Cancer & the Preservation of Fertility
Fertility preservation at a glance
- Before undergoing chemotherapy or radiation therapy to treat cancer, men and woman can preserve their sperm and eggs, or a couple may create and preserve embryos, for later use with assisted reproductive technologies like IVF.
- Cryopreservation freezes embryos and sperm at a very low temperature to keep them viable for long periods of time.
- If the cancer patient does not survive, what to do with the preserved sperm or embryos can be a difficult choice.
- Preimplantation genetic diagnosis (PGD) to avoid the birth of offspring with a high risk of inherited cancer is ethically acceptable.
Preserving fertility before cancer treatment
Before a man begins chemotherapy or radiation therapy, he may give semen samples to be frozen at a sperm bank or fertility clinic. His samples can be stored and used later for artificial insemination or other assisted reproductive techniques like in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI).
Women, if time and circumstances allow, may be treated with in vitro fertilization (IVF) prior to cancer treatment. Embryos created through IVF may be frozen and stored for years. This is called cryopreservation. Of course, the woman must decide if delay of cancer therapy is worth the risk. Other factors to consider for this approach include time, expense, and availability of sperm. In some cases, if a woman’s cancer therapy requires radiation to the pelvis, her ovaries may be repositioned surgically to protect her eggs from the radiation. Also, freezing of ovarian tissue can also be considered, but these techniques are still experimental, and according to the American Society for Reproductive Medicine, may only be offered in an experimental study with proper oversight.
Cryopreservation freezes embryos and sperm at a very low temperature, such as in liquid nitrogen (-196 degrees C). In most cases, the embryos and sperm remain viable for long periods of time. For a man diagnosed with cancer, cryopreserved sperm may be used after cancer treatment for in vitro fertilization (IVF), intrauterine insemination (IUI), or Intracytoplasmic sperm injection (ICSI). If the man’s sperm does not survive the freezing process, then another option is using donor sperm.
Post-mortem fertilization or donation
There are cases where a man does not survive cancer and his sperm have been used to fertilize his partner’s eggs. This is an obviously difficult choice emotionally for a woman to make and may require counseling, not only with a physician, but with a therapist or clergy.
There are cases where both sperm and fertilized embryos are donated for use by others after the death of either the man or woman. Once again, this choice requires not only legal consent but also counseling beyond the doctor-patient relationship. In the event of cryopreservation of sperm, embryos, or eggs, precise legal instructions should be given about the disposition of those in the event of the patient’s death or other contingency.
What if your minor child’s future reproductive potential is in danger?
Parents may act to preserve fertility of cancer patients who are minors if the child assents and the intervention is likely to provide net benefits to the child. Consult with your doctor, oncologist, or reproductive specialist.
Preimplantation genetic diagnosis to avoid the birth of offspring with a high risk of inherited cancer is ethically acceptable.
For a woman diagnosed with cancer, embryo cryopreservation offers the best chance of pregnancy for women. If a woman decides to use embryo cryopreservation, the egg must be fertilized with a man’s sperm before it is frozen because there’s a much better chance of an embryo surviving freezing, thawing, and implanting in the uterus than that of a cryopreserved unfertilized egg. For women without partners, donor sperm is also an option.