Cancer treatment is about to start

If you – or your child – have to undergo cancer treatment and you are concerned about the consequences for your fertility or that of your child, then you should first talk to your oncologist. He knows the potential harmful effects of the treatment that has been prescribed to you and may be able to give you a prognosis about its impact on your fertility.
At the same time you should also contact the Oncofertility team at UZ Brussel. We can give you all the information about the options to safeguard your fertility or that of your child.
Cancer treatment should usually be started as soon as possible. Therefore, limited time is available for fertility preservation – sometimes up to two weeks, but sometimes only a few days.
Therefore, we have to act quickly: contact.

As mentioned in ‘Cancer and your fertility’ the (in)fertility of girls and women is closely related to the number of egg cells that is (still) available. These are contained in small vesicles (follicles) which are stored in both ovaries. Almost every cancer therapy – both chemo and radiotherapy – have a negative impact on the stock of follicles.
Sometimes the ovaries are displaced outside the radiation field prior to radiotherapy by fixing them superiorly in the abdominal cavity.
However, for girls who have not yet reached puberty, this procedure is seldom applied.
In case of radiotherapy and/or chemotherapy the most efficient protection of the stock of egg cells is to remove them from the body and to cryopreserve them in a tissue bank.
But ovarian stimulation in order to retrieve mature egg cells and to bank them, is currently not available for prepubertal girls. Research will be needed to investigate the developmental potential of egg cells harvested trough puncture of follicles in prepubertal ovaries.

Fortunately primordial follicles can also be used to prevent infertility: see also: What if you want to have children? Ovary transplantation.
The ovarian cortex, which is the outer layer of the ovary, contains a high number of primordial follicles. It can be cryopreserved after removing a part of the ovary or a complete ovary (ovariectomy, see below). The other ovary remains in place. This ovary can be used later as a site for transplantation of thawed ovary tissue.
One-sided ovariectomy
Cryopreservation of ovary tissue

One-sided ovariectomy – the procedure  

Ovaries are a few centimetres in size and can easily be reached with keyhole surgery (laparoscopy). Via this route we can remove one ovary with minimal risk of complications.
In order to see the ovaries with the laparoscope, the surgeon will first fill the abdomen with air. A surgical laparoscopy typically involves three small incisions (< between 5 mm and 2 cm) in the abdominal wall: one to insert the air and the laparoscope and two for the tools.

The procedure takes place under general anaesthesia and requires a (day's) admission to the hospital. In the six hours prior to the procedure you (or your daughter) are (is) no longer allowed to drink (or smoke!). The entire procedure, including stitching up the incisions, takes about forty minutes.
Usually you will be allowed to eat again after six hours. We ask you to stay in bed during the first twelve hours, because the anaesthesia has weakened you. The insufflation with air may cause discomfort in your abdomen for one or two days. The incisions of the procedure will heal after one week, and we will be able to remove the stitches after seven days.

The procedure is performed after written 'informed consent' containing an explanation about the procedure and the scientific state of affairs. In that document you give your permission for the procedure and you define what must happen with the cryopreserved material after the end of the storage period.
The costs of the procedure are covered by the Belgian public health insurance, obviously to the extent that you meet the conditions of affiliation.

Cryopreservation of ovary tissue  

We put cortex (the outside) tissue fragments of the removed ovary, containing the primordial follicles, into a tissue bank.
The tissue can be preserved without limitations at a freeze temperature of -196°C. At that temperature all biological processes are stopped and no ageing can occur.
However, a maximum preservation time is defined by law: click on the link and read the relevant information. Certainly for cryopreservation in the context of cancer treatment this information is crucial.

In What if you want to have children? Ovary transplantation we discuss how we can use the banked tissue with egg cells at a later time to try and repair your fertility.
It is promising that in the meantime more than thirty children have been born through assisted fertilization in which thawed ovarian tissue was used.
At the same time we have to emphasise that we can give no guarantee with regard to pregnancy and live birth. It cannot be guaranteed that cryostorage of your ovary tissue will result in a successful transplantation, and neither that a successful transplantation will result in the re-initiation of the egg maturation process. We are still dealing with an experimental technique.

That is why ovariectomy and cryostorage of ovary tissue should only be considered when the risk of becoming sterile due to cancer treatment is very high. Parents can only take this decision for their underage daughter after meeting and in consultation with the oncologist, the radiotherapist and the gynaecologist.


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