Oncofertility: fertility preservation before cancer treatment

Why Cancer Therapies Threaten Fertility

Modern oncology treatments save lives, but many alkylating chemotherapy agents (such as cyclophosphamide) and pelvic ionizing radiation cause severe gonadotoxicity:

• In Women: Chemo drugs induce widespread apoptotic death of dormant primordial follicles, frequently causing premature ovarian insufficiency (POI) or immediate menopause.
• In Men: Chemotherapy destroys rapidly dividing spermatogonial stem cells, causing prolonged or permanent azoospermia (absence of sperm).

Rapid-Start Stimulation Protocols for Women

Historically, doctors believed ovarian stimulation had to begin on Day 2 of the menstrual cycle, causing delays of up to 4 weeks while waiting for menses.

Today, our team employs Random-Start Controlled Ovarian Stimulation:

• Treatment can begin immediately, whether the patient is in the follicular phase or the luteal phase.
• Stimulation medications (gonadotropins) are administered alongside letrozole for hormone-sensitive malignancies (such as ER-positive breast cancer) to prevent serum estradiol from rising above physiological thresholds.
• Oocyte retrieval is completed in just 10 to 12 days, allowing the patient to start chemotherapy or radiation on schedule.

Male Fertility Preservation: Rapid & Non-Invasive

For adolescent and adult men, sperm cryopreservation is non-invasive and should be performed prior to the very first dose of chemotherapy or radiotherapy.

• Even 1 or 2 semen samples collected over 24 to 48 hours provide sufficient material for multiple future ICSI cycles.
• For hospitalized patients unable to produce a sample, gentle bedside testicular sperm aspiration (TESA) can be coordinated with the oncology team.