Fertility preservation in lymphoma
After diagnosing for lymphoma, you probably already have read a lot about it. So you are must be aware - there will come the day when you will be completely cured.
What happens then depends a lot on what happened before your treatment began. Take our hand and keep on reading!
Lymphomas are a group of malignancies that arise from a certain type of white blood cell called a lymphocyte.
Lymphomas are divided into two major groups: Hodgkin lymphoma and non-Hodgkin lymphomas.
Hodgkin lymphoma accounts for about 10% of all lymphomas, and occurs predominantly in the 15-35 age group, as well as after the age of 55. This disease is one of the great success stories of oncohematology science, because thanks to modern chemotherapy regimens and radiotherapy there is a complete cure in about 90% of all patients..
Non-Hodgkin's lymphomas are more common (90% of all lymphomas) and occur in all age groups with a tendency to increase after the age of 40-50.
They are a very heterogeneous group of diseases, represented by dozens of different subtypes, such as diffuse B-cell lymphoma, follicular lymphoma, T-cell lymphomas and others. There are high chance of successful completion of therapy and cure for them as well.
Treatment of lymphomas is usually complex and includes combination of both chemo- and immunotherapy, as well as radiotherapy.
Unfortunately, effective therapy often comes with unwanted side effects, and often being in shock after the diagnosis, not enough attention is given to another very important organ – the ovary. Therapies we use today can cause the ovaries to stop functioning, which we call premature ovarian failure.
The unpleasant consequence of this is an early menopause – the ovary stops working and producing hormones and eggs. Hormones could be easily replaced with hormone tablets. This is, however, quite impossible for eggs. The good news is that they can and should be saved in advance.
You probably already know most of the things mentioned and the reason you are here is the worry about the future, the questions plaguing you – "Will I be able to have children?", " How will pregnancy affect the disease?".
Have no fear! It is our mission to help women like you. We have a solution, and it is SAFE – storing eggs, embryos, or ovarian tissue, before starting active treatment. We do it every day for girls with your disease, discussing and working together with your hematologist.
We are here to help you, and we will answer all of your questions. Get in touch with us!
Frequently asked questions and common situations you may run into
Which therapies would harm my reproductive abilities the most?
The risk of infertility or premature ovarian failure depends on many factors, such as your age, the chemotherapy regimen to be used, the dose of medication, and whether radiation therapy is planned for the area of the lymph nodes near the ovaries and uterus.
After the age of 30-35, ovarian reserve naturally diminishes, and even chemotherapy regimens with normally low risk could lead to premature ovarian failure and infertility.
Another important factor is the so-called gonadotoxicity of the regimen used (the ability to damage the ovaries).
The regimens most commonly used in the treatment of Hodgkin's lymphoma, are ABVD and BEACOPP, and in the most common forms of non-Hodgkin's lymphomas, the most common regimens are ABVD and CHOP, which are considered to be less gonadotoxic, whereas BEACOPP is associated with a very high incidence of premature ovarian failure.
It is important to know that even if your menstrual cycle recovers after treatment is completed, the quality of the eggs may have suffered irreversibly, and they may no longer be fit to conceive a baby.
No one can say with certainty whether a specific treatment will harm the eggs, and to what degree. What we do know is that once damaged, they very rarely regain their potential.
High-dose chemotherapy followed by hematopoietic stem cell transplantation is a therapy that successfully heals the disease, but the cessation of ovarian function after it is very common.
Such type of treatment could be proposed if the purpose is to cure a relapsed lymphoma or one that is not sensitive to initial treatment.
A common characteristic for the most of such regimens is that the doses of the used drugs are such that very often they cause premature ovarian failure.
Regardless of what regimen is chosen by your treating physician, our advice is to seek us out for a consultation, as the treatment of your disease may require that the therapeutic plan be changed for your benefit.
Which is better, eggs or embryos?
The matter should be discussed with your reproductive specialist. Even with married partners, eggs are the more common option, because frozen embryos are unusable in the event of a change of partner. However, embryo freezing is also an option.
How will I use them after I have recovered?
The eggs will be thawed at the right time, then they will be fertilized in vitro, then at a precise moment one or two of the developing embryos will be placed in the uterus. More information about this is available HERE.
What is this procedure's success rate?
Success depends on both your age and the number of eggs stored. For example, if you are up to 36 years of age and have 15 stored eggs, the chance of having a child with them is about 70%. It is an unrealistic to think that without stimulation and with 1 frozen egg you have a real chance. That chance really is very low.
What will happen if I don’t succeed in getting pregnant with the frozen eggs?
If your ovaries are still working, we can try new stimulation to extract more eggs, despite the fact that their quality has deteriorated. In recent years, studies have shown that this type of stimulation is also safe. If this does not work, or if your ovaries have stopped working completely, a good option remains to get pregnant with a donor egg.
Is there any sense to do it if I am 40 or over 40 years of age?
The answer is a resounding yes. 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! If government funding is not available because of your age, the consultation, exams, stimulation and the procedure itself will be free to you! The only cost will be the stimulation medications.
If I am not sexually active, can I preserve eggs?
Yes, we have done this repeatedly. In these cases, a brief surgical intervention is required to remove part of the hymenal ring to allow the ultrasound probe to enter. The procedure takes minutes and is performed under anesthesia.
In conclusion - the worldwide practice preserving the reproductive ability in cases with almost all forms of this disease, because a large proportion of patients recover and return to their everyday lives. If you want to have a baby crying as part of your everyday life, all you have to do is get in touch with us, and we will help you make that a reality.
Remember that...
You should seek advice NOW!
Every woman with cancer at reproductive age should consult a reproductive specialist, regardless of the stage of her disease, and whether she has given birth or not. This is also the official recommendation of the most recognized international oncology and reproductive medicine organizations, such as ESMO, ASCO, ESHRE, ASRM.
This will not delay your therapy in any way.
Your consultation with our reproductive specialists will be done within 24 hours of your call, no matter where you reside in the country.
Fertility preservation options
In current best practices, the following procedures are used to preserve reproductive ability in cases with lymphoma – egg/embryo freezing or ovarian tissue freezing.
| Fertility preservation options | Frequency of application and success rate of the approach | Limitations of the approach in relation to cancer characteristics |
| Egg/ embryo freezing | ★★★ |
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| Ovarian tissue freezing | ★★ | The method is particularly suitable in cases requiring immediate initiation of treatment, but it has some theoretical drawbacks, such as the possibility that the ovarian tissue is "contaminated" by cancer cells. Such a possibility is largely ruled out in Hodgkin's lymphoma, but not in some subtypes of non-Hodgkin's lymphomas. For this reason, each case is evaluated individually and in detail by our specialists before a decision is made on the fertility preservation plan. |
| Transposition of the ovaries | ★ | This method comes into consideration as an adjunct to the aforementioned in cases where the treatment plan requires radiotherapy for lymph nodes in the pelvic area where your ovaries are also located. |
★★★ - most commonly used approach, highest success rate ★★ - less frequently used approach, lower success rate ★ - less frequently used approach, lower success rate