What is oncofertility
The term oncofertility describes an area that connects oncology to reproductive medicine, with the aim of developing and applying new options for fertility preservation in young patients with diseases or treatments that pose risks to fertility.
A more recent concept of oncofertility refers to the use of more conservative therapies that can preserve fertility and provide the same chance of cure as radical treatment, especially in neoplasms involving the gynecological tract, such as cervical, ovarian, or endometrial cancer.
Data reaffirm the growing importance of the area within oncology. In Brazil, about 19% of new cancer cases in women occur in patients up to 44 years old, and 21% up to 49 years old, a period considered fertile for about 90% of women. In the age group of 20 to 39 years old, some of the most common tumors are breast cancer, cervical cancer, and ovarian cancer, all of which can affect fertility and not allow women to become pregnant after cancer.
How cancer patients’ fertility can be affected
Cancer and its treatments such as chemotherapy and radiotherapy are not necessarily a barrier for patients facing the disease to have children. New techniques for preserving fertility and even less harmful strategies for fighting the disease are gaining ground. Therefore, the idea that the relationship between fertility and chemotherapy is that treatment for certain types of cancer – such as breast, ovary, and uterus – inevitably leads to infertility is no longer a reality.
Doctors should advise patients about this at the beginning of treatment, and women who wish to have children should express this interest and discuss the available options with the medical team to preserve their fertility.
The topic of cancer and oncofertility is also of interest to men, who may have their reproductive capacity directly affected by some cancers or their treatments, such as prostate and testicular cancer.
Treatments that can affect fertility in women
Understand the effect that cancer treatments can have on female fertility:
- Chemotherapy – Most chemotherapy drugs can damage a woman’s eggs. The extent of this damage will depend on the woman’s age, the types of drugs, and the doses administered;
- Stem cell transplant – usually involves high doses of chemotherapy and sometimes radiotherapy. In most cases, this procedure can permanently stop ovulation;
- Radiation therapy – high doses of radiation to the abdomen or pelvis can destroy some or all of the eggs, causing infertility or early menopause;
- Surgery – hysterectomy, surgery to remove the uterus, is part of the treatment for some types of cancer, which prevents childbearing. The ovaries can also be removed (oophorectomy) along with the uterus; and
- Hormone therapy – used in the treatment of breast cancer or other types, hormone therapy can also affect a woman’s ability to have children.
Treatments that can affect fertility in men
Understand the effect that cancer treatments can have on male fertility:
- Chemotherapy – Cancer treatment during childhood/adolescence can damage the testicles and their ability to produce sperm. The risk of chemotherapy causing infertility varies according to the patient’s age, type of medication, and doses administered;
- Hormone therapy – some hormone therapies used in the treatment of prostate cancer can affect sperm production. These medications can also cause sexual side effects, such as decreased libido and problems with erection;
- Stem cell transplant – as the treatment requires the patient to receive high doses of chemotherapy and sometimes radiotherapy, it can permanently prevent sperm production;
- Radiation therapy – if radiation therapy is directed at the testicles, it can affect fertility. Even when a man undergoes radiation therapy to treat a tumor in the abdomen or pelvis, the testicles can receive a sufficient dose of radiation to impair sperm production; and
- Surgery – the types of surgery that can affect a man’s fertility are orchiectomy (removal of one or both testicles), removal of the prostate (affects semen production and ejaculation or damages nerves that allow an erection), removal of the bladder (radical cystectomy, which also removes the prostate), and other procedures that may interfere with ejaculation, such as removal of abdominal lymph nodes.
Treatments for Preserving Reproductive Capacity
There are several options for preserving fertility in cancer patients, both in men and women. Some of the key options include:
- Cryopreservation of embryos, oocytes, and sperm – involves the conservation of cells through a cooling process and maintenance at about -190°C. At such low temperatures, there is no metabolic activity, and the cells are in a state of suspended chemical reactions. The basic principle of cryopreservation is to maintain cell viability and function after thawing. It can occur at different times, preserving already fertilized embryos or sperm, or oocytes (cells that give rise to the female egg); and
- Oophoropexy – a surgical procedure that aims to move the ovaries out of the radiation field, usually above the pelvic cavity. It is used in cases of radiation treatment in pelvic organs, such as cervical cancer.
There are also experimental treatments that deserve attention:
- Cryopreservation of ovarian tissue – involves the removal of a portion of ovarian tissue (or even its entirety), with subsequent use of oocytes found in the tissue or immature follicles (later matured in the laboratory for in vitro fertilization); and
- Transplantation of ovarian tissue – in this process, the thawed ovarian tissue can be autotransplanted into the atrophied ovary or into the peritoneum (orthotopically). However, safety in this technique becomes a concern due to the risk of disease recurrence with the introduction of cancer cells that may be present in the transplanted ovarian tissue.
