Five-year survival rates for many cancers (including hematological malignancies) are increasing. This makes it essential to consider patients’ future and their quality of life after treatment. Among the most important aspects to take into account is the possibility of having children.
Some cancer treatments can cause temporary or permanent infertility. To prevent this, which may affect both male and female fertility, several strategies can be adopted before starting therapy.
The approach should be individualized for each patient, based on factors such as age, type of cancer, planned treatment, and available time.
Preserving female fertility before treatment
The strategies currently used to preserve female fertility before chemotherapy include:
- Ovarian protection with GnRH analogues: this approach induces a temporary ovarian state similar to that before puberty. GnRH analogues or agonists suppress ovarian function, inhibiting ovulation and related hormonal activity.
- Oocyte cryopreservation (egg freezing): this is an important fertility preservation strategy and may be offered to patients who can delay chemotherapy by 2–3 weeks and have an adequate ovarian reserve. It is a validated and minimally invasive technique involving ovarian stimulation before egg retrieval. It cannot be used in prepubertal patients.
- Ovarian tissue cryopreservation: through a minimally invasive laparoscopic procedure, fragments of ovarian cortex are removed and cryopreserved before exposure to gonadotoxic treatments. After disease remission, the tissue can be reimplanted (autotransplantation) to restore reproductive function. This method can also be used in prepubertal patients.
- Ovarian transposition: this technique is used when radiotherapy involves the pelvic area. It consists of temporarily repositioning the ovaries away from the radiation field. The success rate of this procedure is relatively high.
Preserving male fertility before treatment
Approximately 15–16% of patients may experience azoospermia (infertility) six months after completing cancer treatment.
The strategies currently used to preserve male fertility before chemotherapy include:
- Semen cryopreservation (sperm banking): a well-established and simple technique involving the storage of sperm in liquid nitrogen at -196°C. Sperm can be preserved indefinitely without genetic damage and later used in assisted reproduction techniques. This method is not applicable in prepubertal patients or in cases of very advanced disease.
- Testicular tissue cryopreservation: this option may be used in children and in patients with very low sperm counts. However, it is still considered experimental.
- Use of hormonal analogues or antagonists: these are easy to administer but have uncertain clinical effectiveness, as controlled studies are still lacking.
Attention: even if the information provided has been verified by the Foundation’s doctors, every decision and therapy must be individualized and monitored for each patient by the attending physician. We ask you to always refer to your doctor because the information offered cannot be replaced, in any way, by doctor / patient relationship.