Monday, 17 November 2014

Cancer Treatment and fertility - 7 questions which patient need to think about and ask

Patients undergoing cancer treatment are at emotional cross roads where on one hand they are receiving counselling for treatment for life threatening condition-CANCER and on the other hand they are having discussions about long term effects of treatment of cancer on REPRODUCTIVE ORGANS and FERTILITY. This can be very difficult and challenging at times not only for patient but also for treating oncologist. 

Patient need to think and ask following questions to their oncologist/fertility specialist regarding fertility which will help them to make a right decision with regards to their treatment-

·       Will any of my cancer treatments affect my fertility?

·       Are there effective cancer treatment options for me that are less likely to cause infertility?

·       Are there any options for preserving fertility prior to cancer treatment?

·       How will I know if I am fertile after treatment?

·       If I don’t preserve my fertility before my cancer treatment, what are my parenthood options after treatment?

·       Do I have a type of cancer that can be inherited by my children?

·       How long do I need to wait after cancer treatment ends to start a family?



Courtesy- Fertilehope 



Sunday, 12 October 2014

Fertility Self Assessment Questionnaire



 Fertility Self-Assessment Tool

Advice about your fertility?
For most, achieving pregnancy causes no problems but some couples do experience difficulties.
If you’re a woman trying for a child and are worried you might be having problems, take this test. It will assess your situation and let you know if you should seek further medical advice.  


QUESTIONS

1. How long have you been trying to get pregnant?

a) Less than six months (0 points)

b) Between six months and one year (1 point)

c) Over one year (5 points)


2. Are you 35 years or older?

a) Yes (3 points)

b) No (0 points)


3. Do you have a regular period?

a) Yes (0 points)

b) No (5 points)

c) Don’t know (2 points)


4. Have you had two or more miscarriages in a row?

Yes (5 points)

No (0 points)


5. Have you been diagnosed with polycystic ovaries or polycystic ovarian syndrome (PCOS)?

a) Yes (5 points)
b) No (0 points)


6. Have you ever had surgery that may have affected your reproductive organs? (Uterus/tubes/ovaries)

a) Yes (5 points)

b) No (0 points)
  

7. Do you have or have you ever had Tuberculosis, Chlamydia, gonorrhea, or any other sexually transmitted infection (STI)?

a) Yes (5 points)

b) No (0 points)

c) Don’t know (0 points)
                                                                                                                                                                                          

8. Has anyone in your family had difficulty becoming pregnant or gone through early menopause?

a) Yes (5 points)

b) No (0 points)



ADVISE:
Depending on the answers-
If your score is more than 3, you should seek and consult fertility specialist regarding further advise in relation to achieving a pregnancy.



HELPFUL SUGGESTIONS:

Duration of subfertility:
It’s common for it to take longer than six months to get pregnant and in the majority of cases this does not indicate any problem.
If you’ve been trying to get pregnant for more than a year so it is worth getting a check up with your fertility specialist.


Why age matters
Both women and men are at their most fertile, (that is, most likely to conceive a child through unprotected sex) in their early twenties.
In women, fertility declines more quickly with age. This decline becomes rapid after age 33-35. A range of factors causes this, especially the decline in the quality of the eggs being released by the ovaries.
Around one-third of couples in which the woman is over 35 have fertility problems. This rises to two-thirds when the woman is over 40.
Hence, after the age of 35 if you are having fertility problems, it is advisable that you seek fertility specialists advise sooner rather than later. 

Regularity of periods and menstrual cycle
A period is a bleed from the uterus (womb) that is released through the vagina. It happens approximately every 28 days, though anywhere between 21 and 35 days is normal.
Periods are part of the female reproductive cycle.
Every month the lining of the womb thickens in preparation for receiving a fertilized egg. But if the egg is not fertilized, or even if is fertilized but not implanted in the womb, hormonal changes signal to this lining to break down. A period bleed is made up of this lining, and a small amount of blood.

 If you have regular periods, it is in most situations a good sign and it also makes it easier for you to keep track of your most fertile time of the month.

If your periods are irregular or absent, this may indicate a problem with your fertility cycle, in this case you should seek fertility advise sooner rather than later.

Polycystic Ovaries/Polycystic looking ovaries/Polycystic ovarian syndrome  (PCOS)
If you have been diagnosed with PCOS, it can cause ovulation problems, which may make it difficult to get pregnant so do seek advice.

More about PCOS
The most common cause of ovulation problems, leading to failure to become pregnant, is polycystic ovarian syndrome (PCOS). This is a condition associated with multiple cysts in the ovaries. As well as problems getting pregnant, symptoms can also include light, irregular or absent periods, weight gain, acne, and excessive hair growth.
The symptoms of this condition can be improved by losing excess weight through a healthy diet and exercise. Medicines or surgery can also help women with PCOS to ovulate, and achieve pregnancy.

INFECTIONS:
If you have been diagnosed with any of the infections like Tuberculosis, Chlamydia and Gonorrhea, please discuss with your fertility specialists about effect of these infections on fallopian tubes and hence fertility, which in turn makes it difficult to achieve pregnancy. 


Sunday, 15 December 2013

Fertility and Female Age

Social trends have led to deferring the age of child bearing not only in the developed countries but also in developing countries.

It is well understood that the number of oocytes in the ovaries decline naturally and spontaneously through process of programmed cell death.Hence chances of achieving pregnancy not only decline through natural conception but also through assisted reproductive technologies (IUI/IVF/ICSI)

This has been re-enforced by research led by Prof Siladitya Bhattacharya, of the Reproductive Medicine team at the University of Aberdeen (UK) who found that the chances of a woman having a baby following IVF go "very rapidly downhill" from the age of 37.Data was obtained from 121,744 women from across the UK.

They found the chances of having a baby following IVF start to decline by the time the woman reaches her mid-30s, but especially from 37.The team used data from women who underwent their very first cycle of IVF using their own eggs.The research also found that even after a pregnancy has been confirmed, women aged 38-39 were 43% more likely to have a miscarriage than women aged 18-34, while women aged 40-42 were almost twice as likely to lose the baby as the younger age group.

To conclude, age is amongst one of the most important factors which determines the success to achieving conception. Hence awareness of effect of age on fertility is important when counselling couples with infertility.

Monday, 18 November 2013

Fertility Preservation in Children with Cancer in India - A New Initiative to Address a Neglected Issue

The use of chemotherapy, radiotherapy and surgery in the treatment of children with cancer has implications for their future fertility. Guidelines exist in Europe and North America in regards to offering counselling and fertility preservation options to these patients when risk of loss of fertility is high. The scenario (prevalence, guidance, practice and utilisation) is unknown in India.

On 8th November 2013, a closed educational and brain-storming forum was held at Cankids India, New Delhi, with the presence of all stakeholders – patient survivors and their parents, parent support groups and representation from the largest childhood cancer NGO in India, and of health professionals (reproductive medicine specialist and pediatric oncologist). The aim was to educate, increase awareness and formulate an action plan to address the issue of fertility preservation in children with cancer in India.




An action plan was formulated which included
  • Development of a risk-based algorithm for fertility preservation at diagnosis of a child with cancer
  • Endorsement of algorithm by relevant organisations like Paediatric Haematology Oncology Chapter of Indian Academy of Paediatrics and by Indian Fertility Society
  • Dissemination and advocacy for adoption of algorithm by centres treating childhood cancer across India 
  • Commencement of monthly fertility clinic for childhood cancer survivors who have hitherto not been offered any counselling or service
  • Development of pan India programs for fertility counselling and services for children with cancer
  • Prospective collection of data from these patients so as to understand the current epidemiology