What is Oncofertility? Oncofertility (onco, plus the word fertility) stands for the field or the topic of freezing eggs or sperm before cancer treatment. “Onco” stands for anything having to do with cancer. It is a hot topic because it’s important to think about, or to have the opportunity to think about, freezing your eggs or sperm before you go through cancer treatment. In the United States, this is considered standard of care. It’s recommended that everyone of reproductive age who might not have finished their family or even started their family, who has cancer, think about whether or not they want to preserve their fertility through egg or sperm freezing before they go through cancer treatment (often surgery, chemotherapy, or radiation).
How Does Cancer Affect Fertility?
The good news is that we’re doing a really great job with curing cancer, and a lot of people are cancer survivors and the number of cancer survivors in this country is growing and growing and growing. It’s in the millions, but cancer survivors do have much higher rates of infertility. The radiation, chemo, and surgery can directly impact the number of eggs and sperm that you have, which can directly impact the health and the function of the eggs and sperm. Cancer survivors often have to delay childbearing and may experience age-related infertility because they have to wait until their cancer is cured to start their families. People (especially women) who undergo chemotherapy or radiation are often told by their oncologist to wait two to five years, sometimes even longer, before conceiving in order to make sure that they’re safe and they’re cured from cancer. They need to have finished their treatment before they actually go through a pregnancy.
What Fertility Preservation Methods Does Oncofertility Utilize?
Oncofertility is essentially in vitro fertilization. When we freeze sperm and eggs, it’s usually done by reproductive endocrinologists or IVF doctors. Freezing sperm is most commonly done by sperm banks. Egg freezing is the first part of the in vitro fertilization cycle, so it’s done by reproductive endocrinologists, where you take fertility drugs so you make more than one egg instead of your usual single egg. You take small injections for 6 to 10 days that don’t cause a lot in the way of side effects, and then you go to sleep for 10 minutes. You get an IV so you’re totally asleep, and a small needle goes through the top of the vagina, one on the right side and one on the left side for each ovary. They pull the eggs out this way. After the procedure is done, you wake up 10 minutes later, you’re a little bit sore, and you go home.
Benefits of Egg Freezing for Cancer Patients
Hopefully, this procedure allows your doctor to freeze some of your eggs. Those frozen eggs can keep forever. They’re frozen via a technology called vitrification, which is this amazing technology that’s like pressing the pause button. If we take your eggs out when you’re 29 years old, those eggs behave like 29-year-old eggs. So when you’re 40, if you use those 29-year-old eggs, you have the risk for miscarriage and the risk for Down Syndrome of a 29-year-old, not a 40-year-old. It’s a phenomenal technology that has been very, very helpful for helping cancer survivors have families later. Now, freezing your eggs is not a guarantee that you will have a baby, but it definitely can make a difference, because there are many cancer survivors who might actually go through menopause from their chemotherapy or radiation and therefore be making no eggs at all.
Oncofertility: Starting the Conversation
Having some frozen eggs can often mean the difference between having your own biologic child or not. Now, people who don’t freeze their eggs, or where the frozen eggs don’t work, still have the option to consider egg donation, or adoption, or child-free. That’s not the only choice. Not everyone who has cancer who wants children will necessarily want to freeze their eggs. The important thing is to have the conversation, to talk with a specialist, to talk with a reproductive endocrinologist about what it would mean for you.
Access to Oncofertility
Because insurance coverage is fairly poor in the United States and most people do not have IVF coverage, Oncofertility or egg freezing is not often covered. Sperm freezing is usually much less expensive. Even if you don’t have coverage for that, it is usually much more affordable than egg freezing. Egg freezing can cost thousands of dollars if you don’t have coverage, so a lot of top programs and pharmaceutical companies participate in programs to try to make these technologies more accessible to cancer patients. Just because you don’t have coverage, don’t think that you cannot do it. There are a lot of grant programs, not for profits, and IVF programs and pharmaceutical companies that are offering discounted or free services to try to help cancer patients preserve their fertility. It is a national recommendation by ASRM (American Society for Reproductive Medicine) and the American Society for Clinical Oncology (ASCO) that everyone who has cancer, who is of reproductive age, consider talking with someone seriously about whether or not to preserve their fertility, whether or not to freeze their eggs or their sperm prior to treatment. That’s what I want you to know about oncofertility.
Everyone deserves to have unrestricted access to answers to all of their questions about oncofertility. If you have any more questions about this process, or about fertility, pregnancy, or reproductive health in general, please don’t hesitate to reach out to me. It is my passion to ensure that everyone has all the information they need to promote positive reproductive health throughout all stages of life.
