Preserving Fertility in Women Undergoing Chemotherapy

Infertility caused by chemotherapy is an unfortunate problem that many cancer patients face. Although chemotherapy can be effective for treating cancer in young women and girls, their ability to conceive following chemotherapy is markedly reduced.  A 2010 study conducted at UCSF found that up to 23% of women can have trouble conceiving after chemotherapy, yet only 5% received fertility counseling, and only 4% took action to preserve their fertility. 

Ovaries are particularly sensitive to and are more affected by chemotherapy, which can irreversibly damage oocytes (eggs) and the ovarian follicles they develop in.  This is why chemotherapy is described as gonadotoxic.  However, several options are currently available to preserve fertility in women with cancer to give them the opportunity to become mothers after undergoing chemotherapy. These options include embryo freezing, oocyte freezing and ovarian autotransplantation.

In a 2015 Cancer and Metastasis Reviews article (a journal associated with the Metastasis Research Society) Dr. Teresa K. Woodruff and colleagues describe what ovarian autotransplantation is and discuss its' advantages and disadvantages.  We are summarizing the information in this article now with the hope that it will encourage women undergoing chemotherapy to talk to their oncologists about fertility options and enable them to make more informed choices regarding their reproductive future.

The process of autotransplantation involves freezing a patient’s ovarian tissue, storing it while the patient undergoes chemotherapy, and then transplanting it back into the patient to allow them to resume regular reproductive function.  The procedure is approved for teenage girls and young women (approximately age 15-42), especially those undergoing gonadotoxic treatments for cancers such as breast cancer.

Ovarian autotransplantion is considered the most promising procedure for preserving fertility in comparison to embryo and oocyte freezing because: (i) it does not require additional procedures, (ii) it allows patients to begin chemotherapeutic treatment immediately, and (iii) it can restore full reproductive functionality after cancer treatment. So far, autotransplantation has resulted in 40 healthy babies worldwide.

However, ovarian autotransplantation is not a technically easy procedure. It is a very sophisticated procedure that requires a highly skilled team of oncologists, gynecologists, biologists, and surgeons, and it may not be suitable for all patients.  One of the major challenges is avoiding the reintroduction of cancer cells into the body of the woman.  It is critical to thoroughly analyze samples of the tissue to be transplanted for any sign of remaining tumor cells.  

Still, ovarian autotransplantation is an exciting and promising option for fertility preservation and offers a beacon of hope for female cancer patients. Researchers are actively working together to further guarantee the preservation of a woman’s fertility and we are making great strides.  Now, we also need to raise awareness among young women in the cancer community so that they know to discuss fertility options with their doctors prior to undergoing cancer therapies such as chemotherapy that are known to be toxic to the reproductive system.  

 

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