Twenty three years old,female patient Anita presented with mass in rectum,the required treatment is radiation,chemotherapy and subsequently surgery.The said female is unmarried.The issues that needs discussion are cancer staging,cancer prognosis,quality of life issues and fertility as patient is young.This patient came to me in certain depressed state of mind with long face.Upon enquiring her name she took some time to remember her name.Before I asked next question(we bombard the patient,our bad) her mother told that she does not sleep at all for last one week.Lots of plans started coming to my mind that how to preserve the fertility in this case and this gave me motivation to write this article to make people aware regarding this issue.
The main issue in young patient is infertility as these patients are curable with anticancer treatment and have long life.The treatment whether surgery,chemo or radiotherapy all some how leads to infertility.Surgeries that remove reproductive organs,certain types of chemotherapy and Radiation to pelvis and abdomen can lead to this issue.As our armamentarium is expanding against cancer we don’t know the newer treatments that are coming may worsen this issues further.For some women ,infertility can be the most difficult and upsetting .This need long sessions with physicians to understand the effects on fertility.Similar issues arises with kids also as malignancy in kids are curable and options to preserve fertility should be discussed with parents before starting treatment.
Whether fertility will be affected or not will depend upon various factors Like baseline fertility of patient,at what age we started the treatment,type and treatment received for cancer,amount of drug and radiotherapy received,duration of anticancer management etc.The amount of time that has passed since cancer treatment.Patients should choose reliable form of birth control during anticancer treatment as treatment also leads to somatic mutations in off springs.As per literature,you should not try to conceive for at least two years after treatment as earlier conception leads to miscarriages,genetic complications in fetuses.Waiting for these two years are inner way helpful as patient is out from window of early recurrence and body is also recovered from treatment side effects.One should disclose the history of anticancer treatment received in the past to your fertility physician consultant.
There are several ways by which we can preserve it for men and women,In men we can store semen in sperm banks or preserve testicular tissue (experimental treatment) before starting treatment.
In females there are assisted reproductive technologies to retrieve and freeze eggs.In case of married women eggs can be fertilized and stored as embryos.In certain patients who need higher radiation dose to abdomen,we can transpose the ovaries out of radiation field called as ovarian transposition (surgical procedure).
Another option is suppression of ovarian function during chemotherapy with medications and this make ovaries resistant to ill effects of chemotherapy.In case of minor girls we can store ovarian tissue and it can be used later on for curing infertility.
Sometimes patient who are on chemotherapy or radiotherapy stops having periods,it can be temporary or permanent.Women can become pregnant if she ovulates (releases an egg) but if period stopped permanently,she might be in premature menopause and it is highly unlikely that she will conceive.My main aim is that masses should ask right questions before starting the anticancer management like what is the estimated risk of infertility with particular cancer protocol and what are the options to preserve the fertility.In the end I must say “Take the cancer head on,certainly you can wipe it” and consider it as a small chapter in your life and I wish you all (patients) close this chapter as soon as possible.