergoes cryopreservation. The patient then goes through the rest of the process, and when the cancer treatment is successfully over, the cryopreserved ovarian tissue can be transplanted back into her body.
This year, the American Society of Reproductive Medicine officially announced that, after thorough research and successful outcomes, these procedures have passed from the experimental phase to extended implementation with increasingly high successful rates. There are 103 fertility centers in the US that are already offering egg and tissue cryopreservation. Known protocols refer either to sections of the ovarian tissue or the entire ovary.
It is, therefore, obvious that important decisions such as that of fertility preservation, in case of malignancy, depends directly on the smooth collaboration of the attending oncologist and the patient’s gynecologist.
Legislation
According to current legislation, the egg cryopreservation procedure cannot last more than 5 years, while the option for extension is provided only upon relevant approval by the National Authority for Assisted Reproduction
With regard to underage individuals, Greek legislation (L. 3305) sets out that IVF methods can only be applied by exception in case of a severe medical condition that entails the risk of infertility. In such cases, tissue cryopreservation is performed to ensure the possibility of childbearing.
Let’s not forget that when a person goes through a tough period, the only thing that can make him/her feel better and overcome any difficulty is to look to the future with optimism. Therefore, knowing that motherhood is not only a hope but an actual possibility that can become reality is a true gift to women.
