cMaintain fertility after a cancer diagnosisand is a topic that involves today in Italy about 100,000 people between 15 and 39 years old. A figure that collects those who have received the diagnosis and have started treatment, but also those who have ongoing therapies and are following them the five-year process of controls. These are estimates from the Higher Institute of Health and in many cases this path ends with the healing, restitution to the life and future of patients. And in the future there is also the desire to become parents.
Why cancer threatens fertility
“In women chemotherapy and radiotherapy can cause a natural reduction in the number of oocytes and the termination of the related accrual. Moreover, reduction in egg quality and premature ovarian failure, with cessation of reproductive and hormonal function. In humans this type of treatment can cause pathology of the testicles, cessation or decrease in the production of sperm. Besides that decrease in libido and sperm count» explains Daniela Galliano, gynecologist and reproductive medicine expert, responsible for the PMA IVI Center in Rome.
Preserving fertility: when to act
The preservation of oocytes and sperm allows you to undergo Pma once the cancer has passed.
In the dramatic moment in which the tumor is diagnosed begins a fight against time. Start treatment for countering it is the patient’s priority and also of the doctors who take care of it. Preserving fertility takes a back seat when you feel like fighting for life. «But in very many cases start an ovarian stimulation pathway does not hinder the effectiveness of cancer treatment. Instead, don’t deal right away the problem of preserving fertility can irreparably harm the chances of procreating» says Galliano.
In the case of women the chances of getting pregnantafter recovery from the tumor depend still from the age in which the route is tackled of assisted procreation. The success rates are then in line with those for PMA age.
Tumor treatment and ovarian stimulation
« They have been around for ten years shared protocols that are used for ovarian stimulation of cancer patients They involve the use of very low estrogen levels which leave traces in the blood that can be superimposed on the level that is normally recorded. In short, there is no risk that the stimulation aimed at preserving fertility becomes a growth factor for tumor cells» continues the specialist «Of course this path is outlined in collaboration with the oncology structure following the woman. The intervention times are also agreed with it ».
According to the information provided by Ministry of Health this modality is feasible for women who have the option of delaying it by 2-3 weeks the start of oncological therapies.
Oocyte retrieval
The oocytes are collected in test tubes after being harvested from the follicles.
Subsequently it is realized an ovarian harvest, accessing the ovaries through the uterine cavity. From there it happens sampling from each of the follicles ( the small cavities that contain the ovules) by aspirating the ovules that are inside them. These eggs are collected in test tubes and then treated in the laboratory for freezing. The procedure that is performed under anesthesia in the operating room lasts 15-20 minutes. The same day, the patient can return to normal activity and begin treatment when the oncologist recommends it».
Sperm collection
Spermatozoa and oocytes are placed in small holders and immersed in liquid nitrogen, at -196 degrees.
In the case of man it is enough collect semen. Before being frozen. is analyzed to verify its status.
Waiting times and costs
In Spain, all hospitals with an oncology department offer a fertility preservation service with the collection and freezing of oocytes and sperm. In Italy it is not like this, even if the public structures that are equipped with them (which can be searched for by placing the word oncofertility as the keyword) guarantee immediate and free access to patients. The service is guaranteed by many assisted reproduction centers affiliated with the SSN (the complete list of centers in this links). THE costs are covered by the national health system. «IVI of Rome guarantees immediate access and free access to the itinerary» concludes Daniela Galliano, who is in charge of the centre.
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