Oncofertility involves study and practice, bridging oncology and reproductive medicine. Certain cancers may require treatments that have an effect on fertility. Fertility preservation options ensure that cancer survivors can still achieve their dreams of parenthood.
Fertility Specialist Dr. Sharon Moayeri, MD MPH, discusses with Dreaming of Baby oncofertility and what it entails.
CJ DeGuara: Hello and welcome to Dreaming of Baby! Today we have with us Sharon E. Moayeri, MD, MPH, a Fertility Specialist here to discuss a very important subject: Oncofertility. Dr., would you be so kind as to start by introducing yourself to our readers?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Yes, thank you. I’m Dr. Sharon Moayeri, a Board Certified Reproductive Endocrinologist in Private Practice in Newport Beach, Southern California. I take care of patients seeking fertility treatment including in-vitro fertilization and have a special interest in patients wanting to do fertility preservation procedures for medical reasons, such as a cancer diagnosis.
CJ DeGuara: So to better understand Oncofertility: I believe that there are different types of situations that impact fertility, the diagnosis of cancer itself as well as the treatment of it has an impact. Can you walk us through some of the most common situations today and what is normally done or recommended?
Cancer Treatments and Fertility
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Sure, certain cancers that may affect women of reproductive age, such as breast cancer, may require treatments like chemotherapy that causes early menopause. Many cancer doctors will support a woman’s decision to undergo fertility treatment to harvest and freeze her eggs prior to this exposure to give her the chance to have children once she is in remission. In other instances, cancers may impact a woman’s ability to carry a pregnancy and the use of a gestational carrier surrogate may be needed.
CJ DeGuara: Excellent and for the male counterparts, I believe the radiation therapy and chemo can have an impact also?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Yes, for men the impact may be short term or long term. Collecting and freezing sperm prior to treatment is a great option to preserve his fertility.
CJ DeGuara: An important question, do all cancers that require chemotherapy impact fertility?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Not all chemotherapy or cancer treatments necessarily affect fertility or lead to early menopause -the type of medicine used and the age of the patient play a part in this risk.
Preserving Your Fertility Following a Cancer Diagnosis
CJ DeGuara: So it would be advised that an oncology patient asks the right questions if they are going to undergo treatment? Who should they ask and what should they be asking?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Yes, it is important for patients to discuss fertility concerns early on with their Oncologist and preferably before they receive any treatments. Though it is increasingly common for Oncologists to discuss fertility as part of a patient’s comprehensive treatment, this practice is still not universal. Fertility treatments can be performed in a short amount of time and most Oncologists support patients who choose to pursue their options.
“It is important for patients to discuss fertility concerns early on with their Oncologist and preferably before they receive any treatments.” Dr. Sharon Moayeri
Fertility preservation options for cancer patients
CJ DeGuara: On that note, in cases where the patient is aware that their condition may lead to sub-fertility or infertility, you mentioned egg vitrification as an option. What does this entail and why should it be done?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Egg vitrification (or freezing) is a modern technique to freeze eggs (and embryos) that has been shown to improve their survival upon thaw and use. Using vitrification, women can preserve their eggs and/or create embryos to bank. The process involves fertility medications over approximately two weeks leading to a minor procedure under anesthesia to extract a group of mature eggs. These eggs are stored for the future and remain the age they were when extracted. Importantly, the eggs are removed before exposure to the cancer treatments, since such exposure has a negative impact on the eggs. If the woman has a partner, she may opt to create and freeze embryos.
CJ DeGuara: Ok, so that is also an option?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Yes, absolutely. Some women choose to freeze both eggs and embryos; whereas other women elect to freeze eggs only. This is a personal option and depends on whether or not she has a partner or is willing to use an anonymous sperm donor.
CJ DeGuara: If the eggs have not been frozen, what options will a cancer survivor have?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: If a woman doesn’t pursue egg retrieval and freezing of eggs or embryos prior to treatment, then she still has options later. Some women may not go into menopause and may resume their menses after their cancer treatment. If they are in remission and cleared by their Oncologist, then they may have the chance to conceive naturally or with the help of fertility treatments – such as in-vitro fertilization using her own eggs. Alternatively, women may opt for a donor egg and/or possibly gestational carrier surrogacy depending on if they are medically cleared to carry a pregnancy and the amount of time they are advised to remain in remission before carrying a pregnancy.
CJ DeGuara: And for men?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Men will often resume sperm production following their treatment. If not, and if they did not bank sperm beforehand, then they can opt to use donor sperm with their partner using either intra-uterine insemination or in-vitro fertilization.
CJ DeGuara: Is there any specific differences with oncofertility once the process (IVF) starts?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: The timing is critical for oncofertility cases. Women start medicines immediately since we need about 2 weeks to reach the stage that their eggs are mature enough to be extracted and we don’t want to delay their cancer treatment. Also, we sometimes use concomitant medicines alongside the fertility medicines to reduce the risk of hormonal fluctuations that may be risky for some cancers. For example, concurrent medicines may include letrozole or lupron in patients who have breast cancer. However, most oncologists and fertility specialists agree that the short course of exposure to hormone fluctuations should not have much risk to women undergoing fertility treatments.
“Timing is critical for oncofertility cases” Dr. Sharon Moayeri
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Another consideration for some types of cancer is that women may need more careful monitoring and management for the egg retrieval procedure if, for instance, the patient’s blood counts are affected.
CJ DeGuara: This has been very interesting. To summarize, for males and females diagnosed with cancer, banking eggs or sperm is highly advised prior to starting treatment?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: It is definitely advised that men and women diagnosed with cancer consider banking eggs, sperm, and/or embryos PRIOR to their cancer treatment. This limits the exposure of the eggs and sperm to toxic medicines, radiation therapy and/or fertility-damaging surgery. There are some great options to do this and given the speed that we can accomplish this, there is rarely an instance where it should not be supported from an oncologist’s standpoint. Particularly, since cancer survival is increasing, and improving the quality of life after cancer includes consideration of family building goals. This is an area we are understanding better since regret is high among those who survive and may not have considered fertility-sparing treatments before their cancer interventions.
“It is definitely advised that men and women diagnosed with cancer consider banking eggs, sperm, and/or embryos PRIOR to their cancer treatment.” Dr. Sharon Moayeri
CJ DeGuara: Excellent, you have been a wonderful guest. If you had to give our readers some advice what would it be?
Sharon E. Moayeri, MD, MPH, Fertility Specialist: Talk to your oncologist early on to let him/her know your intent to preserve fertility and make sure that you don’t underestimate the options that are available for you to grow your family once you are cancer free!
CJ DeGuara: Thank you for your time today, Dr. Moayeri!