Children after cancer: treatments preserve fertility

Recent advances in medicine and oncology regarding early diagnosis and effective treatment of cancer patients promote cure in a considerable number of people, many of them young people of reproductive age. Unfortunately, some of the procedures against tumors end up affecting the ovaries, among other reproductive organs.

This scenario brings a demand for a comprehensive view of the patient, focusing not only on the treatment of the disease, but also on initiatives that promote better quality of life. The good news is that you can take steps to preserve fertility.

According to the annual report of the American Cancer Society (ACS), cancer death rates have dropped considerably over the past 30 years. According to the group’s data, the number of deaths due to the disease fell by 32% compared to the highest historical rate, between 1991 and 2019.

Thus, it is important that the doctor who treats the patient with cancer is aware of current techniques for preserving fertility in order to guarantee, after the cure, the possibility of having children, if they so desire.

A look to the future

The patient’s fertility should be addressed by the oncologist at the time treatment planning begins. After the diagnosis, the doctor will choose, together with the patient, a therapeutic strategy and when to start it. In the case of chemotherapy, for example, it will be necessary to understand when to administer it, since the drugs can cause infertility.

“Chemotherapy, surgery and radiotherapy sometimes damage the ovaries. But that depends on the type of tumor, the type of treatment, the type of drug, the dose and the number of sessions. The oncologist’s priority will always be to cure the disease, but he cannot lose sight of the patient’s future wishes”, he explains. Daniel Gimenesoncologist at Oncoclínicas São Paulo.

The challenges that weigh with the age factor

When the risk of infertility is addressed, the age factor also deserves attention. Women, for example, have an egg reserve that decreases with age. If the reserve is lower, the risk of the treatment affecting fertility is higher.

Some options that can be discussed with the medical team, including egg freezing, which is the most common technique, in addition to embryo freezing, ovarian tissue freezing and ovarian suppression.

“Preserving fertility goes far beyond the physical impacts. The emotional part is also involved in the whole process. Therefore, together with a multidisciplinary team, it is essential to consider both issues when planning the most appropriate method”, explains the oncologist.

The biggest challenge in preserving the fertility of cancer patients is the unequal access to treatments and techniques offered by the health system. In Brazil, access to assisted reproduction is still very restricted to the private sector and often not covered by health plans.

And after the treatment?

According to the oncologist, after cancer treatment, talking to a specialist is an important step.

“In cases where fertility is recovered, it is recommended to try to conceive naturally. However, if there is difficulty in getting pregnant after six months of treatment, always talk to your doctor. In some cases, consult a fertility specialist as well may be needed during the process,” he explains.

It is also worth emphasizing that so far there are no scientific statements relating congenital malformations in babies to the effects of cancer treatment in general.

Understand what is oncofertility

The term oncofertility describes an area that connects oncology to reproductive medicine, with the aim of developing and applying new options for preserving fertility in young patients with diseases or treatments that pose risks to fertility.

A more recent concept also refers to the use of more conservative therapies, which manage to preserve fertility and provide the same chance of cure as radical treatment, especially in those neoplasms involving the gynecological tract, such as the cervix, ovary or endometrium.

Data reaffirm the growing importance of the area within oncology. In Brazil, about 19% of new cases of cancer in women occur in patients up to 44 years of age, and 21% up to 49 years of age, a period considered fertile for about 90% of women. In the age group of 20 to 39 years, some of the most incident tumors are breast, uterine cervix and ovarian cancer, all of which can affect fertility.

“The objective of this area of ​​oncology goes much further, as the oncologist has a great responsibility to pay attention to details, that is, to have a humanized look at both the cure and the patient’s fertility”, comments Daniel Gimenes.

Despite being a very delicate moment, it is essential to always guide and raise awareness.

“It is necessary to comment on the risks and benefits, in addition to alternatives so that the best treatment option can be chosen. And it is also necessary to be the support network for that patient, giving the necessary support so that the moment is as light as possible” , he finishes.

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