Fertility Preservation in Young
Cancer Patients
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Dr. Jyoti Bhaskar |
| EVERY IVF CENTRE NEEDS to do ONCOFERTILITYCOUNSELLING |
India is a young country as 40% of its population is under the age of 40yrs.
The youth is the future of our country β who need to move forward with courage, hope and targeted determination. But unfortunately, this age group is inflicted with 10% of all the cancers in India, halting their progress midway.
Less than 0.1% are counselled by IVF centres in Delhi on Fertility Preservation in future.
It is a time of severe crisis within the family both emotionally, financially and physically. At this time to breach the subject of Fertility preservation needs courage and rationality. But it has to be done β by someone elder and influential in the family.
If appropriate counselling and action is not taken at the right time, it may be too late.
The young man or woman will forever live with a unfulfilled desire and guilt.
It is essential that the index person or the family members ask Cancer specialist their fertility options or ask to be referred to an IVF Centre or to an ART Specialist for counselling
ONCOFERTILITY Counselling is a new field being offered as a routine by Lifecare IVF Faculty to explore and expand options for the reproductive future of cancer survivors. Oncofertility incorporates fertility and reproductive issues after caner treatment such as family planning , contraeption, H.R.T, Survivorship,surrogacy and adoption.
This Term was coined in 2006, by Dr. Teresa K. Woodruff at the Oncofertility Consortium..
Treatment such as chemotherapy, radiation, and surgery may destroy a person's ability to have children later in life and Oncofertility research focuses on increasing fertility preservation We shall now discuss the options available for men, women and children afflicted by cancer.
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| A. FERTILITY OPTIONS FOR MENβ |
- Preserving Fertility in men before Treatment
1. Sperm Banking at Sperm Banks or ART centres with cryopreservation facilities
2. Testicular sperm extraction β Biopsy at ART centre
3. IVF-ICSI using the thawed sperms from Biopsy or frozen Semen
4. Testicular Tissue Banking ( experimental)
5. Radiation Shielding before Radiotherapy
- Fertility options for men after Treatment
1. Wait for 6 months to 2 years after chemo or radiotherapy
2. if semen Count is Less β IVF ICSI
3. No Sperm β TESE for sperm retrieval
4. Donor Sperm
5. Adoption
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| B. FERTILITY OPTIONS FOR WOMEN |
- Fetility Options for Women before Treatment
1. Embryo Freezing β
Caution in Breast cancer and fast growing cancers for ovarian stimulation.
Option : Natural cycle IVF; Letroz/tamoxifen during the IVF cycle
2. Ovarian Transposition and Shielding β only effective for radiotherapy treatment.
3. Radical Trachelectomy for Cervical cancer patients instead
of Radical Hysterectomy
4. Fertility Sparing surgical procedures in early Ovarian cancer β Remove only diseased ovary , complete family and then do complete surgery
5.
Quieten the ovary to Save Number of Eggs
A. GnRH analogue Treatment
1. Women < 35yrs
2. Started couple of weeks before chemo o radiation
3. Monthly doses as long as therapy for cancer is on
B. Oral Contraception Treatment can be used
Not to be used in breast cancer patients
- Fertility Options after treatment in women
1. Natural pregnancy _ wait for 6 months to 5 years
β’ Recurrence of cancer
β’ Increased chances of miscarriages and anamolies
2. Donor eggs
3. Embryo Donation
4. Surrogacy
5. Adoption
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| C. FERTILITY OPTIONS FOR CHILDREN |
| Prepubescent children have fewer options to preserve fertility than adults. |
| Boys |
Girls |
- Attained Puberty Sperm banking
- Testicular sperm extraction ( TESE )
- Shield Testis
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- Ovarian Shielding
- Early menopause a Possibility
- Early menopause a Possibility
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| Lifecare IVF is striving hard for a concept building exercise, to sensitize the Oncology experts & Infertility specialists to these special needs of young cancer patients. In fact in future, it could be area of specialization. |
In the 2nd National conference on Teen and Young Adults cancer (TYACON 2013),
Dr. Sharda Jain , Programme Director Lifecare IVF, sensitised the Oncologist and Experts to
this important issue and it was well taken and appreciated. |
