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Fertility Preservation in Cancer Patients

Questions for Sharon Schwartz,
Certified Nurse Practioner and Cofertility Coordinator at Fox Chase Cancer Center

What is fertility preservation in cancer patients?
Fertility preservation is the effort to help cancer patients protect their ability to biologically conceive in the future, or ability to have children. Cancer treatment can have a big impact on fertility. Certain types of chemotherapy can cause early menopause in women and/or infertility. Surgical procedures, such as having the ovaries or uterus removed, can prevent patients from carrying biological children. Radiation treatments also have an impact, especially for patients who have radiation to their pelvic area.

What is the role of the oncofertility coordinator?
I serve as the point person for the oncofertility referral service at Fox Chase to help patients with fertility issues caused by cancer treatment. At the treating physician’s request, I contact patients to discuss resources and information. I can also coordinate referrals and appointments so people are able to have all options on the table before moving forward with their cancer treatment.

What are the options for women diagnosed with cancer to preserve the ability to have children?
Depending on the patient’s gender, age, partner status, type of cancer, available time, and future reproductive goals, different options for fertility preservation are available. A consultation with a reproductive endocrinologist should be offered to all cancer patients who have not completed childbearing. Some options recommended for women are: freezing embryos (fertilized eggs), freezing unfertilized eggs or surgery and radiation therapy given in specific ways to avoid harming a woman’s reproductive organs. Women may have their ovaries moved to a different part of the abdomen before pelvic radiation. For men, the most common and successful option is sperm banking.

How long does the fertility preservation process take?
Fertility preservation methods can take as little as 24 hours for men and for women take 2 to 4 weeks. Timely referral to a reproductive specialist is very important.

What are the barriers for patients to proceed with fertility preservation?
The largest barrier is typically cost. I work with people to identify financial assistance that may help bring down the costs of freezing eggs. Additionally, Fox Chase has relationships with fertility clinics in the Philadelphia area that offer a discount for Fox Chase patients.

Is this an option for a woman without cancer but who has a genetic predisposition to cancer, such as a BRCA mutation?
Yes. Women with BRCA mutations are advised to have preventative surgery to remove their ovaries and fallopian tubes (bilateral salpingo-oopherectomy, or BSO) before they would naturally reach menopause, some as early as ages 35-40. By this age, many women have not completed childbearing. Women with a BRCA mutation could consider freezing eggs or embryos before having BSO. There are some potential grants to help women with BRCA mutations who want to preserve fertility.

For men and women with a BRCA mutation, with or without cancer, there is an option to have pre-genetic diagnosis (PGD) for their future children. This is something that is done before pregnancy. The process involves participating in In-vitro fertilization (IVF). The female partner takes medication to make many eggs in one cycle. The eggs are not ovulated naturally but taken out via an egg retrieval process and then combined with the male partner’s sperm.

Once fertilized and developed, the embryo will reach a certain number of cells, one of which will be able to be sent to the lab for testing. The lab can then test that cell for the BRCA gene mutation in the family. The couple can then decide if they only want to use the embryos without the BRCA mutation. Patients interested in this option should meet with a fertility specialist prior to getting pregnant to discuss the procedure and costs involved. This is not typically covered by insurance.