Female cancer patients at the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center, have a new option to preserve their fertility before undergoing treatment.
“It is extremely common that cancer patients will experience the loss of fertility and early menopause after gonadotoxic therapies required for many cancer patients,” said Randal Robinson, MD, chair of the Department of Obstetrics and Gynecology at The University of Texas Health Science Center at San Antonio.
“Ovarian tissue cryopreservation includes removing one or both ovaries, freezing tissue from an ovary and eventually transplanting the cryopreserved tissue for fertility preservation.”
Robinson, who specializes in reproductive endocrinology and infertility, said the first successful transplantation of cryopreserved ovarian tissue in the United States was reported in 1999 and was considered experimental until recently. In 2019, the American Society for Reproductive Medicine removed the experimental status of the technique, making it a standard procedure for fertility preservation and opening the door for health insurance coverage.
Robinson began offering the procedure in January at UT Health San Antonio. He said the technique is ideal for patients not yet partnered and, in some cases, for adolescents, as incidences of cancer among younger patients have increased over the years.
“It’s helpful for younger patients who don’t have enough time to undergo ovulation induction and cryopreservation of oocytes, or if partnered, in vitro fertilization (IVF),” he said.
Oocyte development is the process of growth and maturation of eggs in the female ovary. Ovulation induction is the use of medication to stimulate oocyte development to allow the retrieval of eggs for cryopreservation or for IVF if the patient is a candidate for that option.
Robinson said during the process of ovarian tissue cryopreservation, one or sometimes both ovaries are removed laparoscopically before cancer treatments begin. Strips of tissue from the ovary, which contain unfertilized eggs, are removed and frozen.
“For some patients, we leave one ovary behind just in case there is a chance that some ovarian function will remain,” Robinson said.
Once a patient has undergone cancer treatment, is considered cancer free and is ready to have children, the tissue is then placed near the location of the removed ovary in a peritoneal pocket to hope for the return of normal ovarian function and give the patient the best chance of conceiving a child.
“But most patients will have to undergo assisted reproductive technology with IVF in order to conceive,” Robinson said.
Assisted reproductive technology includes all fertility treatments in which either eggs or embryos are utilized, with the most common treatment being IVF, he added. Any woman seeking to start a family and undergoing cancer treatments should take the time to meet with a fertility expert, said Robinson.
“There are studies — some we’ve conducted here — that show that if the patient talks to a fertility specialist, they are more likely to consider it an option. So, we encourage those consultations for reproductive-age patients.”