Patient diagnosed with cancer should consider fertility treatment as soon as possible and always before the treatment will starts because once the treatment will starts, the first chemotherapy cycle start, the gametes can be affected but sometimes it is not that easy because those patients need authorisations of the oncologist because they know better the urgency of the treatment. For women it is more difficult in the sense that for them to preserve fertility, the ovaries need to be stimulated to obtain eggs and to stimulate, they need medication including hormones and sometimes the cancer is estrogen dependent, so it can increase the risk of developing the cancer much faster. In case of men, it is easier because they will be able to collect a sample in a few minutes and preserve fertility before starting the treatment very easily, they only need to collect samples by masturbation and they don’t need medication for that.
In all cases, the effects of chemotherapy will depend on the dose, on the age, type of treatment and sometimes the fertility can be restored but most of the time oncological treatment has an impact on fertility and preservation of the fertility is a good choice.
I would say as soon as possible. At the same time, I do understand that when somebody has been recently diagnosed with a cancer, there are many things that he/she needs to consider and decide and while this period is very challenging for the patient, it seems that it’s the best period for this patient to consider fertility preservation among the many other things that he/she needs to consider. As it’s very very important to proceed to fertility preservation before the onset of the oncotherapy and sometimes even before the surgery so, my advice is to try to discuss with an expert in collaboration with the oncotherapist and first check whether this is a possible, an option, for the patient and try to schedule the treatment the sooner possible before or after the surgery but absolutely before the onset of the oncotreatment regime.
The severity obviously of the cancer and how fast the treatment or the surgery needs to begin, obviously that is something that it has to do with the medical practitioner that decides what needs to be done, how cancer needs to be dealt with, a clinical case. But we are always in the lab, we always store sperm as soon as possible before the patient starts going under surgery or before they start the first cycle of the radio or chemotherapy. So, when we say what stage of cancer treatment it’s always before the initiation of the cancer treatment.
The management of the patients when diagnosed with cancer is multidisciplinary. First, we should know that oncological management and a reproductive consultation with a fertility specialist are very important. Once the treatment plan has been carried out in the patient, the threat to fertility posed by cancer treatments to young patients cannot be prevented in many cases and therefore research on fertility preservation methods has been developed with the aim of offering patients with cancer the ability to have biological related children in the future. Several multidisciplinary groups and societies have made great effort in revealing the currently available data of fertility preservation to produce guidelines for healthcare providers. We have strategies for fertility preservation depending on the type of cancer trial, for example, if the guidelines that we have, depends if the treatment includes first cancer surgery so the following options should be considered: fertility sparing surgery preserving gonads, preservation of the uterus in females. Use of cryopreservation may also be considered prior to surgically if the risk of gonadal damage is high but if the treatment includes radiation therapy to pelvic organelles and domes should be aiming at reducing damage of reproductive organs and surgical ovarian transportation could be offered and use of cryopreservation may also be considered prior to treatment of radiotherapy. If the cancer treatment will include according to the guidelines treatment that could be very toxic with high risk of gonadal damage, use of cryopreservation with such as sperm banking for males, freezing for embryos and oocytes for females and gonadal tissue freezing should be considered in these cases. On the other hand we have chances for the patient, for example, if the patient would have a hormone therapy for breast cancer that is very common, we should offer to this woman cryopreservation if in five year some toxic treatment is planned so that is a good option and it is planned to cryopreserve oocyte in some cases could be cryopreserve embryos if she is planning to have children in the future.
We said before it’s crucial that patients diagnosed with cancer get referred very quickly to a fertility specialist to discuss their options. We usually want to do oocyte vitrification. We will need a time frame of at least two weeks to be able to do the ovarian stimulation process and the egg retrieval so it’s true that we we don’t have much time to make a decision and we know that patients with cancer get overwhelmed with lots of diagnosis and different tests at the same time but they should make the decision in within a few days after the first consultation because otherwise we won’t have time, however sometimes although it’s not ideal, patients get referred to us after having chemotherapy treatment because there wasn’t a place for fertility preservation before, there was no time and then what we can do is assess the ovarian reserve at that point. We can also sometimes still preserve something even if it’s not the ideal situation if it could not be done beforehand but of course the ideal situation is to get referred as soon as possible and to make a decision within a few days to be able to have time to harvest and then get a good number of eggs retrieved.
It’s important for couples who are diagnosed with cancer to consult their reproductive specialists right away. It’s important that we freeze eggs and freeze sperm as well as embryos if you’re in a stable relationship with a partner prior to the onset of the chemotherapy treatment. In any case, it is very traumatizing emotionally that you’ve been diagnosed with cancer, and many times you forget to think about your fertility. But cancer treatments are so successful nowadays that the majority of people who are diagnosed with cancer will survive into the future; disease-free. So it is really really important for us, particularly young couples who are young men and women who are diagnosed with cancer to think about their fertility in the future because most likely you’ll be successfully surviving the cancer treatment. However, the cancer treatment does make sperm and eggs go away or cause sterilization in many cases, and thus, you may not be able to have children in the future unless you preserve your fertility ahead of time. So it was really important to have men and women consider freezing their eggs and sperm prior to the treatment that begins for cancer.
Of course, the main issue that has to do with the right time for egg freezing is the time before the start of chemotherapy. After a diagnosis of cancer, like after a breast cancer diagnosis, for example, we have around three to four weeks until we start with chemotherapy treatment or endocrine therapy in case we don’t need any chemotherapy. So this is the time that we could take advantage of in order to prepare egg freezing. There is a so-called random start possibility which means that we would start with treatments in a day that has nothing to do with the period of the patient.
So that we can take advantage of these two weeks that we really need. The right time to do it is before starting chemotherapy or any other treatment. Since there is a conflict between the chemotherapy and the preparation of egg freezing, patients that decide on egg freezing have to have completed this treatment before starting their chemotherapy.
Regarding sperm, the only time that we need is abstinence of two days before sperm freezing. There is no real conflict between the time of the diagnosis and the start of treatment. Since we always have these two days needed.
