When someone faces a cancer diagnosis, the initial focus primarily lies on which treatments can stop the spread of the cancer and save the patient's life. Unfortunately, these same lifesaving treatments can affect long-term quality of life. One of the most pressing issues facing young patients treated for cancer is that the very treatment that saves their life may affect their ability to have children in the future.
"We know from research and anecdotally that future fertility is one of these things that is super important to some cancer patients," said Douglas Fair, MD, MS, FAAP, an oncologist with University of Utah Health. "Studies have demonstrated that three-quarters of people diagnosed with cancer between the ages of 18-45 are interested in the possibility of having children after cancer. Yet probably only half of all cancer patients in this age range are discussing fertility before starting therapy—fewer still are receiving specialized fertility preservation counseling. Things are improving, but we still have a long way to go."
For men, the process of banking sperm is relatively straightforward and has been common for many years. However, the process of storing eggs or ovum for women is more complicated—but has seen recent advances. Eggs are the largest cells in the body and contain the most water. When that water is frozen, it can form sharp ice crystals that can damage the structure of the cell. The removal of water from the egg helps improve the likelihood that the egg will survive freezing and be viable when it is needed.
"We now use a process known as vitrification," said Joseph Letourneau, MD, a reproductive endocrinology expert at U of U Health. "It's a process of dehydrating the egg a little bit with a sugar-type solution. That basically takes the water out of the egg while we freeze it. Prior to being able to vitrify eggs, the survival of a single frozen egg was around one or two percent, but now it's probably 80 to 90 percent or more."
Before the egg can undergo vitrification, it has to be removed from the body through a two-step process similar to what women undergo with in vitro fertilization for infertility treatment. The patient takes hormone shots to help the ovaries develop as many eggs as possible, and the mature eggs are then removed from the body. "Our goal is to retrieve as many fertilizable, or mature, eggs as we safely can," Letourneau said.
Once the eggs are in their dehydrated, frozen state, their shelf life is indefinite as long as they remain in cold storage. Technology makes it easy. The hard part is making patients aware of this option, along with finding ways to pay for it since many insurance plans do not cover it as part of cancer care. Those are things doctors and researchers would like to see change.
"The American Society of Clinical Oncology (ASCO), the American Society of Reproductive Medicine (ARSM), the Children's Oncology Group (COG), and the National Comprehensive Cancer Network (NCCN) have all published policy statements affirming that discussion about fertility preservation is an integral part of cancer treatment," Fair said. "It takes a lot of coordination between the oncologists and the reproductive team, and University of Utah Health's Oncofertility Program is working to improve the system, making it smoother for both groups. Our goal is to assure every cancer patient in Utah has the opportunity to discuss the impact of their treatment on their fertility and what options are available."