Fertility of women after cancer treatment.

Diagnosis indicates cancer? Whether the diagnosis concerns a woman of teenage childbearing age or a child, it is worth consulting a gynaecologist - a specialist in oncofertility. Such an expert at the InviMed clinic in Warsaw is Dr Jarosław Kaczyński, who has answered a few questions for us regarding female fertility after oncological treatment.

Malignant tumours of the breast, colon, lung, endometrium, cervix, kidney, stomach and thyroid... These are just some of the reasons why cancer treatment is implemented. Treatment that destroys cancer cells, cancer cells, but not only.

What consequences does cancer treatment have on fertility?

Dr Jaroslaw Kaczynski: Aggressive chemotherapy or radiotherapy not only puts a huge strain on the whole body, but also wreaks havoc on the ovaries.

Aggressive oncotherapy:

• in 80% results in damage to maturing follicles in the ovary and oocytes (oocytes are the cells that give rise to egg cells).
• as a mechanism for reducing the number of primordial follicles leads to premature ovarian insufficiency (failure) and consequent loss of fertility.

Can the ovaries be protected from the consequences of cancer treatment?

Yes, oncofertility comes to the aid of oncology patients. Oncofertility procedures are aimed at women in the reproductive period before starting cancer therapy, with autoimmune diseases and at girls before puberty. These procedures can be started at any time during treatment, as the effects of chemotherapy or radiotherapy are greater the longer it lasts.

So it is best to safeguard fertility even before starting oncotherapy?

Yes. The initiation of procreative protection prior to the implementation of oncological treatment is particularly important, as oocytes are very sensitive to damage from both radiation and drug treatment (especially alkylating compounds). Until now, it was thought that a radiation dose of 4 Gy would lead to the loss of half of the oocytes present. However, more recent studies show that a dose of less than 2 Gy is already sufficient to reduce the ovarian reserve by half. Furthermore, radiotherapy not only reduces the ovarian reserve, but also causes endometrial atrophy and reduces the volume of the uterus.

What do oncofertility procedures consist of?

Cryopreservation of oocytes and embryos is considered the gold standard for fertility preservation in oncology patients - we perform such procedures at all InviMed clinics.

On the other hand, the future of fertility preservation in women seems to be the ovarian tissue freezing procedure, which is currently not only the only option for fertility preservation in children, but also the only technology that allows ovarian hormonal activity to be regained after oncological treatment. The procedure is performed as part of InviMed Warsaw's collaboration with the medical team at Bielański Hospital.

What does the ovarian tissue freezing procedure mean in practice?

In practice, this means laparoscopic removal of part of the ovary during surgery performed at Bielański Hospital. The ovarian tissue obtained in this way is then subjected to specialised processing in the embryology laboratory of the InviMed clinic, where it is later frozen and deposited until the oncological therapy is completed and transplanted back into the woman's body at Bielański Hospital.

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Jarosław Kaczyński, MD

Specialist gynaecologist-obstetrician, endocrinologist, treating couples undergoing infertility treatment, as well as an expert in oncofertility and fertility preservation at the InviMed clinic in Warsaw.