Sperm and egg banking give patients hope for parenthood after cancer treatment.
Although 91% of oncology physicians agree that sperm banking should be offered to all men at risk for infertility because of cancer treatment, Fertile Hope (2007b) reports that only 10% do so in their practice. In addition, only 24% of men choose to bank their sperm prior to potentially sterilizing cancer treatments.
Women undergoing chemotherapy or radiation to the pelvic area during their reproductive years have a 40%-80% chance of losing their fertility. Successful parenthood options exist for men and women before, during, and after cancer treatment (Fertile Hope, 2007b).
Men can use sperm cryopreservation before chemotherapy so that they can later father a child through assisted reproduction. As long as sperm contains live sperm cells, it can be stored for future use. Once frozen, samples can be kept for 25 years or longer. Men who have reached puberty, even as young as 12 or 13, can bank sperm as long as the sperm contains enough live and healthy cells.
Semen samples are collected over two weeks. Routine tests are performed, such as hepatitis B and HIV. About six sperm deposits are needed for each child (Mills, 2003). The cost of cryopreserving three specimens is typically about $800. The storage fee for each specimen is $85 per year. Private insurance carriers may cover part or all of the cost, especially before cancer treatment.
The only established method of female fertility preservation is embryo cryopreservation. Women must undergo a cycle of in vitro fertilization and create embryos for later use. The option is viable only if enough time is available before treatment to undergo a cycle of stimulation to obtain eggs and if a safe method of ovarian stimulation exists. A spouse or partner, or the woman's willingness to use donor sperm, is also necessary.
Pregnancy rates are 10%-25% per embryo stored. The procedure can be done after puberty and takes about 12-14 days per cycle. The average cost of standard embryo freezing is $8,000 per cycle, and storage can cost $600 per year.
Eggs have been difficult to freeze because they can develop ice crystals during the process, which compromises their integrity and hardens the outer membrane (Later Baby, n.d.). However, a new culture media system now protects eggs from damage during the freezing and thawing process. The system dehydrates eggs during freezing and rehydrates them during thawing, thereby minimizing the formation of ice crystals.
A new technique, intracytoplasmic sperm injection, has been developed, whereby an embryologist injects the egg with a single sperm to fertilize it. The advances in cryopreservation have increased post-thaw survival rates to as high as 90% and fertilization rates as high as 80% and have led to a pregnancy rate of 35% per embryo (Later Baby, n.d.).
The understanding of the relationship between cancer and fertility remains an unmet need for patients in the reproductive ages. Discussion regarding fertility should occur before patients undergo cancer treatment. As cancer survival rates continue to increase, patients should not be left infertile because of a lack of knowledge.
Fertile Hope. (2007a). Cancer and fertility professional education program. Retrieved May 1, 2007, from http://www.fertilehope.org/resources/ pe-program.cfm
Fertile Hope. (2007b). Statistics. Retrieved May 1, 2007, from http://www.fertilehope.org/about/ statistics.cfm
Later Baby. (n.d.). Egg freezing services. Retrieved May 1, 2007, from http://www.laterbaby.org/ egg-freezing.htm
Mills, S. (2003). Sperm banking: Keeping fatherhood as an option. Retrieved May 1, 2007, from http://www.cancersupportivecare.com/spermbank.html
Susan D. Bruce, RN, MSN, OCN[R], Contributing Editor
Contributing Editor Susan D. Bruce, RN, MSN, OCN[R], is an oncology staff nurse at Duke Raleigh Hospital in North Carolina.
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|Title Annotation:||A CLOSER LOOK|
|Author:||Bruce, Susan D.|
|Date:||Jun 1, 2007|
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