Multi-disciplinary approach to
Fertility Options after Cancer
Michael S. Neal
Scientific Director, ONE Fertility, 3210 Har...
Outline
	

•  Assisted Conception Options	

•  A team approach 	

•  Cancer and Fertility (comparison b/w Male and Female)...
Cancer and Fertility Crossroads	

Increasing Cancer Survival Rates	


Increased emphasis on Quality of Life	

+
Advances i...
Multi-disciplinary Team Approach to 	

Fertility Preservation	

Patient Centered Research	


Scientific Community	

New ide...
Assisted Conception Options	

Embyro Adoption	

Donor Sperm	


Donor Oocytes	

No Oocytes	


No Sperm	

After Biopsy	

No ...
Cancer and Male Fertility	

•  Male infertility can result from:
–  Disease
–  Anatomic problems
–  Primary or secondary h...
Semen Assessment	

Infertility or Sub-fertility = 	

no conception after 1 year of 	

	

	

	

	

unprotected regular inte...
Sperm Preparation for IUI	

IUI = Intra-uterine insemination
Surgically recovered Sperm	

Percutaneous Epididymal Sperm Aspiration (PESA)	

The procedure of Percutaneous Epididymal Sp...
Surgically recovered Sperm	

Testicular Biopsy	

Surgical recovery of seminiferous tubules.
Cryobiology
•  Removal of water
•  Additions of Cryoprotectants
(PROH, glycerol, DMSO)
•  Slow cooling vs. Vitrification
•...
Eggs and Sperm
	


IVF	


ICSI
Sperm Selection for ICSI
ICSI
Awareness of 	

Fertility Preservation Options	

	

Only 17.8% (146/821) newly diagnosed AYA cancer patients
utilized sper...
Cost and Success	

Procedure

Cost

Success

Natural Cycle IUI
Sperm prep (wash)

$350.00

8 – 12%

FSH stimulated IUI
Spe...
Additional Options	

Donor sperm commercially available for sperm banks	

	

Cost ranges from $500 - $1000 per vial of spe...
Resources	


fertilefuture.ca
Conclusions	

•  Cancer treatment can have a devastating effect on the 	

reproductive system	

•  Awareness and Education...
Discussion	


Michael S. Neal
Scientific Director, ONE Fertility
mneal@onefertility.com
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Multidisciplinary approach to fertility options after cancer 1st annual brain works conference - edmonton - 2013

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Multidisciplinary approach to fertility options after cancer 1st annual brain works conference - edmonton - 2013

  1. 1. Multi-disciplinary approach to Fertility Options after Cancer Michael S. Neal Scientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario www.onefertility.com mneal@onefertility.com
  2. 2. Outline •  Assisted Conception Options •  A team approach •  Cancer and Fertility (comparison b/w Male and Female) •  Fertility treatments / Cost / Success •  Discussion
  3. 3. Cancer and Fertility Crossroads Increasing Cancer Survival Rates Increased emphasis on Quality of Life + Advances in Assisted Reproductive Technologies (ART) = Greater need for Information and Understanding about Fertility Risks and Options
  4. 4. Multi-disciplinary Team Approach to Fertility Preservation Patient Centered Research Scientific Community New ideas and approaches Female • Developing reliable ooctye freezing technology • Ovarian tissue cryopreservation. • In vitro maturation of oocytes • Improved communication between patients and Allied Health Professionals • Referrals Quality of Care Research • Sperm and oocyte banking brochures • Referral algorithm Social Work Fertilie Future www.fertilefuture.ca Family of their own in future Cancer Patient Patient Support Male Research Fundamental Questions • DNA fragmentation study. • Germ cell regeneration. REI Physician ART Lab Medical Team Parents Nursing Oncologist Help a Child Smile Nursing Risk Management Legal, ethical., government regulations (AHR) Oncology Fertility
  5. 5. Assisted Conception Options Embyro Adoption Donor Sperm Donor Oocytes No Oocytes No Sperm After Biopsy No Banked Sperm Sperm Recovered Testicular Biopsy Azospermic Pre-treatment Cryopreserved Sperm Frozen Oocytes (Frozen Pre-treatment) A R T IUI, IVF, ICSI IVM, FET Abnormal Sperm Parameters Frozen Embryos (Created Pre-treatment) Normal Ovarian Function Spermic Normal Sperm Function No Ovarian Function No conception (12 mths) Spontaneous Conception Female Cancer Survivor Male Cancer Survivor Ovarian Tissue Transplant
  6. 6. Cancer and Male Fertility •  Male infertility can result from: –  Disease –  Anatomic problems –  Primary or secondary hormonal insufficiency –  Damage or depletion of the germinal stem cells •  The effects of chemotherapy and / or radiotherapy include: •  Compromised sperm number; •  Motility; •  Morphology; and •  DNA integrity.
  7. 7. Semen Assessment Infertility or Sub-fertility = no conception after 1 year of unprotected regular intercourse Semen Assessment – first step to see if sperm in ejaculate. •  Validates sperm production •  Confirms patency of the male ducts (vas deferens) 1.  Concentration > 20M/ml 2.  Motility > 50% 3.  Normal Morphology (4%) Azoospermia – no sperm
  8. 8. Sperm Preparation for IUI IUI = Intra-uterine insemination
  9. 9. Surgically recovered Sperm Percutaneous Epididymal Sperm Aspiration (PESA) The procedure of Percutaneous Epididymal Sperm Aspiration (PESA) is performed by passing a fine needle into the epididymis and aspirating sperm.
  10. 10. Surgically recovered Sperm Testicular Biopsy Surgical recovery of seminiferous tubules.
  11. 11. Cryobiology •  Removal of water •  Additions of Cryoprotectants (PROH, glycerol, DMSO) •  Slow cooling vs. Vitrification •  Storage periods of more than 40 years (J Assist Repro Genet Sept 2013) for sperm and 11 years for embryos prior to pregnancies established have been documented, but these records will be broken. •  Cost to freeze = $250 – 500 •  Annual Storage = $200 - 600
  12. 12. Eggs and Sperm IVF ICSI
  13. 13. Sperm Selection for ICSI
  14. 14. ICSI
  15. 15. Awareness of Fertility Preservation Options Only 17.8% (146/821) newly diagnosed AYA cancer patients utilized sperm cryopreservation technology. Oncology banked sperm used for conception is effective: a) 36.4% clinical PR/IUI b) 54.5% clinical PR/ET with IVF/ICSI Awareness is the key to increased use of sperm banking for oncology purposes. Neal et al., Cancer 2007
  16. 16. Cost and Success Procedure Cost Success Natural Cycle IUI Sperm prep (wash) $350.00 8 – 12% FSH stimulated IUI Sperm prep (wash) $1,000.00 – 1250.00 17 – 20% COH with IVF $9800.00 – 11,500.00 45 – 65% COH with ICSI $11,300.00 – 13,000.00 COH = Controlled Ovarian Hyperstimulation; dependant on individual response and patient age.
  17. 17. Additional Options Donor sperm commercially available for sperm banks Cost ranges from $500 - $1000 per vial of sperm; still requires the cost of processing $350; Donor selection based on phenotypic traits. Embryo Adoption – allows couple to experience pregnancy. Conventional Adoption
  18. 18. Resources fertilefuture.ca
  19. 19. Conclusions •  Cancer treatment can have a devastating effect on the reproductive system •  Awareness and Education is required for not only patients, allied health care professionals. but, •  Oncologists combined with a multi-disciplinary team of health professionals provides hope for the future fertility of oncology patients.
  20. 20. Discussion Michael S. Neal Scientific Director, ONE Fertility mneal@onefertility.com

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