Correlation between cancer and fertility

Cancer is on the rise, with medical interventions the survival rate has increased to 80 per cent. Quality of life becomes an issue after a successful treatment. Cancer treatment lowers their ability to father or mother a child i.e. their fertility. Treatments like surgery, chemotherapy or radiotherapy can decrease ovarian reserve or sperms.

Fertility preservation is a fundamental issue for individuals of reproductive age (both male and females) or prepubescent boys and girls whose future fertility may be compromised. There is consensus on the need to provide counselling about currently available options to all individuals wishing to preserve their fertility. People with cancer are interested in discussing fertility preservation. Fertility preservation is often possible, but to preserve the full range of options, fertility preservation approaches should be discussed as early as possible, before treatment starts. The discussion can ultimately reduce distress and improve quality of life. Another discussion and/or referral may be necessary when the patient returns for follow up and if pregnancy is being considered. The discussions should be documented in the medical chart.The discussion about their risk of infertility prior to initiating cancer treatment is a mandatory intervention for patients of reproductive age as per latest medical guidelines.

Fertility preservation is saving gametes which are at risk of losing either by cancer or genetic disease. For men option of sperm banking and for females egg freezing are standard options which are usually available at fertility centres which can be considered before planning treatment. Cryopreservation (freezing) of ejaculated sperms is routinely used for fertility preservation in adult male. Success rates in achieving pregnancy have increased with the use of ICSI (Intracytoplasmic sperm injection technique). Cryopreservation of mature eggs or embryos is effective method for preserving female infertility. A live birth rate of about 45 per cent is quoted in a recent study of cancer women survivals. There are some options like donor gametes programme which can be considered in cases where reserve is already low.

Multidisciplinary team approach with oncologists, fertility specialists, family physicians, psychologists, urologists, gynaecologists, counsellors is required for optimum results. Patients should be referred to fertility experts by oncologists and haematologists before initiating treatment so that adequate counselling can be done on the available fertility preservation options. Patients who have very high chances of premature ovarian failure like those receiving abdominal radiation or where high dose chemotherapy is planned, indication for fertility preservation should be evaluated.

Timely counselling and intervention can provide these individuals an opportunity to preserve their fertility while they undergo treatment for the above conditions. Sometimes cancer survival patients are not able to focus on fertility preservation earlier at the time of starting treatment, they should not get disheartened. There are options of donor egg and sperms available which can be discussed on an individual basis. Hence, with improved assisted reproduction technologies we can fulfil desire of pregnancy in majority of the cases.