Gynaecological cancers, including those of the ovaries, uterus, cervix, vulva, and vagina, pose significant threats to a woman's fertility.
Options for women with cancer wanting to conceive. (Getty Images)
At 29, Trupthi Srinidhi, a successful banker, had set her sights on starting a family after three years of marriage. However, when the time came, a routine pre-pregnancy check-up swiftly transformed into an unforeseen confrontation with ovarian cancer. This diagnosis shattered Trupthi’s plans, thrusting her into a reality she had never imagined.
Yet, amidst the upheaval, Trupthi’s journey stands as a testament to the remarkable progress in both fertility preservation and medical innovation, offering a glimmer of hope for women grappling with similar adversities.
Commonly categorised as gynaecological cancers, including those of the ovaries, uterus, cervix, vulva, and vagina, these conditions pose significant threats to a woman’s fertility. Doctors note a gradual increase in cases where cancer or its treatments — surgery, chemotherapy, and radiation — jeopardise a woman’s ability to conceive.
Dr Kirankumar Sajjanshetty, Consultant Medical Oncologist & Hemato Oncologist at Gleneagles BGS Hospital in Bengaluru, tells South First, “Discussion regarding fertility preservation is crucial for women of childbearing age diagnosed with gynaecological cancers who wish to have children in the future.”
He says that the number of women opting for fertility preservation is on the rise. This increase can be attributed to improved technologies which have enhanced the success rates of egg thawing and survival; also owing to increasing awareness of the importance of fertility preservation among women diagnosed with these conditions.
Speaking to South First, Dr V Annapurna, Senior Consultant and HOD of Department of Gynaecological Oncology at Shankara Cancer Hospital and Research Centre, reminds us that a young woman, planning to conceive, being diagnosed with gynaecological cancer is not uncommon today.
“However, today’s advances in reproductive medicine have helped women conceive and bear children — even in young women afflicted by cancer in their reproductive parts,” she says.
Dr Annapurna outlines several options available for women diagnosed with cancer to preserve their fertility. These include cryopreserving eggs or embryos, ovary transposition, among others.
“Results from these procedures show that 40-50 per cent of women can have a live child in their hands! All this can be achieved through a combined consultation with a gynaecological oncologist and a fertility specialist. So, there is light at the end of the tunnel!” adds Dr Annapurna.
Dr Kirankumar elaborates on some of these options:
1. Egg or Embryo Freezing (Cryopreservation):
The most common and effective fertility preservation method is cryopreservation, which can be done with eggs or embryos.
Doctors explain that many cancer treatments, including chemotherapy and radiation, can significantly impair fertility by damaging the eggs or reproductive organs. Cryopreservation allows women to preserve their eggs or embryos before starting cancer treatment, providing a chance to conceive after their cancer treatment is completed.
Embryo freezing paves the way for patients to take proactive steps towards preserving their chance of having biological children in the future, thereby giving them a sense of control and hope.
The success rates of both egg and embryo thawing have improved significantly due to advances in cryopreservation technology. This makes egg and embryo freezing a more viable option for cancer patients wishing to preserve their fertility.
“After completing cancer treatment and achieving remission, patients may wish to start or expand their families. Having frozen eggs or embryos available can provide a viable path to parenthood that might not have been possible otherwise due to the impact of cancer treatments on fertility,” explains Dr Kirankumar.
However, doctors stress that it’s important for patients to discuss the timing and implications of fertility preservation with their oncologist and fertility specialist. While these techniques might require some time (typically a few weeks), careful planning and coordination with the medical team can help to minimise the delay in cancer treatment while maximising the chances of preserving fertility.
2. Ovarian Tissue Freezing:
Dr Kirankumar explains that this process involves surgically removing strips of ovarian tissue and freezing them before cancer treatment. The tissue can later be re-implanted to restore fertility. This method is particularly beneficial for those who cannot delay treatment or are too young to undergo egg retrieval.
However, this is not recommended in women at increased risk of developing ovarian cancer.
3. Ovarian Transposition (Oophoropexy)
This method is used particularly in certain cancers where pelvic radiation is indicated, as this technique offers a way to preserve ovarian function by surgically moving the ovaries out of the radiation field. The method is effective in preserving ovarian function, with approximately 50 per cent chance of success.
Ovaries may need to be repositioned to allow assisted or natural conception. However, it does not guarantee fertility if chemotherapy is also part of the protocol, which can still affect ovarian function.
4. Gonadotropin-Releasing Hormone Agonists (GnRH Agonists)
Using GnRH agonists is an option generally resorted to in cases where women who desire for potential preservation of ovarian function like those who have completed childbearing/in whom other techniques are not an option, explains Dr Kirankumar.
GnRHAs are available as a depot preparation which is generally administered before and concurrent with chemotherapy to protect ovarian tissue. These are given through an intramuscular or subcutaneous route often in a monthly interval.
These drugs protect the ovaries by inducing a temporary menopausal state, thereby reducing the risk of chemotherapy-induced ovarian damage.
5. Radical Trachelectomy
Doctors explain another procedure which is commonly indicated in early-stage cervical cancer, which involves the removal of the uterine cervix while preserving the uterus, offering a possibility for future pregnancies. This surgical option is suitable for localised early-stage cervical cancer in young women where fertility preservation is strongly desired.
6. Ovarian Shielding during Radiation Therapy
Dr Kirankumar says that shielding of the pelvic area during radiation therapy can minimise the exposure of reproductive organs to radiation, potentially preserving fertility. However, this method’s effectiveness is limited to the radiation’s scope and does not protect against chemotherapy’s systemic effects.
Onco-gynaecologists warn that each of these techniques has its benefits and limitations, and the choice of method depends on various factors including the type of cancer, its treatment, the patient’s age, and future family planning goals.
“Overall, the approach to fertility preservation in the context of gynaecological cancers is multifaceted and depends on a variety of factors, including the stage of the disease, the patient’s age, and her reproductive goals. It is critical to have multidisciplinary team involvement to optimise treatment strategies, ensuring both tumor eradication and consideration of the patient’s fertility preservation wishes,” adds Dr Kirankumar.
Dr Annapurna also suggests that early intervention and a multidisciplinary approach involving the treating oncologists and reproductive specialists are vital to optimise the fertility outcomes. Through early consultation and personalised treatment planning, doctors say that many women can look forward to fulfilling their dreams of motherhood after completion of anti-cancer therapy.
(Edited by Kamna Revanoor)
Apr 27, 2024
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