Preserving Fertility: Options for Patients With Cancer

In an interview with Targeted Oncology, Katherine McDaniel, MD, reproductive endocrinologist at the University of Southern California and HRC Fertility, discusses the landscape fertility preservation with special consideration to patients facing a cancer diagnosis.

Unfortunately, a significant number of patients diagnosed with cancer face treatments that can severely impact their fertility. This includes chemotherapy, which uses powerful drugs to kill cancer cells but can also damage reproductive organs; radiation therapy, which targets and destroys cancer cells with high-energy rays, potentially harming the ovaries or testes; and even surgery to remove organs crucial for reproduction, such as the uterus or other parts of the gynecologic anatomy.

Whenever a patient of reproductive age—typically women up to 44 years old—is anticipating cancer care that may affect their fertility, it is crucial to discuss the option of fertility preservation. For women, the primary focus is often egg freezing, known as oocyte cryopreservation. In some cases, eggs can be combined with sperm to create and then freeze embryos. For male patients, sperm freezing is a readily available and effective option. These are the main, established methods for preserving reproductive potential.

The landscape of fertility preservation has evolved significantly. A decade or two ago, many patients with new cancer diagnoses simply weren't counseled on these options, according to McDaniel. This was understandable, as the primary focus of their oncology teams was, and remains, treating the cancer and saving lives. However, there's been a substantial increase in awareness within the oncology community. This heightened understanding has led to a significant rise in referrals to fertility specialists.

As a reproductive endocrinologist, McDaniel's goal is to see patients as soon as possible after their cancer diagnosis. This allows for a proactive approach to fertility preservation, sometimes even before the oncology team has finalized a treatment plan. The urgency of referral is paramount, as certain fertility preservation procedures need to happen before cancer treatment begins.

Beyond the core techniques of freezing eggs, embryos, and sperm, there are also advanced techniques for patients who aren't candidates for conventional methods. For example, prepubertal girls cannot undergo egg freezing because their reproductive systems haven't fully matured. For these patients, and others, significant pioneering work over the past two decades has led to a technique called ovarian tissue cryopreservation. This procedure involves surgically removing an entire ovary or a portion of it, freezing the tissue, and then transplanting it back into the patient when they are ready to conceive, often many years or even decades later. This offers a vital lifeline for those for whom traditional egg freezing isn't an option.

The overall awareness of fertility preservation and the speed at which patients are referred to fertility clinics have both improved dramatically, offering more hope and options to individuals facing a cancer diagnosis.