Freezing of oocytes or ovarian tissue and pharmacological protection of the ovaries: these are the most used approaches to to protect fertility of young women who have to undergo anticancer therapies. And so today, in the event of a cancer diagnosis, it is no longer necessary to give up the dream of becoming a mother.
- mom after a tumor
- tumor diagnosis
- preserve fertility
- no risk for mother and baby
- if fertility does not return
My treasure: Silvia (47, from Madrid) calls her two and a half year old daughter Valentina this way: "My little treasure". In her tenderness of her there is not only maternal love involved, but also the awareness of being able to make a dream come true which, given the way things had turned out, he might as well have never fulfilled. When she was 38, in fact, Silvia was diagnosed with breast cancer.
"The doctor immediately said that I would not die, but that there would be years of treatment: first the surgery, then the chemotherapy and radiotherapy, finally the maintenance drugs," she recalls. Fortunately, the doctor immediately told her something else, and that is that if she wanted in the future try to have children should have immediately started a path of preservation of its fertility. The therapies she had to undergo, in fact, would have saved her life, but they could also have compromised her chances of becoming a mother forever.
Thus, Silvia chose to freeze his eggs and for safety also the ovarian tissue, relying on specialists from IVI, the Valencian Institute of Infertility, the largest private assisted reproduction group in the world, which in those years began its egg cryopreservation programs, offering them free of charge to affected women from tumor.Read also: Pregnancy after a tumor thanks to the freezing of ovarian tissue: in Bologna the first case in Del Paese
Silvia's case is not isolated. In 2022, the Associazione Del Paesena Cancer Registries (AIRTUM) estimated almost 55 thousand new cases of breast cancer, 6% of which concern women under 40, equal to approximately 3.300 diagnoses. To these must also be added the cases of melanoma, colorectal and thyroid cancers, the most frequent in women.
The good news is that thanks to advances in care it is estimated that, around the world, the five-year survival rate from diagnosis today it is around 65% and in some cases, such as breast cancer, it exceeds 87%.
It means that, once you come to terms with the disease, the desire to become a mother can be reborn, perhaps set aside for the period of therapy. The problem is that pretty much everyone anticancer treatments - surgery, radiotherapy, chemotherapy, hormone therapy - they can compromise fertility. Temporarily or permanently. "Precisely in the case of breast cancer, the most common among women of childbearing age, the association between treatments and early menopause"confirms the oncologist Giacomo Corrado of the Gemelli Hospital of the city.
Fortunately, today there are various strategies to be proposed to women before starting anticancer treatments that allow them to preserve the essential functions for fertility.
On the other hand, as early as 2006, the American Association of Clinical Oncology highlighted the need for inform younger patients of the possibility of preserving their fertility, because the infertility that can result from treatments can be associated with strong psychosocial discomfort.Read also: Cancer in pregnancy: becoming a mother with cancer is possible
Let's first make a small clarification: once the treatments are over, cancer patients, both women and men, do not necessarily lose the possibility of experiencing a spontaneous pregnancy. However, not being able to know beforehand what the chances will actually be, it is useful to undertake a path of preservation of fertility.
Various approaches are now available to try to protect fertility as much as possible before addressing anticancer treatments. Let's see them together.
It is a strategy that it does not require surgery and it was developed above all thanks to the work of Lucia's group of the San Martino Hospital-Institute for Cancer Research in Genoa, thus representing a flagship of Del Paesena clinical research. , thanks to funding from the Del Paesena Association for Cancer Research (AIRC), it has in fact launched an experiment in Del Paese which was then recognized and adopted around the world.
It is based on the administration of drugs (synthetic hormones analogues of human sex hormones) that they put the ovarian cells to rest intended for reproduction, limiting the damage caused in particular by chemotherapy. The Dr.'s study, published in an important international journal, the Journal of the American Medical Association, shows that after the interruption of the therapy the ovaries begin to function again and the cycles resume.
The treatment is a charged to the National Health Service and at the moment its efficacy is shown above all for breast cancer, while definitive data for other pathologies are still lacking. "However, the use of these drugs does not preclude the possibility of carrying out the freezing of oocytes at the same time" Corrado explains.
