"We can't make assumptions about what is important to our patients, and consequently, we must provide them with information about all their options." -- Joanne Frankel Kelvin, RN, MSN, AOCN |
Although clinicians cannot always prevent fertility problems in their patients, they can frequently provide options for many patients who wish to preserve their fertility and parent their own biologic child after cancer treatment.
Fertility Preservation and Parenting Options for Men
For men, the simplest method of doing so is sperm banking, in which a man manually stimulates ejaculation at a sperm bank before receiving treatment. In the best-case scenario, patients collect three separate specimens, two to four days apart. However, if there is not adequate time before treatment must begin, a single sperm collection may be adequate. The specimen is analyzed and the sperm are then frozen and stored. If the man is unable to father a child naturally after treatment, his sperm are thawed and used to fertilize the egg of his partner or of a donor.
For men who cannot ejaculate normally, a procedure known as electroejaculation may be an option. In electroejaculation, controlled electrical stimulation is used to induce ejaculation. For men who do not have an adequate amount of sperm in their ejaculate, testicular sperm extraction may be an option. In this procedure, a small piece of testicular tissue is surgically removed to attain sperm.
Fertility Preservation and Parenting Options for Women
For women, the standard method of fertility preservation is a procedure known as embryo freezing, which is performed by a reproductive endocrinologist. The procedure starts with ovarian stimulation with hormone injections that will be given over the course of about two weeks, followed by retrieval of eggs, fertilization, and then freezing of the resulting embryos for later use.
Some women do not have a partner at the time of diagnosis and are unwilling to use donor sperm. And other women may have religious or ethical objections to freezing an embryo. For both these groups of women, there is another, experimental approach called egg freezing, in which the eggs, after ovarian stimulation and retrieval, are frozen and stored to be fertilized at a later time, when a woman is ready to use them. It is important to note that both embryo and egg freezing require that a woman delay her cancer treatment for at least two weeks.
Post-Treatment Options
Not all patients will have the opportunity to preserve their fertility before treatment nor will all patients want to undergo such procedures. There are other options for patients who wish to become a parent after treatment. Patients can use donor sperm or donor eggs if they don't have enough healthy sperm or eggs of their own. Patients can contract with a surrogate mother or gestational carrier if they are unable to carry a pregnancy. And of course adoption is also an option.
Not all cancer treatments cause fertility problems. Countless individuals go on to have children naturally after successful cancer treatment. However, some young cancer patients planning to have children may have their fertility affected by the treatments required to save their lives. If you have concerns about the effects of your treatment on your fertility, discuss these issues with your doctor.
"We at Memorial Sloan-Kettering recognize that many young patients want to have children after treatment, regardless of their age, their disease, or whether they have children already," Ms. Kelvin explains. "We can't make assumptions about what is important to our patients, and consequently, we must provide them with information about all their options. At the same time, not everyone will be able to collect sperm or eggs before treatment. It is equally important to talk about the other ways of becoming a parent."
