Fertility preservation

Given the recent increase in cancer survival rates, fertility has become an important quality-of-life concern for many survivors who are unable to achieve or maintain pregnancy as a result of their cancer treatment. Thus, Fertility Preservation is the consorted effort to provide fertility-saving options to patients prior to their cancer treatment.

Infertility

Infertility, which is the inability to achieve or maintain pregnancy, can significantly affect a person's sense of self-worth and overall satisfaction with life. It occurs in men when the testes stop producing sperm and in women when the ovaries no longer make mature eggs. Infertility may also come about when the reproductive organs can no longer produce and/or release the hormones necessary for development and normal reproductive function.

Reproductive Insufficiency

For many cancer patients, the decrease or loss of reproductive function is temporary; many men and women, however, do not regain fertility after cancer treatment. Patients undergoing serious radiation or chemotherapy as part of their cancer care sometimes experience symptoms commonly associated with menopause (in women) or andopause (in men). In women, decreased estrogen levels commonly lead to weakened bone, changes in temperature control, altered mood, and decreased sexual desire. Men may also experience similar symptoms.

Research

Research on fertility preservation for cancer patients strives to improve current methods so that any person diagnosed with a fertility-threatening disease can have the option of saving his or her reproductive ability before treatment. Some of these studies are currently being done at the Division of Fertility Preservation at Northwestern University. The goal of this research and scholarship is to develop optimal technologies for storing patients' reproductive tissue, which can later be used in initiating pregnancy. Additionally, these new methods may be able to provide reproductive options to patients with other fertility-impairing diseases.

Options

Currently, men hoping to preserve their fertility before undergoing treatment for cancer or another fertility-threatening disease can cryopreserve, or freeze, their sperm, which can be obtained through masturbation in post-pubescent boys and men. This is the most established fertilty preservation method for males. For pre-pubescent boys, sperm can be obtained through testicular aspiration or electrostimulation and then stored for future use. New research is also looking at methods for cryopreserving testicular tissue samples so that they can be re-implanted into the body after treatment.

Fertility preservation options for women are slightly more limited than for men. Some female patients choose to have one of their mature eggs extracted, fertilized with sperm from a partner or donor outside of the body, and frozen. When the woman is ready to initiate pregnancy, the embryo is thawed and implanted into the uterus for maturation and birth. While this option is currently the most common fertility preservation method in women, it is not available to pre-pubescent girls, who do not have mature eggs that can be fertilized, or to women who do not have a partner. Additionally, because this procedure requires a two-week period of hormonal stimulation to encourage egg maturation, it is not optimal for female patients who are diagnosed with hormone-sensitive cancers (such as breast cancer, ovarian cancer, etc) or those who cannot delay cancer treatment.

References

Bahadur, G. (2000). "Fertility Issues for Cance Patients". Molecular and Cellular Endocrinology. 169: 117–122.

Early Menopause (Premature Ovarian Failure), American Society for Reproductive Medicine, 1996

Petak, Steven M. (2002). "American Association of Clinical Endocrinologist Medical Guidelines for Clinical Practice for the Evaluation and treatment of Hypogonadism in Adult Male Patients - 2002 Update". Endocr Pract. 8 (6 ed.): 440–456.

Woodruff, Teresa Kaye (2007). Oncofertility: Fertility Preservation for Cancer Survivors (Cancer Treatment and Research). Chicago: Springer. ISBN 978-0387722924. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

External links

More information can be found at:

• http://www.cancer.northwestern.edu/fertilitypreservation/
• http://oncofertility.northwestern.edu