This document discusses fertility preservation options for cancer patients. It begins by outlining how cancer treatments can impact fertility through damage to reproductive organs and systems. For men, sperm banking is the most established option, though there are challenges around timing and ability to produce samples. Alternatives include testicular sperm extraction and intracytoplasmic sperm injection. For women, embryo cryopreservation has the highest success rate, while oocyte cryopreservation and ovarian tissue cryopreservation are also options. The document then reviews potential paths to parenthood post-treatment and challenges to fertility preservation.

1. FERTILITY
PRESERVATION IN
GYNAEC ONCOLOGY

3. FERTILITY PRESERVATION INCLUDES

5. COUNSELING ON FERTILITY
PRESERVATION
• Risks for Infertility
»Is fertility preservation necessary?
»Is it necessary before therapy or after?
• Fertility Preservation Options
• Barriers to Accessing Options

6. POTENTIAL IMPACT OF
CANCER AND TREATMENT ON
FERTILITY
• Germ cell loss - Decreased, damaged, or absent sperm
• Damage to ductal system for sperm transport
• Obstruction • Ejaculatory dysfunction
• Damage to pelvic nerves -Sexual and ejaculatory
dysfunction
• Damage to brain (pituitary) -Sexual dysfunction via the
neuroendocrine system.

8. OPTIONS: MEN
• SPERM BANKING
• Most reliable and well established means of
preserving fertility for males.
• Can be done outpatient or inpatient.
• Reports of successful pregnancies from sperm
stored up to 28 years.
• Banking post start of chemotherapy is
controversial.

9. SPERM BANKING - LIMITATIONS
• Pressure to start chemotherapy
• Optimal: 48 hour abstinence and collection of more than
one sample
• Can deposit every 24 hours
• Even one deposit may be sufficient
• Inability to produce sperm due to age, discomfort, illness
• Alternatives -Testicular Sperm extraction ,Electro-ejaculation

10. TESTICULAR SPERM
EXTRACTION (TESE)
• Can be done before or after cancer treatment as outpatient
surgical procedure.
• If no sperm in semen, testicular tissue is removed, processed
and examined for sperm.
• If sperm are found, they are removed and used immediately
or banked for future use.
• Sperm retrieval success rates range from 30-90% in men with
non-obstructive azoospermia.

11. INTRACYTOPLASMIC
SPERM INJECTION (ICSI)
• Injection of a single sperm
into the middle of the egg.
• Allows banking of very small
amount of sperm
• Very effective method to
fertilize eggs in the IVF lab
after they have been retrieved
from the female.

12. PARENTHOOD AFTER
TREATMENT
• Natural conception -Wait post therapy
• Assisted Reproduction
• Banked Sperm: +/- ICSI
• Low Counts: » TESE » ICSI
• Donor Sperm
• Adoption

19. EMBRYO CRYOPRESERVATION
• Currently the only routinely successful method of preserving fertility
• Approximately 30% success of pregnancy per embryo thawed
• Highly dependent on age of female
• Method:
1. Ovarian stimulation at the start of a menstrual cycle.
2. Collection of mature oocytes
3. In vitro fertilization – partner or donor sperm
4. Cryopreservation of embryo
5. Thawing and Implantation post therapy

20. OOCYTE CRYOPRESERVATION
• Initial process is similar to embryo cryopreservation
• Retrieval of mature eggs
• Retrieved eggs are frozen and stored
• Advantages:
More than 900 children have been born by this.
Clinical Live Births per transfer 21%.
Does not require sperm.

21. OVARIAN TISSUE
CRYOPRESERVATION
• Method:
• Surgically remove ovarian tissue
• can be done laproscopically
• contains hundreds of primordial follicles
• Process into strips that can be cryopreserved
• Requires subsequent maturation of primordial follicles to
oocytes
• autotransplantation(orthotopic/heterotopic)
• in vitro maturation (follicle or organ)
• Studies ongoing

22. PROTECTION OF
OVARIES
• Shield ovaries during radiation
• Fractionate radiation doses
• Surgical transposition of ovaries out of radiation field •
• Can be done laproscopically

24. PARENTHOOD POST TREATMENT:
ACUTE OVARIAN FAILURE
• Thaw and transfer cryopreserved embryos
• Thaw oocytes, fertilize (partner or donor sperm), transfer
embryos
• Assisted Reproduction Techniques
• Donor Oocyte
• Donor Embryo
• Adoption

26. PARENTHOOD POST TREATMENT:
DIMINISHED OVARIAN RESERVE
• Embryo Cryopreservation
•Partner Sperm
•Donor Sperm
• Oocyte Cryopreservation

27. PARENTHOOD POST TREATMENT:
PREMATURE MENOPAUSE
• Assisted Reproduction Techniques
•IVF
•Donor Oocyte
•Donor Embryo
• Adoption

28. PARENTHOOD POST TREATMENT:
UTERINE INCOMPETENCY
• Traditional Surrogacy
•Partner or donor sperm used to impregnate the surrogate
• Gestational Surrogacy
•Embryos (self or donor) transferred to uterus of another
woman
•Live Birth rates range from 18-30%

29. PREGNANCY POST TREATMENT
• Delay 6 months-2 years
• Risk of Relapse
• Damage by Chemo and RT
• Potential High Risk Pregnancy
• Chance of multiples with assisted reproduction
• Late Effects of Treatments
• Cardiac
• Pulmonary

31. CHALLENGES AND SOLUTIONS
• Information is still limited as to who is at risk : Should refer to
On-going studies – before and after therapy
• Physicians are often reticent to discuss infertility and options
: Therefore, On-going educational seminars are to be
conducted, Fertility Preservation Consult Services & Fertility
Preservation Educator and Pre-prepared educational material
should be available.
• Lack of information about resources : Utilization of existing
websites like “fertile hope” should be referred to.
• High cost of fertility preservation/lack of insurance coverage:
Should approach Insurance reform.