When your child is diagnosed with cancer, you don’t have time to waste. You get a whirlwind of information about their cancer and then make decisions about treatment.
But there’s one critical concern that your oncologist may — or may not — bring up. You need to know how cancer treatment could affect your child’s fertility.
Then you need to decide if you want to take steps to preserve their ability to have a baby in the future. If so, we perform fertility preservation procedures before cancer treatment starts.
If you’re at that crossroads, Kutluk Oktay, MD, PhD, FACOG, at Innovation Fertility Preservation and IVF can help. Dr. Oktay is a world-renowned expert in fertility preservation and a pioneer in the field of protecting fertility in children and adolescents. He is the co-chair of the American Society of Clinical Oncology (ASCO) Guideline Committee for Fertility Preservation, which publishes recommendations for cancer doctors on fertility preservation here: https://ascopubs.org/doi/10.1200/JCO.2018.78.1914.
We put together this information to give you the basics about how fertility preservation works. Don’t hesitate to call if you have questions or want to schedule an appointment to learn more.
In girls, radiation therapy and chemotherapy cause infertility by damaging their ovaries or in some cases, scarring their uterus. Boys face a similar problem, as radiation and chemotherapy can reduce or completely stop sperm production.
The infertility caused by cancer treatment may be temporary for some children. For others, it’s permanent. This will be dependent on the type of cancer drug used and/or the dose and field of radiation treatment. However, we can’t always predict the long-term effect on your child, but we can determine if your child is a good candidate for fertility preservation.
Fertility preservation for girls includes two techniques: ovarian tissue freezing and egg freezing.
This method of fertility preservation can be done at any age, even in newborn babies, if necessary. We perform a minimally invasive laparoscopic procedure to remove one ovary.
After we retrieve the ovary, your child’s procedure is finished, and she can immediately start her cancer treatment. Then our work in the lab begins.
We separate the ovary’s outer shell, which holds all the immature eggs. Then we cut the shell into slivers of tissue and freeze them. This is a long process using an innovative slow-freezing protocol developed by us, that follows meticulous techniques designed to safely preserve the eggs.
Your child’s ovarian tissue stays frozen until she’s healthy and ready to restore her ovarian function. To make that happen, we thaw the slivers, reconstruct them, and transplant them into the pelvic wall or the remaining ovary. Dr. Oktay developed and performed the world’s first ovarian transplant procedures (read about it here https://pubmed.ncbi.nlm.nih.gov/32046442/) and he is the world’s most experienced specialist on the technique.
Before we can retrieve and freeze eggs, we need to perform an evaluation of your child’s physical and social development. We have performed oocyte retrieval and cryopreservation from girls as young as 12 years of age, depending on their development. During ovarian stimulation, we use medications that stimulate her eggs to mature. We monitor egg growth by transabdominal ultrasound exams and hormone levels. Then we harvest and freeze the mature eggs. We have published many studies on this topic. Please see some examples here: https://pubmed.ncbi.nlm.nih.gov/?term=oktay+k+turner&sort=date
Boys essentially have the same two options as girls, sperm banking (by freezing their sperm) and testicular freezing. But fertility preservation for boys faces different complications.
We can only freeze sperm after boys reach puberty and can produce living sperm. For that reason, we don’t consider this option unless your son is at least 13 years old. Then we have to determine the best way to collect the sperm.
We talk with you and your son about the process and whether he can provide a semen sample through ejaculation. Otherwise, we explain other options such as electroejaculation and sperm extraction.
Dr. Oktay is a leading expert in testicular freezing and one of only a few in the world who perform this type of fertility preservation (read our study here: https://pubmed.ncbi.nlm.nih.gov/23242649/). Though it’s still an experimental procedure, it’s the only option for boys who have not begun producing semen.
The procedure is similar to ovarian freezing in that part of the testicle is removed, frozen, and safely stored for as long as needed. When your son is ready, we thaw the tissue, retrieve the sperm cells inside the testicle, and reimplant them.
If you have any questions about fertility preservation for your child, call our Midtown Manhattan location in New York City or request an appointment online today.