Cancer and fertility

If you are given a cancer diagnosis today, your chances of recovery are often much more favourable than ten or twenty years ago. Many cancers can now be cured efficiently by means of chemotherapy, whether or not combined with surgery or radiation. This is due, among other things, to new medical techniques, which allow for more aggressive forms of chemotherapy and radiotherapy to be applied.
Unfortunately many types of cancer treatment have a negative and often irreversible effect on your fertility (see gonadal toxicity). At UZ Brussel, the Oncofertility team strives to mitigate the damage inflicted by cancer treatment.

What is oncofertility?

Oncofertility is the medical discipline at the crossroads between cancer treatment and reproductive medicine. It aims to preserve the fertility of cancer patients who are at risk of becoming infertile due to chemotherapy or radiotherapy.

If several cases of ovarian cancer or other gynaecological cancers such as breast or endometrial cancer have occurred in your family, this may be the result of a hereditary defect. The occurrence of bowel cancer in your family may also be an indication of a hereditary cancer syndrome.
If there is a hereditary defect, it will occur, in these cases, in the so-called damage repair genes. Either there is no recognition of defects in the cell division or in the multiplication of the cell core, or the repair process of these errors is neutralised. That is how abnormal cells can continue to multiply.
A good example is the hereditary breast and ovarian cancer syndrome, the cause of which can be identified as a programming error in the repair genes BRCA-1 and BRCA-2 (BRCA stands for 'breast cancer').
Five to ten percent of all breast cancers are caused by a hereditary gene defect and in half of these the error resides in repair genes BRCA-1 or BRCA-2. The defect can be inherited either from the mother or the father. Also in case of hereditary ovarian cancer, a defect in the BRCA gen is often found.
If you are a carrier of a BRCA-1 gene mutation your lifetime risk of ovarian cancer is 25% to 60%. For a carrier of the BRCA-2 gene mutation the risk of ovarian cancer is 20%.

If your family history is an indicator to suspect that a hereditary factor may be involved in the development of cancer, a genetic test may provide a definite answer. You should consult your doctor to verify whether such a test is recommended. If so, your genetic material (DNA) can be tested by means of a blood test.
UZ Brussel will help you answer these questions at the Family Cancer division of the Oncology department.
For a large number of hereditary cancers with a known genetic cause the CRG can offer a solution in order not to pass on the carcinogenic genetic defect to your offspring.
The solution is called PGD or pre-implantation genetic diagnosis.
In short, what it comes down to is that you, as potential parent(s) with a hereditary defect, will undergo in-vitro fertilisation treatment. The embryos thus created in the lab are genetically tested for the defect that you or your partner (or both of you) carry. Only the embryos without the defect will be eligible for replacement in the womb and, hence, for further development. That is how we can avoid that you pass your known genetic defect onto your offspring. For a full explanation, see the PGD hospital.

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