Having a child after cancer: how to preserve fertility
Thanks to advances in cancer research, getting cancer for a woman today is certainly less dramatic than it was a few decades ago.
Five-year survival for frequent cancers, such as those in the breast, in fact, has very high percentages, around 87% (source AIRC).
Cancer is cured, but this positive evidence opens the way to considerations of another nature, making it necessary to face new challenges on aspects of health and quality of life not strictly related to the disease in the strict sense.
In particular, it is in terms of therapies and their effects on the female body that the issue becomes delicate. Dr. Stefania Amicucci, Specialist in Gynecology and Obstetrics at the GynePro Medical Centers, emphasizes on this front the importance of protecting fertility in patients undergoing chemo or radiotherapy, but explains that often the information in this regard is inadequate.
The main objective of anticancer therapies must necessarily be to offer high survival rates, but without relegating an equally important aspect to the background: guaranteeing patients good prospects for a full and satisfying future life. For women who are still young this can mean, among other things, retaining the possibility of having children.
Implementing every possible effort to protect the fertility of the patient affected by cancer should therefore represent a real ethical and moral obligation of the Specialists, and it must be correctly highlighted that the gonadotoxic action of anticancer treatments exposes the cancer patient (this applies to both the sexes, in fact) at a real risk of future infertility.
Speaking specifically of female fertility, all women of reproductive age should, before undergoing antineoplastic therapy, receive a counseling adjusted by the Specialist.
Quick and easy access to a fertility protection program means being able to count on the assistance of a multidisciplinary team made up of oncologists, reproductive medicine specialists and psychologists. These specialists, working in synergy, should inform the patient of the risk that an early menopause can occur following anticancer treatment, or that, even if ovarian function is preserved, her fertility could still be compromised.
Ovarian damage and cryopreservation
The extent of ovarian damage is related not only to the dose and type of radio or chemotherapy, but also to the patient's age at the time of cancer diagnosis, and finally to her ovarian reserve. A useful tool for assessing the extent of ovarian damage is the blood dosage of AMH (anti-Müllerian hormone), considered the most reliable marker of ovarian reserve. The currently most widespread fertility protection strategy in clinical practice is the cryopreservation of oocytes, for which the patient must have the time necessary to carry out ovarian stimulation before starting antineoplastic therapy.
In cases where it is contraindicated to postpone anticancer therapy, or the patient is in prepubertal age, the only possible option is instead the cryopreservation of the ovarian tissue, which has already led to the birth of many healthy children following the preliminary reimplantation of ovarian tissue. removed and frozen.
What information? The role of oncology counseling
Unfortunately, the real situation today is still very different from that hoped for.
In fact, several surveys reveal that many European and American patients report negative experiences regarding the counseling on future fertility: they complain of hasty talks, the inability to ask the Specialists all the questions they would like, as well as unclear explanations and incomplete information on fertility preservation strategies available today.
As early as 2006, the American Society of Clinical Oncology issued recommendations for fertility protection, stating that oncologists themselves should discuss possible fertility preservation options or refer patients to Reproductive Specialists. Unfortunately, however, many cancer survivors report that they have not received one at all counseling before the antineoplastic treatment, nor having had the opportunity to undergo fertility protection treatments, as shown by a recent American study published in the scientific journal Cancer.
Some of the interviews carried out also highlighted how the decision-making conflict and any feelings of regret are less frequent among those who received comprehensive information before starting therapy.
It is therefore clear why women who are about to start cancer treatment should receive from the doctor all possible information on the risk of future infertility: concrete support that helps them choose the most correct solution for the possible protection of their fertility, without future recriminations.
Edited by Portal of Health And Progesti.it
