Oncofertility is a subfield that bridges oncology 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 Adoption is a process whereby a person assumes the parenting of another, usually a child, from that person's biological or legal parent or parents. Legal adoptions permanently transfer all rights and responsibilities, along with filiation, from ...

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 Adoption is a process whereby a person assumes the parenting of another, usually a child, from that person's biological or legal parent or parents. Legal adoptions permanently transfer all rights and responsibilities, along with filiation, from ...

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 launche ...

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

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 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 pare ...

''. 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