Young Cancer Survivors Have More Options to Protect Fertility, Start Families Post-Treatment
For years, the issues of fertility, sexual dysfunction and cancer were never fully addressed. For many patients, having cancer meant that they might be unable to conceive later in life. A new program at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) hopes to make fertility preservation a priority and part of the initial treatment conversation.
Fear of delaying treatment has been one of the biggest obstacles.
“There was a bias with doctors (and patients) in believing there wasn’t enough time to begin fertility preservation prior to treatment,” said Leslie Appiah, MD, director of the Fertility Preservation and Reproductive Health Program at the OSUCCC – James. “But we now have random start protocols, in which eggs can be stimulated and extracted at any time during a woman’s menstrual cycle. It’s very important that women get the appropriate information about freezing eggs. It’s very safe and effective.”
Mandating Fertility Preservation as a Priority
In 2006, the American Society of Clinical Oncology created guidelines for fertility care during cancer treatment in people of reproductive age, mandating that they be counseled prior to treatment and that they be provided options throughout their treatment and during survivorship. However, studies in 2012 still showed that less than 50 percent of patients recalled having a conversation with their doctors about reproduction, and even less went on to pursue treatment, Appiah said.
More and more, cancer patients of reproductive age are being made aware of their options when it comes to fertility preservation, and more viable options are emerging to help. The initiative is called oncofertility, and it brings together the disciplines of oncology and reproductive research to address quality-of-life issues and reproductive concerns of young cancer patients.
For women with breast cancer and some blood cancers, this is particularly good news, as chemotherapy and radiation can drastically reduce her ability to conceive depending on age, treatment plan and baseline fertility. Advances in assisted reproduction therapy allow women to preserve their oocytes (eggs) before cancer treatments begin, Appiah said.
Although more patients are being counseled today, the number who undergo fertility preservation is still less than a third because the procedures can be cost prohibitive since they are not recognized as a standard of care and are therefore not covered by most insurances, Appiah continued.
“Only five states have insurance mandates to cover fertility preservation in patients with cancer, and Ohio is not yet one of them,” Appiah said. But, she added, discussions among medical and insurance industry experts are underway with legislators to bring it to the table.
Additionally, not all cancer institutions have specialists on staff to address fertility concerns, said Appiah, who brought her expertise to the OSUCCC – James last year to serve female patients. She joined Lawrence Jenkins, MD, MBA, who leads the men’s sexual health program.
Fertility Preservation Options
Standard options for women include egg freezing and embryo freezing. The process involves stimulating the ovaries to produce eggs, which are then surgically extracted and frozen under light sedation. These eggs can also be fertilized with the patient’s partner, and the embryos can be frozen to attempt pregnancy after treatments have stopped and the patient has been cleared for pregnancy.
Another option being researched involves removing a woman’s ovary and freezing it before or immediately after cancer treatment begins. Once thawed, it can be re-inserted into her body. So far, 130 births have occurred using this method; more research will allow this option to become standard of care.
For men with testicular, blood, bone and prostate cancer, treatment can cause sexual dysfunction, so sperm banking is the most common fertility preservation method. Sperm can be collected in numerous ways. Another option being studied for men is testicular tissue preservation, but at this point this procedure is only investigational, Appiah said.
Start the conversation early
With all of the existing fertility preservation opportunities available and being explored through clinical research, Appiah says it’s imperative that cancer patients and doctors have a conversation to talk about their options.
“At the OSUCCC – James, we aim to bring everyone together to discuss the options, risks and benefits within the first 24 to 48 hours of our patients’ diagnosis so they have time to think about it and discuss with loved ones prior to making a decision, Appiah said.
For more information about fertility preservation, visit cancer.osu.edu/fertilitypreservation or call 1-800-293-5066.