Fertility and Cancer

Fertility and cancer are subjects that many would not associate with each other but increasingly as cancer treatments are improving, then survivors are living with the consequences of their cancer treatments and for some this means infertility. There are an increasing number of options which are being offered so this blog is an overview of all of the options and what may be coming in the future.

So, I am going to separate the options for men and women. Men first. Freezing of sperm has been successful since the 1950s and in NZ sperm freezing prior to chemotherapy, surgery or radiotherapy is free. Men need however to be told about it ! The sperm may not be of good quality and ICSI may be required into the future. Occasionally no sperm is seen in the ejaculate and then sometimes testicular retrieval of sperm is offered. Studies have shown that less than 10% of men will request that this sperm is used into the future, as some will have normal fertility and some will not choose to parent, but at least if there is sperm frozen, then those men have the option.

Prepubscent boys are in a more difficult space. Those boys have not yet developed mature sperm producing cells in their testes and there is much debate whether testicular tissue should be stored in the hope that technology will develop so this tissue may produce usable sperm. At present in New Zealand this is not offered.

For women the choices are harder. The first option is to get on with the cancer treatment and then consider choices such as donor egg treatment or surrogacy in the future. For some women who are receiving radiotherapy to their pelvis, their ovaries can be moved away from the field of radiotherapy. Other women have the time to undergo a round of IVF treatment prior to starting chemotherapy and the eggs or embryos frozen for their future use. For others, then storage of ovarian tissue may be an option. This is where a part or whole ovary is removed, sliced into fine pieces and then frozen. The frozen tissue may then be thawed and replaced into the woman's pelvis. So far 19 pregnancies have been reported from this technology, so still early days. There are also some concerns around the chances of some cancer cells being present in the ovarian tissue.
There has also been some interest in a group of drugs called gonadotrophin-releasing hormone analogues as they may have a protective effect on the ovaries if used during chemotherapy. There are conflicting reports as to how useful these drugs may be and further studies are awaited. For girls, the only option is ovarian tissue storage.

All people who are facing cancer treatments and who have not completed their families should be given the option of a consultation with a fertility specialist so they can make some informed decisions, as once the cancer treatments have commenced, then it may be too late to preserve fertility.

Donor Sperm

We have just launched a campaign to increase the recruitment of sperm donors. We have deliberately gone with an edgey feel so as to generate some hype and media interest. With slogans such as 'come one come all' and 'give it a shot' then there has been a pleasing amount of interest and after the first weekend 6 potential new donors contacted the clinic yay!
Our donor sperm programme has changed dramatically over the last 10 years. Now more than 90% of those on our waiting list are single or gay women with the number of heterosexual couples becoming very much the minority. This reflects the improvements that have occurred in the treatment of male infertility along with  changing social trends seen in our society. Women in their 30s outnumber men and many have not been able to find a suitable life partner and are aware of their biological clock and are choosing to parent alone. We never have sufficient sperm donors to meet the demand and many women are forced to wait for more than a year before a suitable donor is able to be found.
Potential sperm donors need to be in good health, be aged less than 45 and have no known genetic disorders. They also are required to be identifiable and understand that most children born as a result of sperm donation will want to make contact with their donors at some stage in their lives.