Preserve fertility in women with cancer

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The detection with increasing frequency of some type of cancer in young women, makes it necessary to preserve the fertility of these women, who after undergoing chemotherapy or radiotherapy treatments see their expectations of being mothers limited due to sterility problems derived from oncological treatment.

Below you have an index with all the points that we will discuss in this article.

Index

Preserving fertility in women with cancer

It is of vital importance that the oncologists talk to the patient before beginning the treatment of the effects that this will produce and explain the different options that exist to preserve their fertility .

Ideally, this conversation should occur before starting treatment, but there are options to preserve fertility during treatment. Depending on the type of cancer, the age of the woman and the stage of the disease, the most appropriate option will be decided so that the woman can become a mother in the future.

Before starting chemotherapy and radiotherapy



Vitrification of oocytes

This method consists of freezing the ovules through the vitrification technique (ultrafast freezing), so that the oocytes are kept exactly in the same conditions as when they were preserved, so the treatment will not have damaged their quality. Once the woman has overcome the disease and is ready to be a mother, the ovules are devitrified, inseminated and the embryos are transferred to the woman.

Oocyte vitrification is a good option for women who do not have a partner, since what is stored is ovules.

To perform this technique, it is necessary to perform a controlled hyperstimulation of the ovary, so that several oocytes are matured at the same time in the ovarian cycle. This is achieved by administering medication on day 3 of the cycle, for a period of 10-12 days. Under ultrasound, the growth of the ovarian follicles is observed during the administration of the treatment and when they reach the desired size 16-18 millimeters are extracted by follicular puncture.

Some women with cancer can not perform this technique due to incompatibilities with the administration of hormonal injections. Everyone knows the importance of acting as soon as possible against cancer, to perform this technique it is necessary to delay the start of treatment for about 1 month, which is not always possible. On the other hand, if the tumor is hormone-dependent, such as breast cancer for example, this option is not recommended because the tumor could increase its size with high levels of estrogen. The use of aromatase inhibitor drugs during ovarian stimulation has been identified to prevent an increase in circulating blood estrogen, initial studies show that it works, although more research is still needed.



Embryo vitrification

The vitrification of embryos consists of cryopreservation of embryos, the ovarian stimulation occurs exactly as in the vitrification of oocytes, the difference lies in the fact that the obtained ovules are fertilized and the embryos are frozen.

With this method, higher success rates are obtained, it must be borne in mind that the embryos have already been obtained, whereas in the previous case the embryos would be formed after having overcome the disease. Therefore, the drawbacks of this technique are the same as in the previous one, in addition to the fact that it must be a couple; although it can be done with donor sperm if the woman later has a partner, she could not have biological children with him.



Surgery with ovarian cancer

In young women with cancer in a single ovary, this ovary can be removed. It must be the oncologist who proves that in that particular tumor the removal can be carried out without risk. This tumor must be slow growing, with very low probability of spread, low malignant potential, germ cell and borderline tumors.

A thorough follow-up should be done to verify that no tumor appears in the other ovary. With this option the woman is still fertile and can achieve pregnancy naturally.

During treatment with chemotherapy and radiotherapy

Ovarian suppression

This option involves causing the ovaries to stop working during chemotherapy and radiation therapy to protect them from harmful effects. The normal activity of the ovary is reduced, so that the number of damaged ovules is much lower.

An injection of GnRH (gonatrofine releasing hormone) is given two weeks before starting pelvic radiation therapy or chemo. This injection must be repeated every month for the duration of the oncological treatment.

This treatment is experimental, it seems to work better in women under 35 years, those who wish this option to preserve fertility should participate in a clinical study that analyzes the treatment with GnRH. More research is still required, so it is recommended to combine it with vitrification of ovules or embryos.

Protection of the ovaries

It is used before radiotherapy in the pelvis, to prevent this radiation from damaging the ovaries, an apron is placed in the area of ??the pelvis that acts as a barrier. More studies are still needed to prove its effectiveness.

Ovarian tissue freezing

This technique is still experimental, is recommended in prepubertal girls, tissue is cut from the ovarian cortex and cryopreserved by the vitrification technique.

After the oncological treatment, at the moment the woman wishes to become a mother, the tissue is thawed and implanted near the fallopian tubes. This tissue reactivates and re-produces ovules that can be harvested and use an in vitro fertilization treatment.

Currently, this method is not recommended in women with blood cancers (such as leukemias or lymphomas) or ovarian cancer because of the risk of cancer cells in the implant.

Ovarian transposition

The method of ovarian transposition consists in moving the ovaries away from the radiation zone. It can only be used in cases of radiation in the pelvis and can be performed before and after puberty.

The surgeon moves the ovaries and places them above the pelvic area, then they return to their original position. Approximately 50% of women recover their menstruation naturally.


freezing of blastocysts in Sevilla(Spain)

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