POGO SURVIVORS CONFERENCE Dr. Karen Glass MD, FRCS(C), FACOG Director Fertility Preservation Program, CReATe Fertility Centre Assistant Professor, University of Toronto
I HAVE NO CONFLICT OF INTEREST.
FERTILITY PRESERVATION OPTIONS BEFORE AND AFTER CANCER TREATMENT Before Cancer treatment After Cancer treatment
FERTILITY PRESERVATION OPTIONS BEFORE CANCER TREATMENT Do Nothing: Figure it all out later Do IVF: Freeze eggs or embryos Freeze sperm Do ovarian/testicular tissue freezing (requires a laparoscopic surgery for females) Protect ovaries/testes (nothing fantastic available yet)
FP OPTIONS AFTER CANCER TREATMENT Do Nothing: Figure it out later Do IVF: Freeze eggs or embryos must wait a minimum of 6 mos. Freeze sperm must wait a minimum of 6 mos. Do ovarian/testicular tissue freezing (requires a laparoscopic surgery for females)
DO NOTHING: FIGURE IT OUT LATER Could monitor ovarian reserve with AMH blood test Could do semen analysis
IVF: IN VITRO FERTILIZATION Recently one cycle of funded IVF added to budget in ON Oncology patients included Medications not included ($2000-4000). Compassionate donations. Starts Dec 1, 2015 (possibly) 12-14 day process to stimulate ovaries to produce eggs and then remove the eggs in an office based procedure Can remain frozen in liquid nitrogen indefinitely
IVF
EGGS EMBRYOS
FERTILIZATION
FAMILY BUILDING OPTIONS IF YOU ARE IN PREMATURE OVARIAN/TESTICULAR FAILURE Adoption Egg Donation Sperm Donation Embryo Donation Gestational Surrogacy
A D O P T I O N I N O N T A R I O
EGG/SPERM DONATION: KNOWN OR ANONYMOUS Known Donor work up: Full medical history and physical Infectious disease screening Genetic disease screening (Counsyl test, CF, Sickle cell, thalassemia) Pelvic ultrasound for egg donors Ovarian reserve testing or semen analysis Counselling of donor and her/his partner Known Egg donors should have had a child already (some exceptions) Known Sperm donors will have sperm quarantined for 6 months Legal contracts
ANONYMOUS EGG DONORS Assistance via agencies to locate donor appropriate for each patient: American Canadian Cycles can be Exclusive or Shared Work up done by agency but blood and AMH will need to be updated for egg donors. Takes 1-2 mos once matched to start actual IVF Costs $15,000-30,000 (CDN $ issues) OHIP likely will cover the costs of one donor stimulation & retrieval now
ANONYMOUS & KNOWN EGG DONORS Once all donor blood work and counselling complete, then cycle coordination starts Both donor and recipient start birth control pills to coordinate cycles Donor then starts stimulation medications when her period comes Recipients start Estrogen patches or pills to get lining of uterus ready for embryo On day of retrieval: Intended father will come in to produce sperm sample Intended mother will start progesterone injections or suppositories Embryo transfer on 5 days post egg retrieval
ANONYMOUS SPERM DONATION Counselling for intended parents General infertility work up for intended parents Sperm donors have completed the quarantine for 6 months Very simple, just order sperm from any CDN compliant sperm bank Costs: approx. $1000 per sample Female partner will have cycle monitoring to know when to inseminate sperm
EMBRYO DONATION Long waiting list Less expensive than egg donation plus sperm donation Minimal ability to choose details of characteristics of donor egg and sperm.
SURROGACY Can be known or anonymous (i.e. introduced via an agency) Will have full medical work up similar to egg donor Surrogate and partner will have counselling Intended parents have infertility work up and counselling New OHIP funding will likely cover the cost of the work up and embryo transfer for the surrogate Legal fees and expenses for surrogate not covered
CONCLUSIONS Every case is different Earlier FP consultation will leave more options Lots of options to build families post treatment New Ontario funding will help oncofertility pts!!
POT OF GOLD AT THE END OF THE RAINBOW