Magdalena Bury, Hello Health: In Poland per year only breast cancer Approximately 18,000 women are ill. For all types of malignant tumors — about 100 thousand. Polex. I know that breast cancer patients are the closest to you because of your work. Does the diagnosis of “cancer” mean that a woman will no longer be a mother?

Dr. Monika Łukasiewicz, gynecologist, sexologist and specialist in gynecological and reproductive endocrinology: In most cases, in young women of reproductive age, chemotherapy damages the ovaries. Fertility after chemotherapy treatment may not return. And here a lot depends on the age of the patient. The younger she is, the greater the chance of fertility returning. However, it can happen that even a 25-year-old patient will have to come to terms with the fact that her fertility will no longer return.

Can a woman who finds out she has cancer do anything to be a mom someday?

A woman who goes to her oncologist should discuss with him the side effects of chemotherapy, and later the effects of hormonal treatment. The oncologist is obliged to inform his patients about them. And here it is worth clarifying that if a patient has hormone-dependent cancer, after chemotherapy she receives hormone therapy. Hormone therapy causes the patient during this period to have inhibited fertility. And we are not talking about the complete “destruction” of fertility, only a temporary one.

What else should a patient ask her oncologist?

About what percentage of the chances of pregnancy she will have after chemotherapy. The second important question is where she should go to freeze her eggs or embryos. Remember, however, that we can destroy the egg cells, but the embryos that are potential humans, we cannot. The latter are frozen forever, if, of course, the patient does not return for them. These are controversial topics that many people do not even know about.

An oncologist can also refer his patient to a gynecological clinic, where a fragment of ovarian tissue will be taken, which will later be transplanted. And it is precisely these three methods of preserving fertility that we will probably talk more about in a moment.

These methods are precisely onfertility?

Exactly so. Oncofertility is a cracked version of “oncofertility”. This will ensure that even before starting treatment, the woman can decide if she wants to become pregnant after it ends. This is especially important in a situation where the effect of anticancer therapy is premature menopause, and as a consequence, the lack of the possibility of natural conception.

Preservation of fertility for every woman diagnosed with cancer is of great importance. Studies show that women who have had the opportunity to preserve their fertility endure cancer therapy much better and enjoy a better quality of life after treatment.

I checked. In Poland, there is definitely little talk about onfertility.

Preserving fertility before cancer therapy is often associated with referral to an in vitro clinic. It is known that in Poland IVF treatment is not supported, in fact it is still a taboo subject. If we write about it, we write very little, and if we do, more often in political rather than therapeutic contexts.

Preservation of fertility often requires the patient to freeze embryos or eggs. And the problem arises, since these procedures are paid, there is no refund from the state. However, some cities offer it, such as Warsaw or Poznań. That is, women who live in Warsaw or Poznań, and are before cancer treatment, are reimbursed costs.

What about women from smaller towns?

There are places in Poland where no one even thinks about fertility preservation methods. Patients often do not know anything about it. And it's hard to be surprised. How do they know that they may lose fertility or have an earlier menopause after chemotherapy? Patients are often not told this at all.

And suddenly such a patient undergoes treatment, she is 32 years old, and it turns out that the ovarian function after chemotherapy has not returned. The chances of motherhood in such a situation are very small. However, we must bear in mind that most women diagnosed with, for example, breast cancer survive more than 5 years. And such women after recovery have a chance of motherhood. The only thing is that if we don't think about it sooner, it may be too late.

So, let's take a look at the methods of preserving fertility in turn. The first is...

Freezing of ovarian tissue. Previously, this method was considered an experimental method. This is no longer the case these days. The American Society of Reproductive Medicine has approved the use of this method in selected patients. Such tissue is taken laparoscopically, then it is frozen, and then implanted in the appropriate place in the patient after the tumor is cured.

Thanks to this procedure, about 180 babies were born in the world. That's a lot! The method of freezing ovarian tissue is therefore very promising, but we must bear in mind that not every hospital will take and freeze such tissue, because for this you need to have a suitable place, which most often have infertility treatment clinics, and therefore private clinics. Again, this is a paid procedure.

Another method of preserving fertility is egg freezing.

This is the simplest method from a technical point of view. The patient goes to the IVF clinic with the permission of her oncologist. This is where the stimulation procedure begins Ovulation. In order to collect the cells, the patient needs to stimulate many follicles in the ovary. Such stimulation lasts about 10 days. Egg cells are collected around the 12th day — using a puncture needle, under ultrasound control and under short-term intravenous anesthesia. The cells are then rinsed and frozen by vitrification.

For this to make sense, it is best to freeze 7-12 eggs. And it is not that if we fertilize each of them, we will have 12 embryos, and then 12 children. Statistically, we have a chance of one, two children.

For such a patient, the time it takes to carry out the correct procedure is important. However, it is worth knowing that in the case of a patient diagnosed with cancer, we do not have to start it on the 2nd or 3rd day of the cycle, but at any time. Stimulation drugs, if reimbursed, cost about several hundred zlotys. If not, about a few thousand dollars. The procedure itself, puncture, freezing or research is another approx. 5000 PLN.

What if the patient has a partner with whom she wants to have children?

And here we move on to the third method of preserving fertility. In such a situation, the egg cells that we have taken are fertilized with the partner's sperm and form embryos. They are potential children of this couple and cannot be destroyed. Freezing embryos gives you a better chance of pregnancy. However, the patient should be aware that one day she should return for these embryos.

It is also worth knowing that freezing embryos costs about 5000 PLN more than the eggs themselves.

How long after the end of cancer treatment can a woman start trying to have a baby?

It depends on what kind of cancer the patient was dealing with. There is talk of 2.3 years, of course, with the approval of your oncologist. The first 2 years are critical years when it comes to relapse. It is important that the chemotherapy you have undergone does not increase the risk of birth defects in the fetus. In the case of hormone-dependent tumors, it is necessary to wait 3 months after discontinuation of tamoxifen. After therapy with trastuzumab, due to its adverse effect on pregnancy, it is necessary to wait at least 7 months.

How many women return for their frozen tissues, eggs or embryos?

A study published in 2018 showed that about 10 percent of patients return for their frozen tissues or eggs. The study did not only look at breast cancer patients, where survival and prognosis are very favorable, hence perhaps such a low percentage of returns. This may also be due to the fact that in women who have had breast cancer before the age of 40 after chemotherapy, their period and fertility may return after a few months. If a period occurs, it has been shown that in 90% of patients it is observed within 2 years after the end of oncological treatment. Patients can also become pregnant naturally.