Oncoreproductology is a sub-branch of medicine whose goal is the preservation of the patient’s reproductive function, or oncofertility (from the words oncology and fertility), making it possible to conceive, carry and produce offspring even after treatment of an oncological disease.
Anticancer therapy, although aimed at fighting cancer, can also affect the body’s healthy organs, including the reproductive system. As cancer develops, the body can react to it by causing inflammatory reactions and changing chemical processes in the body. These changes can also affect the ovaries and the maturation process of the eggs in them. Also, cancer can adversely affect the blood circulation and the supply of oxygen and nutrients to the ovaries, interfering with the development and fertilization of the eggs and thus causing difficulties in conceiving a child. However, to dispel anxiety, cancer is not a judgment, and oncology patients also have the opportunity to become happy parents after treatment.
Before oncology treatment, every patient has the opportunity to protect himself against possible adverse effects of therapy on reproductive function by using the options available today, which allow him to have his own child in the future. Thanks to procedures such as egg and ovarian tissue freezing, as well as sperm freezing.
As cancer develops, the body can respond to this process with inflammatory responses and changes in chemical signals in the body. These changes can affect how your ovaries work, where the process of egg maturation takes place.
One of the main mechanisms by which cancer affects oocyte maturation is through changes in the levels of certain proteins, especially matrix metalloprotease (MMP). These proteins play an important role in the uptake and spread of cancer cells. If their levels are out of balance, ovarian dysfunction may occur.For example, a deficiency of tissue metalloprotease inhibitors (TIMPs) relative to MMPs can lead to a delay in oocyte maturation or even destruction of the oocyte membrane and thus make it difficult to preserve and fertilize the oocyte.
In addition, tumor growth factor (TGF-β) also affects the regulation of oocyte maturation processes. High levels of this protein can cause disorders in the development of eggs and reduce their ability to fertilize, which further complicates the process of conception and pregnancy for women who have had to face cancer.
It is important to mention that cancer can also affect the vascular system, altering blood flow and delaying the supply of oxygen and nutrients to the ovaries. This effect may also adversely affect oocyte maturation and fertility.
All these mechanisms by which cancer affects the maturation of eggs can make it difficult for a woman to conceive a child and the course of pregnancy. Understanding these mechanisms can help develop more effective treatments and support for women who want to have children after battling cancer.
The text was written in cooperation with gynecologist-reproducologist, infertility treatment specialist Dr. Ulyana Lapay
Cancer treatments, such as chemotherapy, radiation therapy (irradiation), targeted therapy, and some types of surgery, aim to kill or shrink cancer cells in the patient’s body.
These treatments are necessary to fight cancer and save a patient’s life, but they also often have unwanted effects on healthy tissues and organs, including a woman’s reproductive system and fertility.
This fact is important to consider when planning the treatment process and making decisions about maintaining reproductive health.
- Chemotherapy: Many chemotherapy drugs work on rapidly dividing cells. These are both cancer cells and normal cells such as eggs. This can damage or kill the eggs, which in turn can reduce or completely destroy a woman’s fertility.
- Radiotherapy or radiation therapy: Radiotherapy uses radiation to destroy cancer cells. If the area exposed to radiation is close to the ovaries or uterus, it may damage or reduce the number of functioning eggs. Radiation therapy can also affect the tissue structure of the ovaries, which can lead to their dysfunction.
- Surgical treatment: to remove the tumor, it may sometimes be necessary to remove the ovaries or the uterus, especially in cases where the cancer has spread directly to these organs. It can negatively affect a woman’s fertility, either completely preventing her from having children, or significantly reducing her reproductive function.
- Targeted therapy is a treatment method that acts on specific molecular targets in cancer cells or their environment. It may involve using drugs that block the flow of certain signals or proteins that cancer cells need to grow and survive. This therapy may be less toxic to the body than some other treatments, but it can also have unwanted side effects on organs and tissues, including the female reproductive system:
- Effects on cell differentiation: Some drugs used in targeted therapy can affect cell differentiation, which can cause changes in the maturation of oocytes and thus affect their quality.
- Effects on cellular DNA: Many drugs used in targeted therapies can affect cellular DNA, causing various types of damage or mutations. This can lead to disturbances in the normal functioning of the eggs and deterioration of their quality.
- Effect on folliculogenesis: some targeted therapy drugs can affect folliculogenesis – the process of follicle formation and development in the ovaries. This can lead to ovulation disorders and deterioration of egg quality.
The text was written in cooperation with gynecologist-reproducologist, infertility treatment specialist Dr. Ulyana Lapay
- Evaluation of the oncological condition – evaluated by an oncologist: it is important to find out the type of cancer, the expected effect of therapy, the prognosis of survival, the possibility of pregnancy after cancer treatment and other health status indicators.
- The patient’s decision on the need to preserve reproductive function: due to the urgency of treating the underlying disease, the decision must be made quickly.
- Consultation with a reproductive specialist: it is recommended to discuss the possibility of saving the reproductive material with a reproductive specialist as soon as possible to increase the likelihood of a successful outcome.
- Reproductive system evaluation (assessed by a reproductive doctor): The evaluation is done taking into account your age and existing ovarian reserve.
- Selection of the method of preservation of reproductive function (a reproductive doctor, taking into account the recommendations of an oncologist): the most effective methods, such as cryopreservation of embryos, eggs (oocytes) and spermatozoa, are possible before starting cancer treatment.
Remember, it’s important to preserve a woman’s chance of becoming a mother, and discussing this with your oncologist and reproductive physician will help you make an informed and balanced decision.
The text was written in cooperation with gynecologist-reproducologist, infertility treatment specialist Dr. Ulyana Lapay
Since January 1, 2024, upon the entry into force of the changes in the Cabinet of Ministers regulations no. 555 “Procedure for organization and payment of health care services”, oncology patients who want to become parents to their biological children in the future have access to essential support – the collection, freezing and storage of reproductive material before the start of chemotherapy is included in the range of health care services paid for by the state.
Referring to the annotation of the draft regulations of the Cabinet of Ministers: “People with oncological diseases may have reduced fertility after receiving chemotherapy. Chemotherapy drugs affect the germ cells (sperm and eggs), so their development, maturation and full function may be impaired later. Today, chemotherapy drugs are becoming more and more gentle, so not all patients will have problems with fertility in the future, however, in order to ensure the possibility of becoming parents to their biological children in the future, in many parts of the world it is possible to collect, freeze and store reproductive material for a certain period of time before starting treatment.”
Therefore, from now on in Latvia, oncology patients (both those who have reached the age of 18 and those who are minors) will have state-paid collection, freezing and storage of germ cells. The council of doctors decides on the necessity of the service, and from the moment of freezing, germ cells will be stored for no longer than 10 years, according to amendments to the regulations of the Cabinet of Ministers.