Improving Conception After Cancer
Michelle Matthews, MD
Director, Fertility Preservation,
Levine Cancer Institute
Through a partnership between Carolinas HealthCare System’s Levine Cancer Institute and the Women’s Institute, REhope is a new program that takes a multidisciplinary approach to providing comprehensive reproductive care to patients through a team of experts, including:
- reproductive endocrinologists
- specialty trained nurses
- genetic counselors
- certified embryology lab staff members who have expertise in sperm, oocyte and embryo cryopreservation
Technological Advances Expand Patient Options
Fertility preservation is a rapidly evolving field that includes medical and surgical treatments to decrease the impact of cancer on future fertility. It has been reported that approximately 75 percent of patients express significant distress over loss of fertility related to their cancer treatments. Fortunately, recent advances are providing more options than ever for patients to receive necessary cancer treatments while maintaining hope for having a family in the future.
Sperm may be cryopreserved (frozen) prior to cancer treatments and stored for future use.
For male cancer patients who don’t store sperm prior to chemotherapy or radiation and subsequently have extremely low sperm counts, physicians can now perform microsurgical techniques to obtain sperm directly from small areas in the testicles that may be producing limited numbers of sperm.
Sperm are obtained by testicular sperm extraction and used to achieve a pregnancy through in vitro fertilization (IVF). This technique has recently been shown to be effective for some men who have no ejaculated sperm present after chemotherapy.
Options are also expanding for female cancer patients. Oocytes (eggs) or fertilized oocytes (embryos) may be cryopreserved prior to chemotherapy or radiation. The first pregnancy from oocyte cryopreservation was reported in 1986, but few pregnancies were subsequently reported due to poor survival rates for cryopreserved oocytes. Thanks to a new oocyte cryopreservation technique called vitrification, there have been more than 900 pregnancies reported worldwide. Vitrification uses modifications in traditional cryopreservation techniques and oocyte cryoprotectants that result in up to 90 percent of oocytes surviving the freezing and thawing process. Ovarian tissue cryopreservation has also been evaluated as a modality to preserve future fertility. A portion of the ovarian cortex is surgically removed, cryopreserved prior to cancer treatment and then transplanted back into the patient after her treatment is complete. Although more research is needed, this option holds significant promise for the future.
Until recently, preserving oocytes or embryos required a delay in cancer treatment of up to four to six weeks to complete the IVF process. We’re now able to complete the process in two to three weeks to expedite initiating cancer therapy by using new IVF regimens.
For men and women with hereditary cancers, embryos created through IVF can also be genetically screened for specific cancers through a process called preimplantation genetic diagnosis. This offers patients the option of decreasing the risk of transmitting their specific cancer to children.
Fertility Help for Patients
Call 704-446-5110 to speak to a REhope patient care coordinator if you would like more information about our program.