Fertility Preservation

Cancer treatment can be damaging to the reproductive system (ovaries) leaving many women with fertility challenges after cancer treatment is complete. Discussing options for fertility preservation prior to initiating cancer treatment is vital to young women who would like to retain the option of child bearing. Samuel Kim, MD, of the Center for Advanced Reproductive Medicine’s, is a world renowned specialist in field of fertility and cancer. Dr. Kim offers patients ground breaking technologies to increase a patient’s likelihood of fertility after cancer and is accessible to the timely needs of cancer patients.

To date, there are a few options for fertility preservation in female cancer patients including GnRH analog administration with chemotherapy (protects the ovary), freezing of embryos, oocytes, or ovarian tissue before chemotherapy and/or radiotherapy, transposition of the ovary before radiation, but most of theses options are experimental.

GnRH analog:
The efficacy of GnRH analog (Lupron, Zoladex, Garnirelix) treatment to protect the ovary from cytotoxic cancer therapy is controversial. Nevertheless, most studies showed that GnRH agonist can protect immature eggs from chemotherapy in women with cancer. Of note, GnRH agonist has no beneficial effect to patients undergoing radiation therapy.

Embryo Freezing:
Embryo freezing is a well established technique, but it cannot be an option for the patient who does not have a partner, or who cannot delay cancer treatment for more than 2 weeks (as it requires an IVF procedure). The technology of egg freezing has been improved last 2-3 years, and the live birth rate per transfer after 2005 is above 30% in some centers.

However, the oocyte freezing is not an established technology in most IVF centers, and its success rate is still much lower than that of embryo freezing. Egg freezing also requires ovarian stimulation for 2 weeks, which can delay cancer treatment. Furthermore, the safety of ovarian stimulation with fertility medications (such as Follistim, Gonal F) has not been established to the breast cancer patients with positive hormone receptors (ERPR).

Cryopreservation:
A new strategy, cryopreservation of ovarian tissue followed by transplantation of stored ovarian tissue, may be effective for reinstating fertility for women facing premature ovarian failure. For this strategy the ovary should be collected surgically (usually by laparoscopy) before freezing. The safety of auto-transplantation of human ovarian tissue is a crucial issue for cancer patients.

At present, the type of malignancy and the prognosis are prime considerations to determine the candidates for this procedure. Ovarian cryopreservation for patients with systemic or disseminated malignancies should be discouraged until reliable cancer screening methods become available or in vitro culture techniques can be perfected.

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Jennifer Smith, a young breast cancer patient, took advantage of options presented by Dr. Kim. Read about her experience here: http://www.kmbc.com/health/17434761/detail.html.