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What are the options if you want to have children after cancer treatment?

If you have a desire to have children after a successful recovery from cancer, there are different options to (help you) fulfil it. If you are in that situation, remember you can count on the Oncofertility team and the entire CRG team of UZ Brussel to guide and help you throughout the process.

The options you have depend on your personal (health) situation.
Feel free to contact the Oncofertility coordinator for more information. She will organise an appointment with the CRG doctor, if needed. After the consultation we can anticipate your chances of getting pregnant by means of a few tests. For information about these tests, see 'Cancer treatment is over'.

We would like to mention here that the transplantation of ovarian tissue has so far resulted in the birth of more than thirty children.
Unfortunately, science has not come this far with prepubertal testicular tissue. That is why no information is available about testicular stem cell transplantation or in vitro maturation of testicular stem cells under 'Treatments with banked material'.
However, science is always in motion. The results of the research conducted in this field are promising. Despite the experimental nature of the study, when your fertility is at peril due to cancer treatment, it is worth considering to have testicular tissue cryopreserved for the future.

Finally, if you are trying to get pregnant, there are a few measures you can take to promote your chances of success and the birth of a healthy baby. These include cessation of smoking, restriction of alcohol intake, avoidance of being overweight and (for women) folic acid intake. The latter is important for the development of the foetus and can be bought over the counter.
Read more on the CRG website under Lifestyle and Folic acid.

Of the options below, transplantation of ovarian tissue is the most experimental procedure.
The first results have proven that the technique can actually work: between 2004 and 2012 more than thirty children have been born worldwide after the transplantation of thawed ovarian tissue. At this time scientists worldwide – including at CRG – are working towards an optimisation of the techniques, to improve the chances of success.
It is a fact that ovarian tissue transplantation does not currently offer the same guarantee of success as treatments with banked egg cells or embryos. But science is always in motion and fertility is an important factor in a woman's life. That is why it can sometimes be recommended to bank ovarian tissue for girls and young women who have to undergo cancer treatment.

The other 'treatments' are routine procedures in fertility practice. It involves procedures that involve the use of reproductive cells (gametes) or embryos that have been banked before the start of your cancer treatment. The chance of success of your fertility treatment(s) also depends on the number and quality of the frozen gametes and/or embryos that are available. And sometimes this will only become clear after thawing or warming this material because not all gametes and embryos survive the thawing procedure unharmed.
Treatment with thawed sperm cells
As a man with a stock of cryopreserved sperm, you have a good chance of becoming a father through assisted reproductive technology (ART). In that case you and your partner must undergo ICSI treatment, so that the fertilization can take place in optimal circumstances in the lab. We use the ICSI technique – injection of one sperm cell in one single egg cell – because it has the highest success ratio: out of all egg cells fertilized through ICSI, 90% grows to become an embryo.

How the ART treatment occurs exactly – and especially what it involves for the female partner – is explained on the CRG site: IVF/ICSI – Step by step.

If the amount and the quality of the banked sperm allow so, we may also perform a number of artificial insemination treatment cycles before proceeding with an IVF/ICSI treatment.
Artificial insemination is indeed a less burdensome procedure for women.
Treatment with thawed egg cells
As a woman with a stock of frozen egg cells, you still have a chance of becoming a mother through assisted reproductive technology (ART) if this does not happen spontaneously. The egg cells may have been retrieved during an egg cell pick-up after hormonal stimulation or they may have been picked up when still immature and then undergone in vitro maturation (IVM) before being banked.
In order to get pregnant with these egg cells, you have to undergo IVF/ICSI treatment, so that the egg cells can be fertilized in optimal circumstances in the lab. We do so by means of the ICSI technique – injection of one sperm cell in every egg cell – because it has the highest success ratio: out of all egg cells fertilized through ICSI, 90% grows to become an embryo.

How the ART treatment is carried out is explained on the CRG site: IVF/ICSI – Step by step.
Please note! You do not have to go through the first phase – stimulation of the ovaries up to the pick-up. Your treatment starts with preparing the womb for the replacement of the embryo. You can find this procedure under Replacement of thawed embryos, even though in your case fresh embryos are transferred.
Replacement of thawed embryos
Some patients have the option to go through an assisted reproduction technology cycle before the start of their cancer treatment, up to the time when embryos are banked.
If that was the case in your situation, you can rely on a stock of banked embryos in your attempt to get pregnant. As a prospective father you do not have to do anything in this case (except for being there for your partner), as a prospective mother you will start the treatment by preparing your womb for the replacement of an embryo. You will find information about that procedure on the CRG site under Replacement of thawed embryos.
Transplantation of ovarian tissue
When banking ovarian tissue we only keep the cortex (the outer layer) of the ovary, where the majority of primordial follicles are found, which contain the immature egg cells. The cortex is cut into small pieces of tissue (tissue fragments), which we also refer to as 'grafts'. The tissue fragments are then cryopreserved.

Before we can use that ovarian tissue to produce a pregnancy, the tissue must be examined at the lab.
First of all we will check the follicle density. In one thawed graft we will measure how many primary follicles can be found. On the basis of this analysis we can make a prognosis about the chances of success of a transplantation of ovarian tissue.
A second and just as indispensable test is conducted to see if there are any cancer cells in the ovarian tissue. The risk of this is related to the type of cancer you had and whether or not there were distant metastases at the time of banking. The risk is very high for patients with leukaemia or an ovarian tumour.
If we find that cancer cells are present, the ovarian tissue can under no circumstances be transplanted, as this would certainly result in re-introducing cancer cells into the body.

If a transplantation is possible, it will usually take place by means of laparotomy and a small incision in the abdomen. The tissue fragments are microsurgically attached, i.e. by means of minuscule stitches, to the place of choice in the abdominal cavity. This may be onto or near the remaining ovary, which is no longer functioning, or on the peritoneum where the removed ovary used to be located.
If the transplantation succeeds and the ovarian tissue receives blood again from the surrounding blood vessels, the menstrual cycle will resume after a few months. In that case a spontaneous pregnancy is possible, on the condition that the Fallopian tube is intact.
If that is not the case, hormonal stimulation with egg cell pick-up and ICSI may provide a solution. The embryos which are generated in vitro are then replaced in the womb.

If transplantation on the peritoneum or onto the remaining ovary is not possible, the ovarian tissue may be transplanted subcutaneously. In that case we will be able to let the egg cells mature at a later time, by means of hormonal stimulation, pick them up through the skin and fertilize them at the lab.
Up to present this technique has not yet resulted in a life birth.

At this moment the UZ Brussel based research group FOBI is conducting research to further cultivate the follicles in tissue fragments at the lab to obtain mature egg cells. This technique is called in vitro follicle culture.
If we succeed, it will mean a huge step forward. It would make the transplantation of ovarian tissue unnecessary because we would be able to develop the follicles, the egg cells and the embryos completely at the lab. This would be a solution, for example, for patients who are not eligible for a transplantation because cancer cells are present in their ovarian tissue.

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