The creation and birth of the new life is most often associated with great joy for every woman and couple. Sometimes, however, the conception of the dream child goes through serious obstacles, requires precise long-term planning on the part of the partners and could not happen without the consultation of trained specialists. It is about those cases when the future possibilities of creating a generation are threatened by an oncological disease and its treatment.
In their long-standing practice, the reproductive specialists of the "Dr. Shterev" Medical Complex have repeatedly consulted women, men and couples diagnosed with various types of cancer who wish to preserve their reproductive capabilities
In medical practice, it is difficult for both oncologists and reproductive specialists to determine
how important it is to preserve fertility in cancer patients,
to give proper advice and behavioral counseling to these patients. Patients diagnosed with cancer themselves most often also do not seek counseling and do not discuss options for preserving their reproductive abilities. Quite understandably, this is due to several prerequisites. First of all, the understandable focus of patients on their oncological disease. Secondly, their ignorance of the danger of potential loss of fertility. Thirdly, even with awareness of the threats to their future reproductive potential, there is a reasonable fear that delaying oncological treatment may lead to a worsening of the disease and a fatal outcome. The natural reaction at this difficult time for each individual and family is to focus on dealing with the immediate problem and to put aside questions related to future plans for creating a generation. However, it very often happens that people of reproductive age, who have undergone successful treatment for an oncological disease, resume their desire to conceive later. In these cases, if timely measures to preserve fertility were not taken, it may turn out that the chances of having a child are irretrievably lost.
Chemotherapy and radiation therapy in cancer have been shown to deplete the ovarian reserve
in women and to infertility or at least to impaired sperm indicators in men. In general, in the treatment with gonadotoxic therapy of childless patients of reproductive age, more and more often the specialists directly involved with the disease (oncologists, hematologists, etc.) seek collaboration with specialists in reproductive medicine to consult ways of preserving fertility in these groups of patients. In such cases, the following behavior scheme for oncological patients of reproductive age is appropriate: First of all, the oncological disease is diagnosed. Next comes the development of a plan for his treatment. The fertility risk of the treatment is then assessed and its effect on the patient's reproductive he alth is discussed. In cases where the woman or man who is undergoing oncological therapy wishes to preserve their reproductive abilities, the patient is referred to a consultation with a reproductive specialist. Every similar case that occurs in the Medical Complex "Dr. Shterev" is discussed at a medical collegium with the participation of obstetrician-gynecologists, specialists in reproductive medicine and oncogynecology specialists, endocrinologists, internists, embryologists and biologists. At these collegiums, the entire medical documentation of the case is examined in detail, the possibilities of preserving fertility in the specific patient are discussed and a plan of behavior is created. The developed plan is consulted with the patient and his oncology doctor.
Ways to preserve fertility in women who are planning chemotherapy
include the pre-treatment cryopreservation (freezing) of eggs and/or ovarian tissue and embryos, radical trachelectomy (surgical removal of the cervix) or the subsequent successful onco-treatment use of donor embryos and eggs. The use of these methods depends on the specific type of tumor, the planned therapy, as well as the time available to reproductive medicine specialists before the start of oncological treatment. When applying radiotherapy, the method of choice is operative transposition of the ovaries in order to avoid the damaging effect, but it should be taken into account that the application of this measure has limited results. Of the options listed, embryo freezing is preferred when preserving fertility, as it has the highest chance of achieving pregnancy after successful treatment.
Important conditions for the application of this method are the availability of sufficient time and the medical possibility to carry out hormonal stimulation, as well as the presence of a partner or the willingness to use donor sperm for the in vitro fertilization procedure. Ovarian tissue cryopreservation could be applied in cases where there is insufficient time for hormonal stimulation before starting antitumor treatment, when the ovaries do not respond to stimulation, in girls before puberty or in case the tumor disease does not allow hormonal stimulation (hormone-dependent tumors, etc.) At the moment, however, there is no adequate regulation of the cryopreservation of ovarian tissue in Bulgaria, as it is not included in Ordinance 28 on assisted reproduction, which currently only deals with the freezing and storage of eggs, spermatozoa and embryos.
The possibilities of preserving reproductive abilities in sexually mature men
includes the cryopreservation of sperm before starting treatment. In cases of oncological disease in pre-pubescent boys, the methods of extraction and cryopreservation of testicular tissue are applicable, with options for subsequent autotransplantation at an appropriate time after successful treatment. Another possibility is spermatogenic stem cell transplantation.
Preservation of fertility in patients with oncological diseases is an extremely serious and extensive topic, including a variety of medical, moral and scientific aspects. However, the development of modern medicine reveals more and more possibilities for preserving the chances of creating a generation in women and men who are undergoing oncological treatment.
Presentation of these possibilities and discussion of world experience in this direction is the focus of the 8th symposium with international participation on reproductive medicine, organized by Dr. Shterev Medical Complexand the Institute of Reproductive He alth. The scientific event on the topic "Reproductive Medicine and Oncology" will be held at the Arena di Serdica Hotel on November 7 and 8.
More information about the program of the symposium and ways to register for participation can be read on the websites www.shterevhospital.com and www.reproduktivnozdrave.org