Scientific research at Brussels IVF
Research and clinical studies at Brussels IVF
Preserving your fertility during cancer treatments?
These days, the survival rates of cancer patients are much more favourable than they were 20 years ago. Unfortunately, however, many cancer treatments have a negative and often irreversible effect on your fertility. Our team at UZ Brussel is making a concerted effort to change this.
When you are diagnosed with cancer, you may have many questions that you may wish to ask.
We discuss the options for preserving your fertility with you in the event that you want to have children (one day).
For referring parties:
Are you referring a patient to preserve his or her fertility before starting cancer treatment?
Please contact us as soon as possible at +32 2 477 40 44 or oncofertility@uzbrussel.be
What is oncofertility?
Oncofertility refers to the medical field that offers patients who have been diagnosed with cancer a number of options to increase their chances of having a child after their cancer treatments and reduce the risk of becoming infertile due to treatment with chemotherapy, radiotherapy, or surgery.
If you or your child have to undergo cancer treatments, you may be considering the impact of this treatment on your or their fertility.
Your oncologist or you yourself can contact the Oncofertility Team at UZ Brussel. We then provide you with detailed information about all the options to preserve your fertility or that of your child.
Healthcare provider or medical referrer?
The Oncofertility team at Brussels IVF makes its services available to all medical referrers. General practitioners, oncologists, haematologists, paediatricians, and so on who want to give their patients, who have been diagnosed with cancer, a chance to preserve their fertility can contact us.
The referring physician always retains his/her autonomy. It goes without saying that the main priority at all times is the effectiveness of cancer treatment. The Oncofertility team will thus not take any action or suggest any treatment that may interfere with the course of cancer treatment.
For all your questions and requests or referrals, please contact our coordinator – Tel. +32 2 477 40 44.
For women/girls
As a woman, your fertility is largely determined by your ovarian reserve.
Side effects of chemotherapy
The toxic effect of chemotherapy on your ovarian reserve is strongly dependent on the age at which this therapy is administered. The types, combinations, and doses of medication, and whether this therapy is combined with radiation, also determine the damage to your ovarian reserve. The impact of newer cancer treatments, such as immunotherapy, on oocytes is not yet well known. However, it cannot be excluded that immunotherapy may also have an effect on fertility.
The consequences of damage to the uterus
When cancer therapies result in the surgical removal or radiation of the uterus (radiotherapy), surrogacy or adoption of a child are an alternative for women wishing to have a child.
From diagnosis to treatment: a roadmap
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After diagnosis
When you are diagnosed with cancer, you may have many questions that you may wish to ask. However, when a young person is diagnosed with cancer, one should always consider the fact that they may (one day) want to have children. Our team can advise and support you with this. In consultation with your treating physician, we will explore the effects of cancer treatments on your fertility and how to preserve it.
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Together we review your options before your treatment starts
Freezing oocytes:
A woman or girl (from puberty onwards) may have unfertilised oocytes frozen. The oocytes can be preserved through vitrification (flash freezing).
Thanks to the development of this (ultra-rapid) freezing technique, mature oocytes can be frozen with a high probability of survival after thawing.
A woman or girl (from puberty onwards) may have unfertilised oocytes frozen. The oocytes can be preserved through vitrification (flash freezing).
Thanks to the development of this (ultra-rapid) freezing technique, mature oocytes can be frozen with a high probability of survival after thawing.
Cryopreservation of ovarian tissue:
This intervention is mainly used when there is no time to stimulate the ovaries and freeze oocytes. Ovarian tissue freezing is also an option for girls.
Part of the ovary (and in some cases the entire ovary) is removed. This procedure is performed through keyhole surgery and under general anaesthesia. This is a day surgery. You will be given more information about the procedure during counselling.
Freezing embryos:
In specific cases, embryos may also be frozen.
Moving your ovaries:
Sometimes, prior to radiation therapy, the ovaries are moved higher up in the abdominal cavity out of the field of radiation. This is known as ovarian transposition.
The aim is to move them out of the field of radiation and possibly shield them from radiation from neighbouring tissues.
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During your cancer treatment
Hormonal therapy:
Hormonal suppression of your cycle is sometimes suggested as a method to protect your fertility during chemotherapy. The medication temporarily shuts down the hormonal function of your ovaries, to better protect them against the harmful effects of chemotherapy.
Hormonal suppression of your cycle is sometimes suggested as a method to protect your fertility during chemotherapy. The medication temporarily shuts down the hormonal function of your ovaries, to better protect them against the harmful effects of chemotherapy.
Cryopreservation of ovarian tissue:
During chemotherapy, ovarian tissue can be frozen, after consultation with your treating oncologist, to prevent your (or your daughter’s) loss of fertility. Whether an ovariectomy is still useful at this stage of your cancer treatment needs to be discussed with your cancer specialist and fertility doctor.
