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Cancer and Fertility Preservation

A diagnosis of cancer is life changing, and some cancer treatments such as chemotherapy, radiation and surgery can speed up the natural decline in available eggs, thereby reducing or destroying the egg reserve. It helps to know your options when considering fertility preservation.

Dr. Virginia Mensah shares fertility preservation options available at The Reproductive Science Center of New Jersey.
Cancer and Fertility Preservation
Featured Speaker:
Virginia Mensah, MD
Dr. Virginia Mensah is a specialist in Reproductive Endocrinology and Infertility. She completed her fellowship training at Women and Infants Hospital, affiliated with the Warren Alpert Medical School of Brown University in Rhode Island. Dr. Mensah received her medical degree from the University of Illinois at Chicago, College of Medicine, and went on to complete her Obstetrics and Gynecology residency at Johns Hopkins Hospital. She is a member of the American Society for Reproductive Medicine and a fellow of the American College of Obstetricians and Gynecologists. Her clinical interests include infertility, in vitro fertilization, pre-implantation genetic diagnosis and screening, and oocyte cryopreservation for fertility preservation. Dr. Mensah is a devoted physician, committed to providing excellence in the medical and surgical care of her patients.

Learn more about Dr. Virginia Mensah
Transcription:

Melanie Cole (Host): In recent years, thanks to the improvement in the prognosis of cancer patients, a growing attention has been given to the fertility issues they may face. My guest today, is Dr. Virginia Mensah. She’s a specialist in Reproductive Endocrinology and Infertility at the Reproductive Science Center of New Jersey. Dr. Mensah, what is fertility preservation and what are cancer patients facing as far as a loss of fertility due to treatments?

Virginia Mensah, MD (Guest): Hi Melanie and hi to our listeners. Thank you so much for having me today. And thank you for also discussing this very important topic. Well, fertility preservation Melanie, in a nutshell is essentially the opportunity for patients that unfortunately were recently diagnosed or newly diagnosed with cancer to try to preserve some level of eggs and or embryos for their future use in order to hopefully have children in the future. The main thing that of course the cancer patients face, is oftentimes treatments that can lead to a loss of ovarian function or a loss of egg number or quality. And therefore, these fertility preservation options that are out there, help to attenuate in some ways or at least mitigate somewhat the risks of things like ovarian failure or an absence of being able to achieve pregnancy naturally down the road.

Host: Dr. Mensah, since children are also unfortunately diagnosed with cancer that could affect their future fertility; at what point during cancer treatment, whether it’s a child or whether it’s an adult; should preservation be considered? Who is the first person to discuss this with the patient?

Dr. Mensah: That’s a fantastic question. And honestly, the ultimate first person that these patients often interact with is their oncologist. So, most importantly, it’s important for oftentimes if – even if the patient does not get offered the opportunity to see a fertility specialist to discuss fertility preservation from the oncologist; if they go into the consultation with the knowledge that, that is a feasible option out there; then their oncologist can refer them to a fertility provider within their area to get that conversation started. But oftentimes, it’s actually the primary care provider or the oncologist that first interacts with this patient and ultimately has that discussion or initiates it as an option of preserving future fertility.

Host: Fertility preservation can be both for men and for women, yes, and if that’s the case; what are the treatments doing to men specifically, as far as their fertility?

Dr. Mensah: So, great question. And really the options for men are a little bit less so than for women believe it or not. So, for men, it’s often the case that if they get diagnosed with some level of cancer or malignancy; sperm preservation is the first and probably biggest treatment that’s out there and available. That’s essentially where they produce an ejaculated specimen and all sperm that are viable within that specimen are able to be cryopreserved for use at another time. And typically, depending on the volume of the sperm or really the concentration rather of the sperm that’s there; determines how much they essentially or really what that sperm can be used for in the future whether it’s intrauterine inseminations or things like in vitro fertilization. Whereas for women; the options are a little bit more diverse in the sense that as I mentioned before; typically, it involves in vitro fertilization for the harvesting or collection of eggs or alternatively, embryos can also be created and frozen for future use. And then finally, another budding category, but at this point that’s still somewhat experimental is actually option of ovarian tissue cryopreservation.

