FERTILITY PRESERVATION
Anegative pregnancy test followed by an exploratory colonoscopy ended with Katanya Watherston’s world being turned upside down after she was diagnosed with bowel cancer.
Recently married and actively trying to start a family, the 36-year-old knew oncology treatment such as chemotherapy could leave her with lifelong hormonal and reproductive complications that could affect her fertility. Still shocked from her diagnosis and almost afraid of what the future might now hold, she asked her surgeon, Dr Mike Egerton, what hope she had of ever being able to have children. Dr Egerton called his colleague, local gynaecologist Dr John Esler for advice. Dr Esler, a leading fertility specialist with more than 20 years’ experience, was able to offer hope through fertility preservation treatment.
Oocyte vitrification (freezing eggs) and embryo freezing are techniques Dr Esler uses every day to help infertile couples conceive. He could offer these same techniques to help protect and preserve Katanya’s fertility.
The aim of the medical fertility preservation is to give the patient the best chance of falling pregnant in the future. While Dr Esler’s first preference was to harvest and freeze Katanya’s eggs, the location of her surgery combined with her need to start chemotherapy meant harvesting and freezing eggs was not possible. Her best chance was a technique called ovarian cortex transplantation (OCT), which involved surgically removing one of her ovaries and freezing it for future use. Dr Esler said the technique had previously been considered experimental but recent published research found OCT was a very effective method of preserving fertility, allowing for natural pregnancy and restored ovarian function. Where oocyte vitrification (or egg freezing) was not possible, as in Katanya’s case, OCT was the fertility preservation technique of choice and should no longer be considered experimental.
“Katanya had good ovarian reserves but we did not have time to complete ovarian stimulation to enable us to collect and freeze her eggs, which meant her best hope to be able to achieve motherhood sometime in the future, was OCT,” Dr Esler says.
“We are also taking steps to try to protect Katanya’s remaining ovary from the effects of chemotherapy, but there is no guarantee this will be successful.”
Katanya said she was grateful her symptoms had led to an early cancer diagnosis and that she received advice to explore fertility preservation.
“Now I have hope that once my oncology treatment is completed and I receive the ‘all-clear’ I will be able to start a family,” she says.
“When I am ready, they will surgically graft a slice of my ovarian tissue back into my pelvis and several months later, the grafted ovarian tissue should begin producing reproductive hormones and follicular development. At this stage, I should be able to fall pregnant either with ovarian stimulation and IVF, or perhaps even naturally.
“I wake up every day filled with gratitude for the care and support I have received.”
Dr Esler says fertility preservation treatment was also available for young men, who for a variety of reasons find their fertility is affected.
“Chemotherapy and radiotherapy can affect sperm production – sometimes this is temporary, but in other cases it can be permanent. Once treatment begins, it may be too late to collect and preserve sperm as it may already carry genetic damage, so it wise to take and freeze a semen sample as a precaution to ensure they can still have children in the future,” Dr Esler says.
“Cancer is not the only reason for offering fertility preservation – there are numerous other medical conditions that may require medications which may be toxic to ovaries or sperm.”