Cancer need not mean infertility

When 22 yearold Rasik Mehta name changed to protect identity who was pursuing higher studies in the US was detected with hotchkins lymphoma a type of blood cancer three weeks ago his shocked parents asked him to head back to India so that they could start chemotherapy as soon as possible The oncologist treating Mehta however first asked him and his parents to see an infertility specialist to preserve his sperm samples Dr Firuza Parikh Director Department of Assistant Reproduction and Genetics Jaslok hospital and Research centre says vitrification has ensured a 90 per cent plus chance of recovery of cells at her infertility clinic Pic Satyajit Desai Dr Ameet Patki Chairman Mumbai Obstetrics and Gynaecological Society to whom Mehtarsquos case was referred explains ldquoMore and more oncologists are becoming aware of the irreversible effects of exposure to radiation on the reproductive organs As a result in the last two years they have begun referring young men and women to infertility specialistsrdquou00a0With advanced prognosis most of these young patients get cured of their cancers says Patki That is why it is imperative that they preserve their gametes so that they can procreate at a later stage ldquoThe emergence of new technologies like vitrification have made it easier to freeze sperms eggs and fertilised embryosrdquo he saysu00a0Like Mehta an increasing number of cancer patients are being advised by their oncologists to freeze their sperms in case of men and eggs or fertilised embryos in case of women as chemotherapy puts them at a serious risk of infertility Healthy cells This is where vitrification an internationally acclaimed technique introduced in India in 2010 plays an important role Dr Patki explains ldquoVitrification is a relatively new process of gamete preservation It is a process wherein the sperms embryo or harvested eggs are dipped in liquid nitrogen with a temperature of 196 degC This process ensures that there is minimum damage to the cells and helps preserve the health of the gametes until the patient wants to recover themrdquou00a0Vitrification is more effective than itrsquos predecessor a procedure called Slow Freezing where the molecular water in gamete cells is replaced with a cryoprotectant and then frozenu00a0ldquoSince our cells are made up of 90 per cent water freezing them directly as was the case with Slow Freezing turns the molecular water into ice which leads to disintegration of the cells Also when we have to recover the gametes we have to again replace the cryoprotectant with molecular water and in this process a lot of cells dierdquo says Dr Patki A new chance Dr Firuza Parikh Director Department of Assisted Reproduction and Genetics Jaslok Hospital and Research Centre agrees ldquoIn our labs vitrification has ensured a 90 per cent plus chance of recovery of cellsrdquo u00a0Patients too seem to have faith in the new procedure Dr Patki says he has been carrying out sperm freezing procedures for around 10 cancer patients in a month and egg embryo freezing procedures for around four patients in a month At Jaslok too the numbers have been on the rise In 2011 91 samples of sperm freezing were carried out whereas till July this year the number has already touched 50 ldquoThe youngest sperm sample we have frozen is that of a 14 yearold boy with blood cancerrdquo says Dr Parikh Likewise egg embryo freezing was carried out for five cancer afflicted women in 2011 at Jaslok ldquoThis year we had the opportunity to help two young married women stricken with breast cancer After undergoing minimal ovarian stimulation the eggs were fertilised and each woman has frozen about 10 embryos thus giving them a significant chance of becoming mothers in the futurerdquo u00a0She adds ldquoThere is a very high chance of women undergoing what is known as chemical menopause and men becoming azoospermic medical condition of a male not having a measurable level of sperms in his semen It is associated with very low levels of fertility or even sterility following cancer treatment Vitrification gives cancerafflicted men and women the hope of becoming biological parents once their cancer is in remissionrdquo Thinking about the future Dr Patki cites the example of a 37 yearold commercial pilot who was diagnosed with breast cancer two years ago ldquoThe affected woman was unmarried but was in a steady relationship with her partner for a number of years Before she underwent chemotherapy I counselled them They chose to preserve an embryo as it is easier to preserve than an egg So we had to harvest the womanrsquos eggs and fertilise it with her partnerrsquos sperms to develop an embryo which we then preserved by the process of vitrificationrdquo Dr Ameet Patki VicePresident Mumbai Obstetrics and Gynaecological Society says that due to the irreversible effects of exposure to radiation on the reproductive organs many experts now refer men and women to infertility specialists PicNimish Dave He adds ldquoTwo years later the woman has recovered from her illness and also resumed work In a few years when she will be deemed cancer resistant we will implant the embryo in her womb and she can bear a childrdquou00a0Dr Parikh recalls carrying out the vitrification process of sperm freezing for an 18 yearold commerce student who was diagnosed with testicular cancer She says ldquoThe boy noticed a dull pain in his testes His family physician referred him to a urologist who diagnosed the young boy with testicular cancer The oncologist then had to counsel him and his parents about sperm freezing The family came to us on a Friday and told us that the chemotherapy was to start from Monday Over the weekend we managed to freeze enough sperms to plan for a future pregnancyrdquou00a0Dr Tapan Saikia oncologist Jaslok Hospital and Research Centre who counselled the boy and his parents saidldquoThe patient and hisher family needed to undergo counselling sessions wherein we educated them about the gamete preservation techniques and why it is necessary for them In India as the opinion of the family is very important typically 23 sessions need to be taken The families are under tremendous stress after discovering that a loved one is suffering from a lifethreatening diseaserdquou00a0Similarly Dr Patki says he had to counsel Mehta and his family about the gamete freezing procedure ldquoEven though they were preoccupied with how they could tackle their current crisis I had to make them think ahead to five years down the line when their son would be cured of cancer and would be ready to start a familyrdquo The unlucky survivors Unfortunately a few years ago when there was not much awareness about gamete preservation many young cancer patients paid the price for chemotherapy with sterilityu00a0ldquoI have had to counsel several young men who have had cancer in the past but had not advised to preserve their semen samples Unfortunately they developed irreversible azoospermiardquo says Dr Parikhu00a0Dr Patki adds ldquoI have counselled quite a few patients who were not advised to undergo gamete preservation by their oncologists prior to chemotherapy and had to deal with infertility issues later These patients harboured a lot of anger in them about not being guided properly I distinctly remember a patient dealing with infertility telling me that his doctor cured him of cancer but did not treat him as a complete person Needless to say procreation is an important human needrdquo he says Hope renewed Dr Mandar Nadkarni head breast care unit Kokilaben Dhirubhai Ambani hospital who refers around four young women in a year for egg embryo preservation too believes that more cancer patients need to be made aware of newer techniques that can help circumvent possible sterility following their chemotherapy ldquoIn 99 per cent cases women undergoing chemotherapy stop getting their menses and the chances of them returning are uncertain It is imperative for young women to preserve their egg embryo samples as this will help them procreate a few years later when they are declared fitrdquo However the procedure of gamete preservation is a little complicated in the case of women ldquoThe procedure has to take into account the menstrual cycle of the woman A woman starting chemotherapy may not be in the right phase of the cycle to start ovarian stimulation necessary for harvesting the eggs However in some cases the hormones injected for ovarian stimulation can have an adverse effect and worsen the patientrsquos condition Thus the procedure should be carried out with cautionrdquo warns Dr Parikhu00a0She adds ldquoFor some women in the advanced stages of cancer chemotherapy needs to be started quickly thereby making it difficult to wait for the time period needed for stimulationrdquo ldquoHoweverrdquo she concludes ldquoIt is important for young men and women afflicted with cancer to save their reproductive biological tissues Todayrsquos technology can allow these survivors to become biological parentsrdquo u00a0