Oncofertility is a subfield that bridges
oncology
Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''à ...
and
reproductive research to explore and expand options for the reproductive future of
cancer survivor
A cancer survivor is a person with cancer of any type who is still living. Whether a person becomes a survivor at the time of diagnosis or after completing treatment, whether people who are actively dying are considered survivors, and whether ...
s. The name was coined in 2006 by
Teresa K. Woodruff at the
Oncofertility Consortium
The Oncofertility Consortium is an international, multi-institutional group that assesses the impact of cancer and its treatment on reproductive health. Founded by Dr. Teresa Woodruff in 2007, its primary mission is to expand fertility options ...
.
Cancer treatments, such as chemotherapy, radiation, and surgery, may destroy a person's ability to have children later in life, and oncofertility research focuses on increasing
fertility preservation Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer, ageing and other health conditions effect reproductive health and preservation options are growing. Specifically ...
options. With 10% of cancer patients
being younger than age 40, this issue affects more than 135,000 people in the United States each year. As cancer survivorship increases, the preservation of fertility in women, men, and children becomes a critically important topic to patients and their families. The ability to easily preserve fertility prior to cancer treatment can provide hope at the time of diagnosis for families later in life. Oncofertility also incorporates reproductive issues after cancer treatment, such as family planning, complex contraception, hormonal management throughout survivorship,
surrogacy, and
adoption.
Fertility options for men
Established fertility preservation options for men include
sperm banking, in which a semen sample is produced, frozen, and stored for future use, and
testicular sperm extraction
Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm ...
, during which sperm is retrieved directly from the testes through a short surgical procedure and frozen.
Experimental options include testicular tissue banking when testicular tissue is surgically removed and frozen. Scientists are developing methods to use this tissue for fertility preservation in males.
Men who do not preserve their fertility prior to cancer treatment may have children through
donor sperm
Sperm donation is the provision by a man of his sperm with the intention that it be used in the artificial insemination or other 'fertility treatment' of a woman or women who are not his sexual partners in order that they may become pregnant by hi ...
using sperm from a known or anonymous donor to achieve a pregnancy with a female partner using assisted reproductive technologies or
Adoption by permanently assuming all rights and responsibilities of a child through a legal process.
Fertility options for women
Options for women to have children after cancer have increased significantly in recent years. Women should be counseled on established options such as
embryo banking
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male sperm c ...
in which hormonal stimulation causes the production of multiple eggs, which are removed, fertilized by sperm, and frozen for future use, and
egg banking
Egg was an internet bank headquartered in Derby, that is now a trading name of Yorkshire Building Society. Egg was born out of the banking arm in the United Kingdom of Prudential plc, which was established in 1996, and the Egg brand was launched ...
in which hormonal stimulation causes the production of multiple eggs, which are removed and frozen for storage and future use, and
ovarian transposition
The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...
(surgically moving the ovaries to a different part of the body) and
ovarian shielding (physically shielding the ovaries from the area receiving radiation).
Experimental techniques include
ovarian tissue banking in which an ovary is surgically removed and frozen to be transplanted back into the woman when she is ready to have children. Scientists are also working on ways to mature undeveloped eggs from this ovarian tissue.
After sterilizing cancer treatment, a woman can also choose
surrogacy (when a woman carries a pregnancy for another woman or couple) or adoption.
Recent efforts also investigate the implications of a cancer diagnosis during pregnancy.
Fertility options for children
Prepubescent children have fewer options to preserve fertility than adults. These include
testicular sperm extraction
Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm ...
for males and
ovarian tissue banking for females.
Financial, ethical, and legal considerations
Fertility preservation costs may be prohibitive for young patients and multiple organizations now provide methods to reduce costs for patients. These include
Fertile Hope
Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertilit ...
and Fertile Action.
The
Supreme Court of the United States addressed the
Social Security
Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refer specifical ...
implications of oncofertility in March 2012 with ''
Astrue v. Capato
''Astrue v. Capato'', 566 U.S. 541 (2012), was a case in which the Supreme Court of the United States held that children conceived after a parent's death are not entitled to Social Security Survivors benefits if the laws in the state that the par ...
''.
Research also investigates ethical issues in oncofertility, such as the decision-making process for adolescent children and their families.
[{{cite book , doi=10.1007/978-1-4419-6518-9_33 , pmc=3086488 , isbn=978-1-4419-6517-2 , chapter=Whose Future Is It? Ethical Family Decision Making About Daughters’ Treatment in the Oncofertility Context , title=Oncofertility , series=Cancer Treatment and Research , year=2010 , last1=Galvin , first1=Kathleen M. , last2=Clayman , first2=Marla L. , volume=156 , pmid=20811853 , pages=429–45]
References
Fertility medicine
Oncology