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Fertility preservation in cancer patients

Cancer treatment regimens can have a detrimental effect on female fertility, due to the removal of reproductive organs or the use of radiation therapy and cytotoxic agents. The extent of damage depends on follicular reserve, patient age, and the type and dose of treatment, with alkylating agents being particularly gonadotoxic. In young unmarried patients or in married patients who are diagnosed with cancer and who are going to start surgery or chemotherapy /radiation therapy, it is imperative to freeze their eggs or ovarian tissue prior to starting their treatment. In this way their fertility can be preserved. The most common cancers for which we do fertility preservation are Breast cancer, Hodgkin’s lymphoma, non-Hodgkin lymphoma & borderline ovarian tumours. We can preserve eggs in other conditions such as severe endometriosis, auto immune disorders, fragile x syndrome, turner mosaics and patients with Premature ovarian insufficiency POI (women < 40 years of age with low ovarian reserve AMH < 1.2 ng/ml). There are two methods of preserving fertility. If we have enough time before starting chemotherapy (2-3 weeks) we can go for oocyte freezing. If we have to start cancer therapy immediately, one can go for ovarian tissue freezing. oocyte freezing has already been discussed in other section. In ovarian tissue freezing, the ovary of the patient is removed by laparoscopy or laparotomy and the ovarian cortex is frozen using special vitrification method. Sperm cryopreservation is the standard fertility preservation technique before gonadotoxic therapies is initatiated in adult men and adolescent males. In prepubertal boys where semen cryopreservation is not possible and in some adolescent boys ejaculation is not possible, testicular tissue cryopreservation is an option for fertility preservation.We are the first in India (2006) and one of the few units in India who offer these two techniques of oocyte freezing (2007)and ovarian tissue freezing (2006).