Host: And before we discuss a little bit more about some of those options; when this discussion is taking place doctor, will they affect how well the cancer treatment works?

Dr. Mensah: So, that’s a good question as well. Typically, these treatments don’t affect the efficacy of cancer treatments, however, especially for women; depending on the type of malignancy as well as some of the risks associated with that malignancy; some fertility treatments can exacerbate complications of cancer and by that specifically, I mean things like potentially increased risk of thromboembolism. But again, they, themselves do not increase the either or rather decrease the effectiveness of treatment or worsen the cancer.

Host: After treatment, how does someone know if their fertility has been affected?

Dr. Mensah: So, often women for example, that are undergoing chemotherapy, if it’s at a specific dose that can be toxic to the ovaries; one of the biggest signs will sometimes be an absence of a return of their menstrual periods, or other symptoms often of menopause. So, things like having hot flashes or vaginal dryness. Those can all be signs – also irregular periods themselves – those can all be signs of some level of dysfunction that has been imposed on the ovary as a result of chemo or radiation.

Host: You mentioned a few different ways and options for fertility preservation. Speak about them just a little bit more in detail. What’s involved in egg freezing or embryo or sperm or you mentioned ovarian tissue. Tell us a little bit more about those.

Dr. Mensah: Absolutely. So, the first option that is again, sperm cryopreservation just to talk the guy part of things first. So, that typically involves them coming into the office, producing an ejaculated specimen and that specimen than gets frozen for future use. For women, it’s a little bit more involved. So, for something like egg freezing; that typically involves a cycle of in vitro fertilization which involves use of injectable medications to promote egg formation and development as well as maturation. And what the goal of again, trying to get as many eggs as we can from them during that short window of time that they have ideally before they start their chemotherapy treatments. We then go in, retrieve those eggs and they are frozen for later use.

Along the same lines, the embryo cryopreservation can be done very similarly, still involves the woman taking injectable fertility medications, harvesting the eggs, but now instead of just freezing the eggs; the eggs get combined with their partner’s sperm in order to create embryos. Those embryos are grown out for several days and then frozen, typically in what’s called the blastocyst stage which is a day five embryo and those can be used at any point in time as well after their treatment.

And then finally, the ovarian tissue cryopreservation is definitely one of the newer modalities that are out there. As I mentioned, it is still considered experimental and it’s often best reserved for, for example, those pediatric patients or prepubertal women or girls rather and or even women that have some sort of hormonally sensitive cancer but that typically involves surgery where we go in, harvest a portion of the ovary itself, typically what’s called the cortex of the ovary and then that gets frozen for future use as well.

Host: Dr. Mensah, in a younger child, will fertility preservation affect the ability for that child to go through puberty?

Dr. Mensah: So, the fertility preservation itself doesn’t necessarily affect puberty or puberty milestones. Certainly, if the child undergoes some gonadotoxic chemotherapy or some level of radiation therapy that has a damaging affect on the ovaries; that can affect pubertal milestones and development. But even that, there are medical treatments out there meant to address that again, are sort of separate from fertility preservation itself.

Host: So, what else would you like listeners to know about fertility preservation and their options, if they do have to go through cancer treatments which Doctor, are really stressful enough as it is and then they have to think about future fertility if that’s what it is that they are looking to do.

Dr. Mensah: Yes, of course. I mean I think honestly for any patient that gets diagnosed with cancer; it’s a very devastating moment in their lives and it’s something that they need to know that they are fully supported by all of their physician as well as family I’m sure, teams in order to try get them through to that survivor state. And I have to say, here at the Reproductive Science Center, we do a good job of essentially showing that support and for all of our cancer patients; trying to give them a full overview of all the options of fertility preservation treatments. And typically, for the female patient in particular, which is often the emphasis for our practice; we are happy to see them and also would encourage them to start the conversation early, as early as possible, even as early as that diagnosis gets made with their oncologist and that way, they get the appropriate early referral to a fertility specialist to start that conversation and potentially get that process going.

Host: Thank you so much Dr. Mensah, for coming on with us today and letting cancer patients know their options in regards to fertility preservation when they are going through cancer treatments. This is Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit www.fertilitynj.com, that’s www.fertilitynj.com. This is Melanie Cole. Thanks so much for tuning in.