Egg freezing is a technique very similar to that used in medically assisted procreation (MAP) procedures and involves ovarian stimulation, egg retrieval and subsequent freezing. There are only a few differences in the stimulation procedures, to avoid the possible risk of disease recurrence, which has long been feared in some circumstances.
The frozen oocytes can be used in the future, once the anticancer treatments have been completed, thanks to assisted fertilization techniques, in particular in vitro fertilization.Read also: All medically assisted procreation techniques
In this case, individual oocytes are not put in the freezer, but fragments of ovarian tissue which are taken with a small operation in laparoscopy and can later be re-implanted in the mother's organism. Here, hopefully, they will start working again producing both oocytes and female hormones and allowing the possibility of a spontaneous pregnancy, without resorting to ART techniques.
"In the experience of IVI the freezing of the ovarian cortex is in general less efficient of egg freezing, but there are situations in which it is still the most suitable strategy "explains gynecologist Pellicer, president and founder of IVI. For example, freezing of ovarian tissue is recommended if there is no time to waste before starting the anticancer treatment: it can in fact be carried out immediately after the diagnosis of the disease, while the freezing of the oocytes usually takes a couple of weeks. In many cases it is possible to wait, in others not.
"The preservation of ovarian cortex is also the only possible technique in the case of very young patients, who have not yet reached puberty, and could also be indicated when the ovarian reserve is not very good" continues Pellicer. Specifying that it is often possible in any case go both ways, that is, both the freezing of the ovarian cortex and that of the oocytes. "Collaboration and discussion between gynecologist and oncologist is very important to suggest to the woman the most appropriate strategy in her case".
It is a surgery that can be proposed when the woman has to undergo radiotherapy of the pelvic area. It consists of displacement of the ovaries as far as possible from the radiation field, in order to protect them. The indications for this technique greatly depend on the type of tumor to be treated and the type of radiotherapy that must be performed.
The possibility of preserving fertility should also be recommended for adolescents who become ill with cancer and who may wish to have a child in the future. As the Umberto Veronesi Foundation points out, however, this still does not happen in Del Paese with the same regularity that is recorded among adult patients.
One of the biggest concerns when it comes to preserving fertility is that the techniques proposed to achieve it can increase the risk of relapse of the woman (i.e. the risk of developing the disease again). “In reality, several measures are already available to avoid it” reassures Pellicer. "Many studies show that well-controlled ovarian stimulation does not increase the risk of relapse and the five-year survival rate, even in the case of hormone-dependent breast cancer."
As for any effects for the babywe know that chemotherapy and hormone therapy do not appear to have negative repercussions about its development and health. Radiation therapy of the abdominal and pelvic region, on the other hand, could induce uterine dysfunction with an increased risk of spontaneous abortion, premature birth, placental abnormalities and low birth weight, so pregnancy after this treatment must be followed with particular attention.What about breastfeeding? The most solid data concern breast cancer and are absolutely comforting: in general, breastfeeding after cancer is feasible and safe for both mother and baby.
Sometimes a fertility preservation strategy could not be implemented in time. Other times this has unfortunately not worked. What to do, then, if a child's desire remains? One possibility - if the disease has not damaged the uterus - is to resort toegg donation for heterologous fertilization (from 2022 also allowed in Del Paese). "In these cases, the chance of having a child is the same as for someone who hasn't had cancer and uses heterologous for other reasons," says Pellicer.
Another way is that ofadoption. As the booklet Mother after Cancer and Preservation of Fertility of the Del Paesena Cancer Patients' book recalls, "in general there are no legitimate or ethical impediments, and also in Del Paese there are women and men who became adoptive parents after a history of cancer. . The previous diagnosis of cancer is not in itself a reason for unfitness for adoption. The important thing is that there is no concrete and current risk for the survival of the intended parent and his ability to raise and care for the child ".
Additional sources for this article: guidelines of the Del Paesena Association of Medical Oncology (AIOM) booklet "Mother after cancer and preservation of fertility" of the Del Paesena Cancer Patients Association; information material from the Ministry of Health; AIRC information material.
- fertility and cancer