Fertility preservation in colorectal cancer
If you've recently been diagnosed with cancer of the colon (cancer of the colon or rectum), you're probably asking yourself dozens of questions. The opportunity for preserving fertility probably wasn't the first among them, but since you're reading these lines, it's probably something you care about, and you have now taken the first step.
DON’T PANIC – we are here to help you!
The good news is – modern medical science guarantees a complete cure for the majority of patients with this malignancy!
Yes, you have an uphill battle ahead of you, but you will regain your health! When this happens, your return to a normal lifestyle, including the ability to have children, is very important.
Here we will explain why taking being proactive in preserving your reproductive options is necessary, when is such action necessary, and how to do it together.
Why do we need to think about preserving reproductive options?
Fertility sparing will not be harmful to your health in any way, nor will it delay the start of necessary treatment.
It is your faith and confidence that you will get healthy again! Discussion of fertility sparing with your treatment team and consultation with a reproductive health specialist are underlying recommendations for all current oncology guidelines.
A multidisciplinary approach to treatment is the guiding principle needed for the complete cure of patients with colorectal cancer, i.e., the involvement of physicians from different medical specialties – an abdominal surgeon, an oncologist, a radiotherapist.
Yes, this means that in addition to surgery, you will have radiation or chemotherapy, or a combination of both, depending on the part of the bowel affected, the stage of the disease, and additional risk factors that are taken into account by the treating team.
Depending on the stage of the colon cancer (the initial part of the colon), postoperative chemotherapy may be necessary, including various medications.
This brings a risk of having the ovaries damaged and stopping their function, the so-called premature ovarian insufficiency (POI).
Rectal cancer treatment (the terminal part of the colon) often requires the use of both chemotherapy and radiotherapy. Due to the anatomical proximity of the ovaries to this part of the colon, despite the best efforts of your radiotherapist, their function is often impaired.
Frequently asked questions and common situations you may run into
When do I need to discuss this with the treatment team and refer to a reproductive specialist?
Seek advice NOW! Global recommendations advise every woman of reproductive age, regardless of the stage of her disease, to consult a reproductive specialist. This consultation should be done as soon as possible before starting radiotherapy or chemotherapy, and immediately after diagnosis, if possible, either by way of biopsy or surgery.
What is this procedure's success rate?
Success depends on the number of eggs we have frozen, and our age. The chances of a live birth are > 40% in women aged 35 and under and < 30% in women over 35.
It is an illusion that freezing one egg without stimulation increases the chance of getting pregnant – it is rather low. Our experience shows that if you are up to 36 years of age and have about 15 frozen eggs, the chance of delivering a child with them is about 70%.
If I am 40 or over – does it make sense to freeze eggs/embryos?
It absolutely does! Despite reduced odds, our opinion is that trying is always worth it. We freeze eggs of women up to the age of 45. This is a chance you should take!
Eggs or embryos?
The matter should be discussed with your reproductive specialist.
Yes, eggs are the more common option, even for married patients, because frozen embryos are not usable in the event of a change of partner. However, embryo freezing is also possible.
What will happen if I don’t succeed in getting pregnant with the frozen eggs?
We have a solution for that, too. If your ovaries are still functional after recovery, we will try to help you get pregnant, despite the deteriorated egg quality. If this does not work, or if your ovaries have stopped working altogether, there is the possibility of becoming pregnant with a donor egg.
When is the best time to freeze eggs – before or after surgery?
Either way, you won't be late. Call us immediately, and we can discuss this.
What if I am going to have preoperative radiation therapy, or radiation chemotherapy?
In either case, the recommendation is to perform the necessary procedures before starting the preoperative therapy.
As mentioned, this takes 10-12 days, which will not delay you in any way.
Which therapies could damage ovarian function? (see table on the left)
Our advice is not to be strictly guided by this table, because during the course of treatment your oncologist may change medications, which is for your own good, and this could have an impact on your ovaries.
What if my therapist is against fertility preservation?
First, this is a common occurrence, but with this material we have convinced you that preserving your fertility is an established and even recommended practice around the world.
Second, if your therapist is against it, you can do it yourself, without changing his/her plans.
Third, this is not a reason to change your therapist, but you can always get a second opinion. We can help with that!
If I am not sexually active, can I preserve eggs?
We've done this repeatedly. A short surgical procedure removes part of the hymenal ring, allowing the ultrasound probe to enter the vagina. The procedure takes several minutes and is done under anesthesia.
You should seek advice NOW!
Every woman with colon cancer at reproductive age should consult a reproductive specialist, regardless of the stage of the disease.
Whether you have given birth or not, this is something you should discuss with a reproductive specialist.
No, this will not delay your therapy!
Your consultation with us will be done within 24 hours of your call, no matter where you reside in the country.
Regardless of the day of your menstrual cycle, we can start right away and finish in about 10 days.
In conclusion – you will be healthy again, and that is almost a complete certainty. It may be hard to believe now, but that day will come. Then you will want to have children as well. Contact us now, to be ready for when that day comes!
Fertility preservation options
In current practice, the following procedures are used to preserve fertility in colorectal cancer – egg/embryo freezing, ovarian tissue freezing or ovarian transposition.
|Fertility preservation options|
|Egg/ embryo freezing||★★★|
|Ovarian tissue freezing||★|
|Transposition of the ovaries||★|
★★★ - most commonly used approach, highest success rate ★★ - less frequently used approach, lower success rate ★ - rarely used approach