Lance Armstrong wrote in the book it’s not about the bike: My journey back to life that he wanted to become a father but assumed that would only happen when he fell in love. The seven-time Tour de France champion’s innermost thoughts were: …”[1] I had no other choice. Oncofertility can help address the concerns of Armstrong, who was 25 years old at the time.
In 2006, Dr Teresa K Woodruff coined the term fertility preservation to describe options for preserving fertility after treatments, such as chemotherapy, radiation and surgery. These treatments may affect or even destroy a survivor’s ability to bear children in the future. Men can have their testosterone and sperm secretion affected by cancer treatment. They can also cause genetic damage to oocytes, which in turn leads to medical complications like ovarian failure and early menopause.
The alarming increase in cancer cases is a cause of concern
Oncofertility will become an important medical specialty in India as the number of cancer patients increases. It is a field that offers hope and helps at the same. According to the Indian Cancer Registry by 2026 India will have 9,34 lakh new cases of cancer in women and 9,35 lakh in men. In India, 65 percent of the population is under 35 years old and 50 percent is below 25 years. This means that 11 and 25 percent of cancer patients are in reproductive age.
The number of cancer survivors has risen over the years as cancer treatments have improved. In very few instances, the fertility preservation options for women, men and children are considered important. The consultation with reproductive endocrinologists is part of the psychosocial rehabilitation for cancer patients. It should take place as soon after diagnosis and ideally, before the chemotherapy or pelvic radiotherapy begins.
How to preserve the fertility of cancer patients
It is important to understand that the decision to preserve fertility by cancer patients is not an event, but rather a complex emotional process influenced by a combination of biological, psychosocial, and social forces. According to estimates, up to 40-80% of women may be at risk for infertility due to cancer treatment. [4] It’s important to make sure that cancer survivors don’t end up in the fire because they survived cancer. Both men and women have options to preserve their fertility. The main options are:
- The use of a lead apron to shield the genital region and pelvic area during radiation treatment in order to reduce the harmful effects of ionizing radiotherapy.
- Ovarian Transposition Physically moves the ovaries from the pelvis using surgical techniques for patients who need pelvic radiation.
- The banking of eggs, embryos, and sperm is also an option. The easiest is sperm banking, while egg and embryo bank takes between 2 and 6 weeks to complete. The frozen eggs and oocytes are usable for 10 years after the date of freezing. Tissue banking is still a relatively young process, and new methods are being developed in order to optimize it. [5]
The roadblocks of oncofertility
Cancer survivors in India are often left in a state of confusion due to the lack of survivorship programs that are common in developed countries. In India, fertility preservation options are not yet standardized. The cost is a major deterrent. There are several banks of assisted reproductive technology that offer frozen sperms. However, the options available to women for preserving their fertility are more expensive and therefore, limited. Insurance does not cover fertility treatments, even though the cost of delivering a baby is covered. The cost of preservation is then an out-of pocket expense. This may be the reason why many people have given up on the idea, even if it was necessary. If the oncologist is unwilling or unaware of these options, the patient may not have the opportunity to select one.
