A diagnosis of cancer can be a very overwhelming and emotional process. Questions of mortality, treatment, family, and more can come up. For young adults in particular, one of the many questions that need to be answered relates to the question of having children in the future. Oncofertility is one of the approaches to answering this and other questions.
Will treatment affect the chances of having a child in the future? What if someone doesn’t have a partner yet, or doesn’t know if they want children in the future? What if the cancer diagnosis requires surgery that completely eliminates the chance to have children?
What is Oncofertility?
Oncofertility bridges the gap between oncology and fertility preservation and allows patients of reproductive age to have options for future children. In 2013, the American Society of Clinical Oncology (ASCO) updated their guidelines to recommend that health care providers should discuss fertility preservation (FP) with all cancer patients of reproductive age and refer to reproductive specialists if the patient expresses interest. For males, the ideal FP method is sperm banking. Experimental methods include testicular tissue freezing and testicular shielding (placing a shield over the testicles during radiation treatment).
For women, the most successful current FP options include embryo and oocyte (egg) freezing. Ovarian tissue cryopreservation is considered experimental. Additional alternative options include ovarian transposition (moving the ovaries to a different part of the body during cancer treatments to protect the ovaries) and ovarian suppression (stopping the ovaries from producing estrogen). A discussion of FP between a patient and their physician also is recommended to include the availability of alternative family-building options, which includes the use of donor sperm, donor eggs, donor embryos, surrogacy, or adoption.
Genetics & Oncofertility
Younger individuals are being diagnosed with cancer every year. For many hereditary cancer syndromes, individuals can be diagnosed with cancer as early as childhood. For example, hereditary breast and ovarian cancer syndrome can possibly cause individuals to have a diagnosis of ovarian or breast cancer in their 20’s or younger. In addition, if someone is found to have a mutation in the BRCA1 or BRCA2 genes that causes hereditary breast and ovarian cancer syndrome, several preventative options include mastectomy or oophorectomy (removing the ovaries) before cancer occurs. FP provides these individuals to still have the option of having children in the future and greatly reduce the risk of breast or ovarian cancer by pursuing all treatment options.
In addition to individuals diagnosed with cancer, their partners are also provided with options for the future. Studies have shown that a great majority of young female cancer patients have partners, and that partners often attend medical visits and provide support to cancer patients. In addition, health care providers have reported that fertility is an important concern to partners. The field of oncofertility can provide options and a future for a family as a whole.
Genetic Testing & Counseling for Cancer, Fertility & Other Concerns
If you have been newly diagnosed with cancer and would like to know what your reproductive options are, please ask your physician or a genetic counselor. If you have a family history of cancer and would like to know if you are at risk of a hereditary cancer syndrome, please contact AT-GC to meet with a genetic counselor. Genetic counselors can review your options for genetic testing in addition to discussing environmental risk factors for cancer, risk for other family members, and risk to future children.