Preservation of fertility and IVF in cancer cases

Many potential pathologies can be seen in a person’s life that can negatively affect fertility. For example; Some genetic and blood diseases, auto-immune diseases, metabolic diseases, repetitive operations on reproductive organs and especially cancer are examples of these pathologies.

Although survival rates have been increased with the modern treatment methods developed in the presence of cancer, one of the most important problems in these treatments, perhaps the most important, is the possibility of adversely affecting the fertility of the person, perhaps even disappearing altogether. Chemotherapy, radiotherapy or surgical treatment to be given may have negative effects on reproductive cells at different rates.

Particularly in cancer cases, it should be well thought out how to protect the fertility of individuals. After the diagnosis is made, without losing time, the appropriate fertility-preserving treatment option should be selected for the patient.

Another important issue that needs to be examined is whether the drugs given with in vitro fertilization treatment to ensure fertility in cancer cases and the high hormone levels provided will have a negative effect on the course of cancer.

While the chemotherapy agents used in cancer treatment destroy cancerous malignant cells, they also kill reproductive cells such as sperm and egg-oocyte. Permanent damage to ovarian and testicular cells is seen at very high rates with the radiotherapy-radiation therapy used. It is possible to give the same damage with wide radical surgical treatment.

There is a possibility of early depletion of ovarian-ovarian reserve in women with a family history of early menopause. This condition, which is mostly genetic, can be seen, for example, in galactosemia, a metabolic disease, or in the inherited Turner syndrome. Sometimes it is possible to damage the ovaries at an early age without a genetic or metabolic cause. For example, after repeated operations for a benign disease such as endometrioma-chocolate cyst, the ovaries may be equally damaged.

Again, there are some diseases that are seen before reaching adult age and that the disease itself or its treatment can damage the reproductive cells in the ovaries or testicles. In this case, it is important to protect the reproductive functions of the person.

Now let’s examine the pathologies that require fertility preservation:

Childhood cancers that can be seen in both sexes; Hodgkin and Non-Hodgkin lymphoma, all types of leukemias, osteosarcoma, genital rhabdomyosarcoma, Wilm’s tumor, Ewing sarcoma.

Autoimmune and blood diseases; systemic sclerosis, Behçet’s disease, systemic lupus erythematosus (SLE), Wegener’s granulomatosis, multiple sclerosis (MS), autoimmune thrombocytopenia, aplastic anemia, inflammatory bowel diseases, pemphigus vulgaris.
Cervical-cervical cancers, breast cancer, tumors in organs requiring radiotherapy to the pelvis, cancer requiring bone marrow transplantation, blood and autoimmune diseases.

In some families, for example, with the carrier of BRCA-I and II genes, the increased risk of breast and ovarian cancer and situations in which ovaries may need to be removed for protection.

Benign lesions with the potential to damage the ovary due to repeated operations (endometrioma, benign cysts), galactosemia, family history of early menopause.

Especially cancer cases constitute the most important area that requires pre-treatment fertility protective measures and practices.

Before cancer treatments, we perform some operations to protect the reproductive functions of the person. To summarize them briefly;

ovarian transposition : Radiotherapy to the pelvis-lower abdomen, where the female genital organs are located, damages the ovaries. After this treatment, most people lose their ovarian reserve to the point of menopause. To prevent this, it is necessary to remove the ovaries from the area where radiotherapy will be given by laparoscopy.
process.

Radical trachelectomy:It is an operation that allows the treatment of cancer by removing the cervix and lymph, without removing the uterus, in order to preserve fertility in young women with cervix-cervical cancer.
In order to protect reproductive functions in cancer cases with in vitro fertilization technologies; We apply different approaches depending on the patient’s gender, age and whether they are married or not. Let’s examine them now:

IN FEMALE PATIENTS

prepubertal ; Ovarian tissue is frozen.
post adolescence ; Egg-oocyte or ovarian-ovarian tissue can be frozen.

if person marriedIf so, there are different possibilities:
When emergency treatment is required where chemotherapy cannot be delayed or if the hormones to be administered in the treatment are likely to be harmful on the course of the cancer; The ovary is frozen, or immature eggs are taken from the ovaries and frozen for later in-vitro maturation-IVM.

If chemotherapy is not urgent and the drugs we use in in vitro fertilization technologies do not have a negative effect on the course of cancer; IVF treatment is applied to the patient. Embryos obtained from the patient are frozen. In a period after the patient’s treatment ends, these embryos are used by thawing.

if person if not married;
When emergency treatment is required where chemotherapy cannot be delayed or if the hormones to be administered in the treatment are likely to be harmful on the course of the cancer; The ovary is frozen, or immature eggs are taken from the ovaries and frozen for later in-vitro maturation-IVM. If chemotherapy is not urgent and the drugs we use in in vitro fertilization technologies do not have a negative effect on the course of cancer; eggs are frozen.

IN MALE PATIENTS:

prepubertal: Testicular tissue is frozen.
post adolescence: Sperm is frozen.
married : Double IVF treatment is applied. Embryos obtained from the spouse with the sperm taken from the patient are frozen. These embryos are thawed at a later period and transferred to their partner.

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