Displacement of ovaries prior to radiation therapy:
Sometimes, prior to radiation therapy, the ovaries are moved higher up in the abdominal cavity out of the field of radiation. This is known as ovarian transposition.
The aim is to move them out of the field of radiation and possibly shield them from radiation.
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After your treatment
A woman's ovaries are particularly vulnerable to the effects of chemotherapy and radiation, thus putting a girl or young woman at risk of early menopause after cancer treatment.
Monitoring your hormonal status and fertility after cancer treatment is therefore crucial:
- Bloodwork allows us to establish whether your hormones are balanced. The main values we measure are FSH (Follicle Stimulating Hormone) and AMH (Anti-Müllerian Hormone).
- After the blood test, we check the results against an ultrasound count of the follicles in the ovary(ies). This requires a transvaginal ultrasound.
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What if you want to have children (one day)?
If you want to have children after cancer, there are several options to (help you) achieve this. You can count on the Oncofertility team and the entire Brussels IVF team at UZ Brussel to assist you and offer guidance during this process.
Cancer treatments don’t always cause permanent infertility. The chances of a natural pregnancy are not non-existent after surviving cancer.
The options available to you depend on your personal (health) situation. Together we review whether the intensive treatment had an impact on your menstrual cycle and hormone levels with bloodwork and an ultrasound. These tests can be done six months after the end of your cancer treatment.
What medically assisted reproductive treatments are there?
Five frequently asked questions about oncofertility
Do cancer treatments always affect fertility?
Unfortunately, the answer is almost always yes. Chemotherapy – which targets rapidly dividing (cancerous) cells – usually also affects reproductive cells. Stem cells produce sperm through continuous and complex division. Chemotherapy stops this process, stopping sperm production altogether. Oocytes also go through divisions during the menstrual cycle, a process that stops during chemotherapy. As a result, your cycle is affected and your periods may stop. During your cancer treatment, you are infertile. Whether this is a temporary situation depends on several factors and is difficult to predict. Unfortunately, primordial oocytes in prepubertal girls and spermatogonial stem cells in prepubertal boys are also vulnerable to cancer treatments. Cancer treatments in young children can thus affect their fertility later in life.
How is fertility preservation treatment reimbursed in case of a cancer diagnosis?
If you need to undergo treatment to preserve your fertility and are affiliated with a Belgian mutual health insurance fund, you are entitled to a refund in the following situations: (1) f you have to undergo chemotherapy; as a man under the age of 45, as a woman under the age of 38, if you are a minor (boy or girl). (2) If you have your ovaries preventively removed because you have an increased risk of breast or ovarian cancer due to a genetic mutation. (3) If you have been diagnosed with a borderline ovarian tumour, or a different ovarian tumour. (4) If you have a testicular cancer that does not require radiation or chemotherapy. (5) If you need to undergo a stem cell transplant due to a blood disorder.
What will be reimbursed if I am entitled to reimbursement?
For men, the cost of freezing process and the cryopreservation period of sperm cells is reimbursed. For boys (before puberty), the procedure to remove testicular tissue (containing spermatogonial stem cells), and the cryopreservation process and period of testicular tissue. For women and girls after puberty, the procedure to freeze oocytes (hormonal stimulation, followed by oocyte retrieval) is reimbursed, also the freezing process and storage period of the collected oocytes. If you have a steady partner with whom you want to have children, you can have your oocytes fertilised with your partner's sperm and have the resulting embryos frozen. This treatment is also reimbursed. In women and girls (before or after puberty), we can remove and freeze ovarian tissue in certain circumstances. This procedure and the cost of storage of the ovarian tissue are also reimbursed.
What is the legal storage period when opting for cryopreservation?
Belgian legislation currently provides for a maximum storage period of ten years for the preservation of human gametes (oocytes and sperm cells). This legal deadline can be extended for medical reasons, however.
I am in remission and want to have children. What are my options?
If you want to have children after cancer, there are several options to (help) you achieve this. The options available to you depend on your personal (health) situation. Please feel free to contact the Oncofertility coordinator for more information. She will also schedule an appointment with a fertility doctor for you. After the consultation, we can assess your chances of pregnancy based on some tests. It is worth noting that the transplantation of ovarian tissue worldwide until 2022 has already resulted in the birth of more than two hundred children. Unfortunately, science has yet to make these advances for prepubertal testis tissue. Under ‘Treatments with banked material’, you will therefore not find any information about testicular stem cell transplantation or in vitro maturation of testicular stem cells yet. However, science is continually evolving and the results of research conducted in this field look more than promising. Despite the experimental nature of the research, testicular tissue banking is definitely worth your while for the future in light of the risks for your fertility following cancer treatments
Oncofertility counsellor, Iebe De Quick