Infertility Risks in Young Cancer Patients

Article Published on www.health.economictimes.indiatimes.com

In recent years, better treatment modalities and survival expectations have necessitated the need for addressing the risk of fertility among these patients following therapy and to help them make informed decisions about their future lives

Till some time back, our goal was to just have cancer patients survive the deadly disease. Worries about whether they would be able to bear children in future definitely took a backseat. However, in recent years, better treatment modalities and survival expectations have necessitated the need for addressing the risk of fertility among these patients following therapy and to help them make informed decisions about their future lives. For that, it is important to first assess the infertility risks associated with cancer and its treatment.

Infertility risk:

A patient’s risk of infertility depends on the type of cancer he/she is affected with and the specific treatment that is given to the individual. Different types of cancer and their treatments — including chemotherapy, radiation therapy, surgery, targeted and biologic (immune) therapies, bone marrow or stem cell transplant— can hamper a patient’s ability to conceive in different ways.

Due to their poisonous effect on oocyte (germ cell involved in reproduction), chemotherapy has adverse effects on the fertility of the cancer patient. Depending on the age of the patient, dose administered and type of drugs given, the extent of damage can be determined. Antimetabolites such as methotrexate used as chemotherapy drugs, for example, carry a low risk of infertility, while a high risk is associated with the usage of alkylating agents such as cyclophosphamide. With radiation therapy, high risk of infertility is associated, but methods such as ovary transposition wherein through surgery the ovaries are temporarily moved out of the intended radiation field and radiation shielding are used to lessen the risk. Unless there are any changes in the reproductive organ, cancer surgery generally has a low risk of infertility. The infertility risks of some newer therapies remain unclear. It is true that many targeted therapies inhibit enzymes but all the actions of those enzymes are not known. There exists a misconception that targeted therapies would just hit their cancer targets. However, in reality, some targeted therapies hit multiple targets. These molecular targets are on the cancer but they are also in other places as well. Those other places are crucial to fertility.

After the infertility risk is assessed, next in consideration are the patient’s medical history and treatment plan that help to determine the various options available for fertility preservation for a particular patient. The timing of the cancer treatments also affects the feasibility of fertility preservation.

Article Published on www.health.economictimes.indiatimes.com