Women who are candidates for chemotherapy treatment are usually referred for counseling regarding the effects of treatment on future fertility. During this counseling session, several factors are considered, such as the patient's age, marital status, previous pregnancies and births, drug type and urgency of the treatment. Counseling is done on an individual basis to assess the ovarian reserve by means that include hormonal blood tests and ultrasound.
Preserving Fertility - Types of Treatment for Women:
- Embryo Freezing
Preservation of embryos is routinely used in fertility treatments; women undergo in vitro fertilization (ivf) whereby eggs are removed from the patient and fertilized in a test tube with the sperm of a partner or donor. The resulting embryos are then frozen and stored before the woman begins receiving treatment that affects the ovaries. It takes about two weeks from the start of a woman's menstrual cycle to get eggs to use for ivf. Therefore, there is a need to delay chemotherapy for several weeks to stimulate the ovaries to create follicles and subsequently perform extraction of the eggs under general anesthesia. When ovarian stimulation for egg extraction can damage the woman's health, special protocols are introduced.
- Ovarian Diversion
Suitable in rare situations where pelvic radiation therapy is given. It may be possible to move the ovaries out of the radiation area surgically and relocate them at the sides of the pelvis, out of the radiation target field.
- Ovarian Tissue Freezing
Some women have parts of their ovaries removed surgically and frozen before cancer treatment. Ovarian tissue contains tiny follicles from which eggs will develop in the future. Preservation of ovarian tissue has been performed in the world for over 10 years, and tissue has been frozen for many hundreds of girls and women before chemotherapy treatment. In these patients, the ovary can be removed, tissue carefully dissected with microsurgery, frozen, and subsequently transplanted back to the woman after she has been cured of the cancer. Worldwide, there have been 18 children born in this way. Freezing the ovaries is done using minimally invasive surgery under general anesthesia via a single incision approach in the navel. Although some centers are banking ovarian tissue before cancer treatment, this technique is still experimental and has resulted in only a few pregnancies worldwide. The disadvantage to this method is the need for further surgery in order to complete the ovarian transplant, as well as the need for the woman to have ivf to get pregnant.
- Ovarian Suppression
For women receiving chemotherapy, one option may be to have periodic injections of analogue preparations to GnRH. These injections put the ovaries into temporary 'medical menopause' during treatment and reduces the number of follicles that enter the division cycle thus reducing the exposure of the ovary to various toxic elements. These treatments are designed especially for girls and women after puberty.
- Extracting Mature Eggs and Freezing Them Prior to Cancer Treatment
It is possible to extricate mature eggs from the ovary duting the ivf treatment cycle and to freeze them unfertilized, so there is no need for a partner and no need to use the sperm bank to freeze eggs. Women may opt to have the eggs frozen unfertilized, particularly if they are not in a committed relationship. The eggs can be frozen for preservation purposes both by a slow freezing method and by a glazing method (vitrification), and about 80% of eggs survive after freezing and later thawing. Up till now, hundreds of live births have been reported after freezing and thawing of eggs: about 150 around the world after slow freezing and over 200 after glazing. Reports in the literature attest to healthy children with no difference to any other population that has not undergone the process.
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