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Good idea to freeze eggs before starting cancer treatment

Dr. Duru Shah, Director, Gynaecworld, the Center for Fertility and Women’s Health

Motherhood is a very special experience in the life of every woman. In India, culturally it is considered of supreme importance to give birth to a child and is also a symbol of a fruitful marriage. Unfortunately, about 10-15 % women are unable to conceive due to various reasons and are deprived of motherhood. With the advent of assisted reproduction we are able to help most of the couples.

Cancer is one disease which can deprive a woman of motherhood, especially if she is detected with cancer at a young age. Every year, February 4th is celebrated as World Cancer Day, and awareness about cancer and its prevention, detection, and treatment is created. But everyone presumes that cancer only affects the elderly who are not interested in further childbearing. But in reality today we are seeing many young women suffering from cancer. Hence it is important to create the awareness on the fertility aspect of all young people, both women and men, who are getting treated for cancer.

Cancer treatment affects fertility and its effects depend on factors such as the type of cancer, where it is situated, the age and overall health of the patient, and her response to the treatment. There are many young women today who are cancer survivors, but their cures have cost most of them their fertility. Bone marrow transplants, modern radiation treatment, and aggressive chemotherapy permanently cure a large percentage of cancers in young women today, but their eggs and ovaries are either completely or partially destroyed by these treatments.

A young woman’s ability to get pregnant or maintain a pregnancy is affected by cancer treatment and women who wish to have children in the future, should be given options to protect their fertility. The best time to preserve fertility is before the start of cancer treatment.

With the technological advancements today, there are various fertility-saving options available which may vary from person to person, type and stage of cancer, and the speed at which cancer treatment needs to be initiated. It is not as easy for women to preserve their fertility as it is for men, but there are ways of doing it, such as:

• Freezing eggs: If Single, fertility shots or other drugs to boost egg production are needed following which eggs which are harvested and frozen?
• Freezing embryos: If married, freezing of embryos (fertilized eggs) may be an option, though fertility drugs (hormones) are anyways required to boost egg production, prior to freezing them.
• Freezing ovarian tissue: Before radiation treatment to the pelvic region, a surgeon can move both ovaries to another space in the body outside the treatment field. If it is not possible to get pregnant naturally with the ovaries in their new spot, we may have to move them again or use IVF to allow her become pregnant.
• Surrogacy: Surrogacy is an option for women who cannot carry a pregnancy, either because their uterus has been removed probably due to the cancer, or in those who would be at high risk for cancer recurrence if they got pregnant.

So a visit to the fertility specialist or any IVF center is extremely necessary prior to a young woman or man initiating cancer treatment.

Dr. Duru Shah, Scientific Director, Gynaecworld said, "It is difficult to predict whether a woman will be infertile after her cancer treatments, but her age, the type of cancer and dose of chemotherapy or site of radiotherapy administered to her, decide her risk of infertility following treatment. Hence as an IVF specialist, recommend egg, or embryo freezing, if the couple wants children in the future as the option."

Cancer, or more often cancer treatments, can interfere with some part of the process and affect your ability to have children. Different types of treatments can have different effects.

• Chemotherapy: Most chemotherapy (or chemo) drugs can damage a woman’s eggs and/or affect fertility.
• Bone marrow or stem cell transplant: Bone marrow or stem cell transplant usually involves high doses of chemo and sometimes radiation to the whole body before the transplant. In most cases, this permanently stops a woman’s ovaries from releasing eggs.
• Radiation therapy: Radiation treatments use high-energy rays to kill cancer cells. These rays can also damage a woman’s ovaries.
• Surgery: Surgery by removal of certain organs of the reproductive system can cause infertility.

Girls are born with all the eggs they can ever have. Women cannot grow or make new eggs. Chemotherapy, radiation therapy, and some surgeries can harm or destroy the eggs within the ovaries or cause other fertility problems. There are ways to try to preserve fertility in women.

It is common to feel sad or angry about not being able to have a child. But today, doctors/ couples also feel that just knowing that their eggs are frozen, has positively impacts them, giving them hope and a reason to look forward to a brighter future.