Interview

Recently the group had a presentation on issues surrounding cancer and fertility. The presentation was given by Declan Keane, an Embryologist from the HARI clinic in Dublin, and afterwards we spoke to him to try summarise the issues for those unable to attend.

This gives general information, so please see you own consultant!

Declan, many people reading this will be facing into treatment for cancer, and fertility issues may not be their main concern. Why is it important to be aware of what effect treatment can have?

Because future fertility, although not the main concern at the time of diagnosis, can become a major issue later affecting quality of life.

So what are the options available for men and women?

For both male and female, the oncologist may decide to use a hybrid regimen of chemotherapy which is less gonadotoxic. For males specifically sperm banking prior to treatment is the simple and easy option. For many years this has been a recognised pre-treatment option and was available worldwide. This is now available in Ireland at the HARI unit in the Rotunda Hospital Dublin.

For females the options are

(1) Freezing Eggs/Embryos: However, often this is not feasible in the context of cancer because there is usually inadequate time to complete an ovarian stimulation cycle;

(2) Freezing Ovarian Tissue: Carried out pre-treatment but not available in Ireland as yet as this is still considered experimental worldwide. Centres in the UK and Europe do offer this option.

That seems somewhat limited, especially for women. Is that because of the technology or the laws in Ireland?

It is more so because of the technology. In Vivo there are extravagantly sophisticated systems which produce a mature egg, these are hard to recreate outside the body in the laboratory. There are many issues to be resolved in Ovarian Transplantation before the full clinical use of this emerging technique.

In the case of the HARI clinic, how do people go about making use of the services?

For sperm banking: The patient's consultant refers to the HARI unit. The man visits the HARI unit the next day. That is how fast it can happen. For Infertility treatment following chemotherapy/Radiotherapy: Again it is a doctor that refers the couple to HARI.

Is an option of a referral always offered if someone is about to embark on treatment?

No. It is at the discretion of the oncology specialist.

If a patient gets a referral, how long does the procedure take and how much does it cost?

Sperm banking can happen within 24 hours of referral. It costs £200 at present to freeze up to 3 sperm samples at HARI. At present it is a patient funded private service but we would look positively to the future where this would be a publicly funded service.

Conclusion:

This seems a very important option that should be made available to all patients who may benefit. Many people, especially young people, won't have yet thought of having a family, and it is only after treatment is over and they are preparing for the rest of their life that the issue children will be considered.

It would seem a pity that they could be denied that opportunity that could so easily be offered.