Navigating Fertility Preservation and Cancer Survivorship: Overcoming Barriers and Exploring Options

핵심 개념

Cancer treatments can significantly impact fertility, but timely discussions and proactive fertility preservation strategies can help cancer survivors build families.

초록

This podcast episode features a discussion between Dr. Ann Partridge and Dr. Clarisa Gracia, an expert in reproductive endocrinology and infertility, on the topic of oncofertility and cancer survivorship.
The key highlights and insights from the discussion are:

Oncofertility has become a growing focus in recent years as more cancer survivors express a desire to have children after their treatment. Dr. Gracia became passionate about this field after seeing many patients struggle with infertility after cancer treatment.

Cancer treatments, such as chemotherapy, radiation, and surgery, can have significant impacts on fertility for both men and women. Factors like the type of cancer, specific treatments, and timing of interventions all play a role in the reproductive risks.

There are several barriers that can prevent timely discussions and access to fertility preservation options, including:

The urgency to start cancer treatment, with fertility preservation not being the top priority initially
Assumptions made by healthcare providers about a patient's desire or ability to have children in the future
Financial constraints, as fertility preservation can be costly and may not be covered by insurance

For women, the main fertility preservation options include egg banking, embryo banking, and ovarian tissue cryopreservation. For men, the standard approach is sperm banking. The success rates and availability of these techniques vary.

Assessing ovarian reserve and the impact of prior cancer treatments is crucial when considering fertility preservation options, especially for those who were treated in the past. Genetic factors and the risk of passing on hereditary cancer syndromes also need to be considered.

Beyond traditional fertility preservation, Dr. Gracia emphasizes that there are other ways for cancer survivors to build families, such as using donor gametes, gestational surrogacy, adoption, and fostering. Discussing all available options is important to help patients find the right path forward.

통계

The success rates for different fertility preservation techniques are:

Egg freezing: 6-7% per egg frozen for young patients (<35 years old)
Embryo freezing: ~50% chance of a baby per embryo transfer in young patients
Ovarian tissue freezing: ~25% chance of pregnancy with transplantation in young patients

인용구

"It's much better to talk to patients and strategize before treatment to figure out the best options for them to build a family in the future."
"We want to make them understand that it is possible to live and have reasonable quality of life, and to have things that the rest of us are able to have in our lives."
"All we need is an egg, sperm, and a uterus, and we can figure out how to utilize it to build a family."

핵심 통찰 요약

S2 Episode 3: Oncofertility and Cancer Survivorship: Barriers and Options

by Ann H. Partr... 게시일 www.medscape.com 07-31-2024

https://www.medscape.com/viewarticle/999931

더 깊은 질문

How can healthcare systems and providers be better equipped to initiate timely discussions about fertility preservation with cancer patients?

Healthcare systems and providers can improve the initiation of timely discussions about fertility preservation with cancer patients by implementing several strategies. Firstly, there should be increased awareness and education among healthcare professionals about the importance of discussing fertility preservation options with cancer patients before the initiation of treatment. This can be achieved through training programs, workshops, and guidelines that emphasize the significance of oncofertility. Additionally, healthcare systems can establish standardized protocols for identifying patients at risk of fertility loss due to cancer treatment and ensure that referrals to fertility specialists are made promptly.
Furthermore, the integration of fertility preservation discussions into the overall treatment planning process for cancer patients is crucial. Multidisciplinary teams should include reproductive endocrinologists or fertility specialists who can provide information and options for fertility preservation early in the treatment decision-making process. This collaborative approach ensures that patients are informed about their reproductive options and can make decisions that align with their future family-building goals. Additionally, healthcare systems should address financial barriers by exploring insurance coverage for fertility preservation procedures and offering support services to help patients navigate the costs associated with these treatments.

What are the ethical considerations around using donor gametes or surrogacy for cancer survivors who have a genetic predisposition to cancer?

When considering the use of donor gametes or surrogacy for cancer survivors with a genetic predisposition to cancer, several ethical considerations come into play. One of the primary concerns is the potential transmission of the genetic predisposition to cancer to offspring conceived through these methods. In such cases, there is a moral dilemma regarding whether it is ethically justifiable to knowingly pass on a hereditary cancer risk to future generations. This raises questions about the autonomy of the individuals involved in the decision-making process and the responsibility to disclose genetic information to donor gametes or surrogates.
Another ethical consideration is the psychological impact on the cancer survivor and their family members. The decision to use donor gametes or surrogacy may involve complex emotions related to genetic lineage, identity, and the desire to have biologically related children. Healthcare providers and ethicists must navigate these sensitive issues with sensitivity and respect for the autonomy of the individuals involved. Additionally, there may be societal stigmas or misconceptions surrounding the use of donor gametes or surrogacy, which can further complicate the ethical considerations in this context.
Overall, the ethical considerations around using donor gametes or surrogacy for cancer survivors with a genetic predisposition to cancer require a thoughtful and nuanced approach that prioritizes the well-being and autonomy of all individuals involved while considering the potential implications for future generations.

How might advancements in reproductive technologies, such as in vitro gametogenesis, impact the future of oncofertility and family building for cancer survivors?

Advancements in reproductive technologies, including in vitro gametogenesis (IVG), have the potential to revolutionize oncofertility and family building for cancer survivors in the future. IVG offers the possibility of generating gametes from stem cells, bypassing the need for traditional gamete sources such as eggs or sperm. This technology could benefit cancer survivors who have undergone treatments that compromise their natural fertility by providing them with alternative options for biological parenthood.
For cancer survivors who have preserved ovarian or testicular tissue before cancer treatment, IVG could offer a way to mature and utilize these preserved tissues to create viable gametes for assisted reproduction. This could significantly expand the reproductive options available to cancer survivors, especially those who may have limited or compromised fertility due to their cancer treatments. Additionally, IVG may offer solutions for prepubertal patients who are not able to undergo traditional fertility preservation methods, providing them with the opportunity to preserve their fertility for future family building.
Furthermore, advancements in reproductive technologies like IVG may also address ethical considerations related to donor gametes or surrogacy for cancer survivors with genetic predispositions to cancer. By offering alternative methods for generating gametes from the individual's own cells, IVG could mitigate concerns about passing on hereditary cancer risks to offspring conceived through donor gametes.
Overall, the continued development and implementation of reproductive technologies such as IVG hold great promise for enhancing the future of oncofertility and family building for cancer survivors by expanding the range of options available and addressing ethical considerations in a novel and innovative way.