Kryopreservation – this is the freezing of egg and sperm cells in liquid nitrogen for a long period of time. This means that young cancer patients can continue to have children after therapy. Germ cell tissue – i.e. tissue of the ovaries and testicles – can also be preserved in this way and used to fulfill a desire to have children.
“Preserving fertility is a very important issue for many cancer patients who are still planning a family,” says Felix Pawlowski, spokesman for the German Foundation for Young Adults with Cancer.
“The moment they receive a cancer diagnosis, many of those affected do not think about life after the disease.” That is why the possibility of freezing germ cells or germ cell tissue is also very important psychologically. Because it gives a perspective on life afterward.
What does cancer mean for fertility?
Both the tumor and cancer therapy can limit the ability to father and give birth to children.
But: That doesn’t have to be the case. “Depending on which organ is affected by cancer and which therapies are used, there is a higher or lower risk of becoming infertile,” says Susanne Weg-Remers, head of the Cancer Information Service (KID). The doctor treating you can weigh up the individual risk and the options for maintaining fertility. According to Susanne Weg-Remers, if the tumor affects the brain or disrupts certain structures that regulate hormone metabolism, the risk of infertility is higher. “Fertility can also be reduced if the ovaries, uterus or cervix are affected by a tumor.” In men, the same applies to testicular or prostate cancer.
Cancer therapies can also affect fertility. Chemotherapy, for example, can damage the function of the ovaries or testicles. “For many women, menstruation stops temporarily after chemotherapy,” says Susanne Weg-Remers. In men, it can change the quality of semen and even lead to infertility. The same applies to certain radiation therapies and hormone therapies.
How does cryopreservation work?
“If a cancer diagnosis has been made, the treating doctor should talk to the patient as early as possible about the possibilities of initiating fertility-protecting and fertility-preserving measures.” That says reproductive medicine specialist Ralf Dittrich. This also applies if family planning is still in the distant future.
According to Dittrich, how much time remains depends on the type of cancer. However, it is often still possible to obtain and freeze germ cells or germ cell tissue. “In male patients after puberty, the collection of sperm is relatively uncomplicated and does not take much time,” says Ralf Dittrich, who heads the in vitro fertilization and endocrinological laboratory at the University Hospital Erlangen. For women, the most common method of fertility preservation is egg retrieval and freezing. “For this purpose, the ovaries are stimulated using appropriate hormones,” says Dittrich. Ovulation is triggered in a controlled manner. The egg cells are suctioned out through the vagina using a hollow needle and then cryopreserved.
And if time is short?
“If women have to be quick, it is better to remove ovarian tissue, since there is often not enough time for hormone therapy before egg retrieval,” says the head of the KID, Susanne Weg-Remers. In addition, the hormones estrogen and progesterone, which are used in such hormone therapy, can influence the growth of breast cancer cells, for example.
How is ovarian tissue removed?
During a minor surgical procedure under general anesthesia, a piece of tissue is removed from the abdominal wall. It is later transplanted back into the patient’s body – ideally in the area of the ovaries. The ovaries play an important role in the production of hormones that help maintain the menstrual cycle. This function can be restored by re-transplantation after cancer therapy.
In the best case, this will make ovulation possible again. If the fallopian tubes were not damaged by the cancer therapy, those affected can then become pregnant again naturally after the cancer therapy. In men, if isolation of sperm is not possible in rare cases, testicular tissue can be removed and frozen. This applies, for example, to boys who are not yet sexually mature.
How good are the chances that it will work out later with the child?
“If the patient is very young, there is a very good chance that the desire to have children can be fulfilled after cancer therapy,” says Ralf Dittrich. However, the older a woman in particular gets, the less likely it is that the baby will work out. Just like in healthy women. Normally, despite the natural aging process of egg cells, a woman still has a good chance of becoming pregnant up to the age of 38, according to Dittrich. “Unfortunately, the chances of getting pregnant using one of the methods mentioned after cancer therapy decrease significantly due to the interventions and age, but it is by no means hopeless.”
Does health insurance pay for cryopreservation?
Statutory health insurance bears the costs for cryopreservation for women up to the age of 40 and for men up to the age of 50. But when it comes to storage costs, according to Felix Pawlowski, things don’t always run smoothly. The press spokesman for the German Foundation for Young Adults with Cancer reports that many patients are sent by the health insurance companies to their doctors and then back to their health insurance companies. “This is an additional burden for many young cancer patients who find themselves in financial difficulties as a result of their illness.”
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