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Fertility Preservation for Blood Cancers
Fertility preservation for blood cancers is an issue that is beyond relevant for me. While the average age of newly diagnosed myeloma patients is 69, I was 34 when I was diagnosed. I was still single. Radiation to my tailbone made me sterile.
So this post is for any newly diagnosed cancer patient whose therapy could render them sterile. The article below outlines guidance for oncologists. I apologize for sounding cynical but it didn’t occur to my oncologist to mention anything about fertility preservation.
It was my radiation oncologist, Dr. Donald Shina, who asked me if I ever thought about having kids. Dr. Shina asked me this question when I was on the radiation table, about to get zapped. I said that I did hope to have kids someday, at which point Dr. Shina told me to head straight to the sixth floor. The fertility floor.
What percentage of adolescent and young adult cancer patients go on to have children?
According to AI
While many adolescent and young adult (AYA) cancer patients express a desire to have children after treatment, studies indicate that a significantly lower percentage of them actually achieve pregnancy and live births compared to the general population. Specifically, female cancer survivors are estimated to be 50% to 75% as likely to have biological children as women without a history of cancer, according to ScienceDirect.com. This disparity is often attributed to the gonadotoxic effects of cancer treatments like chemotherapy and radiation therapy.
Factors influencing fertility after cancer treatment:
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Age at Diagnosis:
Younger patients generally have a higher chance of regaining fertility after treatment.
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Type of Cancer and Treatment:
Some cancer treatments, like certain chemotherapy regimens and radiation therapy, are known to have a higher risk of causing infertility.
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Fertility Preservation:
Oncofertility care, including fertility preservation options like egg or embryo freezing before treatment, can significantly increase the chances of pregnancy and live birth after treatment.
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Individual Variability:
There’s considerable variation in how individuals respond to cancer treatments and how their fertility is affected.
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Fertility Counseling:
Access to and utilization of fertility counseling and preservation options are crucial for AYA cancer patients.
Additional Information:
- A study found that 73% of women with breast cancer who attempted to conceive after treatment achieved a pregnancy, and 65% had a live birth, according to ecancer.org.
- However, this study also highlighted that older participants had lower pregnancy and live birth rates, and those who opted for fertility preservation had a higher live birth rate.
- Another study indicated that AYA cancer survivors are more likely to experience infertility (relative risk of 1.3) and primary ovarian insufficiency (relative risk of 2.5) compared to their peers without cancer.
- Despite the desire for parenthood, only about half of AYA cancer patients report receiving oncofertility counseling and preservation options before treatment.
Long story short, I stored my sperm and inseminated my wife when we were ready. Alex graduated from college last year.
I am a long-term MM survivor. Fertility preservation is not one of my usual blog topics, but the study below got me thinking.
Email me at David.PeopleBeatingCancer@gmail.com to learn more about managing your MM with both conventional and non-conventional therapies.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Fertility Preservation in People With Cancer: ASCO Guideline Update
Abstract
ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual. ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines.
Clinical Practice Guidelines and other guidance (“Guidance”) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and 2(online only) for more.
Purpose
To provide updated fertility preservation (FP) recommendations for people with cancer.
Methods
A multidisciplinary Expert Panel convened and updated the systematic review.
Results
One hundred sixty-six studies comprise the evidence base.
Recommendations
People with cancer should be evaluated for and counseled about reproductive risks at diagnosis and during survivorship. Patients interested in or uncertain about FP should be referred to reproductive specialists. FP approaches should be discussed before cancer-directed therapy.
Sperm cryopreservation should be offered to males before cancer-directed treatment, with testicular sperm extraction if unable to provide semen samples.
Testicular tissue cryopreservation in prepubertal males is experimental and should be offered only in a clinical trial. Males should be advised of potentially higher genetic damage risks in sperm collected soon after cancer-directed therapy initiation and completion. For females, established FP methods should be offered, including embryo, oocyte, and ovarian tissue cryopreservation (OTC), ovarian transposition, and conservative gynecologic surgery.
In vitro maturation of oocytes may be offered as an emerging method. Post-treatment FP may be offered to people who did not undergo pretreatment FP or cryopreserve enough oocytes or embryos.
Gonadotropin-releasing hormone agonist (GnRHa) should not be used in place of established FP methods but may be offered as an adjunct to females with breast cancer. For patients with oncologic emergencies requiring urgent oncologic therapy, GnRHa may be offered for menstrual suppression.
Established FP methods in children who have begun puberty should be offered with patient assent and parent/guardian consent. The only established method for prepubertal females is OTC. Oncology teams should ensure prompt access to a multidisciplinary FP team. Clinicians should advocate for comprehensive FP services coverage and help patients access benefits.
Fertility preservation for blood cancers Fertility preservation for blood cancers