INFERTILITY - deal with it before treatment!

[Mary]

If you are about to start chemotherapy, please make your doctors aware if fertility is important to you!

I was at a conference recently where fertility was discussed by a couple of physicians who are passionate about helping cancer patients preserve their fertility. The physician who works with men told us how incredibly frustrating it is when he meets a man who did not bank sperm before his treatments. Some men just aren't told that this is an option. It is a fast and inexpensive option, and sometimes sperm banks will offer discounted or free rates for cancer patients who cannot afford the fee. The physician went so far as to say that he believes that all young men should bank sperm, even if they don't believe that they will want kids later. For young teens who do not want to deal with the sperm banking process, it can be done under general anesthesia. If sperm are not banked, there are a few ways to try and gain fertility, but they are much more invasive and less effective than sperm banking. Even if a man has a zero sperm count, there are still things that can be tried!!! So if you have any questions after chemo, look into it.

The physician who presented about women's fertility options provided a lot of great information. Afterward, I asked him a question: "Many of the young adults I deal with are diagnosed with sarcoma. It can take months for them to get the correct diagnosis, and by the time that they do, they are often told that they need to start chemotherapy immediately. This usually means that women are not given any fertility preservation options. I am wondering if the doctors truly believe that a few weeks delay is too much of a threat to all of these patients' lives, or if they just don't understand how important fertility is to many women, and thus don't make it a priority themselves?"

The doctor said that in most cases, delaying chemotherapy by about three weeks, which is all that is required to do a quick cycle of IVF, is very possible. But this requires a speedy referral to the right fertility specialist (usually a call made from your oncologist or social worker to the clinic explaining the urgency of the situation). Some physicians just aren't familiar enough with the options for women, or their priorities. If a woman is not in the right part of her cycle for IVF, she will need to take one week of medication to change her cycle, and then a couple of weeks of hormones, and then they can take some eggs for IVF. The eggs can be joined together with sperm and then frozen, which is standard IVF. But there is also a new procedure for those women who have not met their love yet - the eggs can be frozen by themselves for use at a later time when the right man is around. While none of these methods are guarantees, they do provide hope!  Of course, every woman is different, and every sarcoma case is different. As we have discussed here before, some sarcomas may respond to hormone levels in the body, which might muddle the waters when making this decision. Ideally, women who want to preserve fertility will quickly educate themselves about the potential options, and will ask questions about the urgency of their case verses the benefits of IVF.

There is a lot more information at Fertile Hope.

[Cari]

Great info Mary  THANKs for sharing!

[Mary]

From the Los Angeles Times

A Danish woman who had part of her ovaries removed and frozen while she was undergoing cancer treatment has now given birth to two children in separate pregnancies after the tissue was re-implanted, researchers reported Wednesday. The results mark nine such successful pregnancies following ovarian preservation and transplantation and give hope to young women with cancer who want to regain their reproductive capacity. Many forms of chemotherapy kill a woman's eggs, so removing them from the body during treatment now offers a successful alternative.

Stinne Holm Bergholdt was 27 when she was diagnosed with Ewing's sarcoma in 2004. Ewing's is a rare form of cancer in which tumors are found in bone and soft tissue, primarily in the pelvis. Her left ovary had already been removed surgically because of a cyst, so Dr. Claus Yding Anderson of the University Hospital of Copenhagen removed several strips of ovarian tissue containing eggs and froze them in liquid nitrogen. Following six courses of chemotherapy, surgery to remove residual tumors, and another three courses of chemo, Bergholdt was apparently cured, but she became menopausal -- she suffered hot flashes and her menstrual bleeding stopped.

Anderson and his colleagues, including Bergholdt, reported in the journal Human Reproduction that six strips of tissue were re-implanted in December 2005. Following mild ovarian stimulation, Bergholdt delivered a healthy girl in February 2007. She returned to the fertility clinic in January 2008 for a second treatment to initiate another pregnancy, but tests confirmed that she had become pregnant without intervention. She delivered a second healthy girl in September 2008. That showed that the transplanted tissue had functioned successfully for four years, Anderson said.

Almost all of the nine pregnancies resulting from such transplantation have occurred in Europe, three of them among Anderson's patients. Experts attributed the success with Bergholdt, in part, to her young age, which meant she had plenty of eggs left to be removed and stored. It is not clear how well the procedure would work with older patients.