Preserve fertility in cancer patients

Both chemotherapy and radiotherapy, which constitute the standard treatment of cancer pathologies, are characterized by the severity of their adverse effects. And in the case of children, adolescents and young people one of them is that they can generate infertility or even the permanent sterility of the patient.

But it is usual that at the time of receiving the diagnosis they do not even consider this possibility, given the emotional weight that comes from knowing that you have cancer . And yet, today there are more and more patients who survive this disease and it is essential to consider the consequences that the treatment will have on their life and, in particular, the possibilities of being able to satisfy the wishes of paternity or maternity.

Today we can assess the risk of infertility that the different drugs (some more and others less) that are used for cancer treatment, as well as radiotherapy, with which it is very high. Surgery, as long as it does not affect the anatomy of the genital apparatus, does not have to compromise the future reproductive capacity of the patient. And this has led to the oncologists themselves taking on the challenge of preserving the patient’s fertility before starting the treatment, taking into account the different means and techniques that Medicine currently offers.

Preserve fertility in cancer patients

In this context, reproductive medicine specialists can play an important role that covers different fields. In the first place, carrying out a study of the patient’s fertility, because we must not forget that 15% of the healthy population has some degree of infertility. And then offering the different options available, yes, always taking into account the type of cancer treatment that the patient will receive. Of course, the fertility study should be done in all cancer patients one year after the end of treatment and be disease free.

In general, the simplest is to recommend the freezing of semen in the case of men or the vitrification of oocytes in that of women. But this is not always the best solution and when it comes to pediatric patients it is not a viable option.

The problem acquires an even greater complexity than a priori can be considered. In the case of men, for example, semen can keep frozen for up to 25 years, but not everyone can provide a viable sample, since in some it is their own disease that prevents them from ejaculating normally, so it will have to be extracted by electroejaculation technique.

On the other hand, on occasion, the need to immediately initiate cancer treatment does not allow it to be postponed long enough to carry out the clinical procedures required to preserve fertility, as is the case with the removal of eggs in the case of women, for which it is necessary to follow an ovarian hyperstimulation treatment that may require between two and three weeks.
In this case, it is possible to remove the ovarian tissue and cryopreserve it to reimplant it once the disease has been overcome. The same has also been done with the uterus, but the truth is that both procedures are still experimental and only viable if the cancer does not affect any of these organs.

However, cryopreservation of ovarian tissue is the only option for girls who have not reached puberty to maintain fertility once the disease is over. In the case of prepubertal children, at the moment there is no opportunity to preserve fertility, although currently the possibility of using stem cells extracted from testicular tissue is investigated so that, once they are matured in the laboratory, they can be used to Develop in vitro fertilization. But so far no positive results have been obtained.

In addition, there is another question that has not yet been answered about the extraction and cryopreservation of tissues and then be reimplanted, such as the possibility that this maneuver can reintroduce cancer into the body.


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