By Soon Li Wei & Suhaila Said
KUALA LUMPUR (Bernama) – Syamimi (not her real name), an executive at a private company, was diagnosed with stage 2 breast cancer two years after her marriage when she was just 28 and underwent treatment for four long years.
Following her treatment and a series of tests and consultations with oncologists, she was told that she was free of cancer, much to her relief.
Unfortunately, when Syamimi, who was 32 then, and her husband planned to start a family, only then did they realise that her cancer treatment had taken a toll on her fertility potential and that her ovarian reserve had depleted. Eventually, Syamimi and her husband resorted to adopting a child.
Getting a cancer diagnosis is heartbreaking but learning that the treatment might also dash their dream of having a family can compound that heartbreak to an indescribable degree.
However, all is not lost for cancer patients who wish to have children as they can opt for fertility preservation prior to undergoing chemotherapy.
Fertility preservation is a process whereby eggs, sperm or reproductive tissue is preserved for future use. A host of fertility preservation options are available in the field of oncofertility, which refers to bridging the specialities of oncology and reproductive endocrinology with the purpose of maximising the reproductive potential of cancer patients and survivors.
Dr Mohd Faizal Ahmad, a reproductive endocrinology and infertility specialist at Hospital Canselor Tuanku Muhriz’s (HCTM) Advanced Reproductive Centre (ARC), said fertility preservation can help cancer patients to retain their fertility or ability to conceive.
"Many cancer patients want to have children after completing their treatment. Unfortunately, due to lack of awareness, they are not adequately informed and prepared for the risks to fertility that may accompany cancer treatments,” he said in a recent interview with Bernama.
HCTM’s ARC is the nation’s first oncofertility referral centre and it was opened one month ago on Aug 26.
ARC head Associate Prof Dr Abdul Kadir Abdul Karim said the level of awareness on fertility preservation is still low in Malaysia, hence referrals from oncology departments of other hospitals are still low.
"Even doctors and specialists are not aware of this procedure,” he said, adding that with the presence of the Malaysian Preservation Fertility Association (MPFA) he is hopeful that awareness will increase.
"We are working with many specialists from different fields of medicines in MPFA in order to help raise awareness among (cancer) patients for these options to be done before their treatment begins,” he said.
He said fertility preservation can also be recommended for younger patients and those who are still single but are diagnosed with cancer as it would enable them to start a family later on when they recover and get married.
He said cancer-stricken patients, upon diagnosis, will be referred by their doctors to the ARC where they will be briefed on the option to preserve their reproductive tissue.
"Usually, the impact of cancer treatments is irreversible, so the concept is not to delay the treatment and also to give them the option to preserve their reproductive tissue if they want to have a family," he added.
Dr Abdul Kadir said ARC offers its fertility preservation services starting from RM5,000 for each treatment, as well as for maintenance and the liquid nitrogen that is used to preserve the tissue.
Pointing out that Malaysia’s fertility treatment is mainly patient-driven, he said the public sector offers fertility services and treatments but on a limited basis.
"The private sector dominates this field but their treatments are usually expensive," he added.
HCTM’s Advanced Reproductive Centre’s conception can be traced back to 2008 when Dr Mohd Faizal, who was then an obstetrician & gynaecology specialist at Hospital Universiti Kebangsaan Malaysia (now known as HCTM) was offered an opportunity to sub-specialise in oncofertility.
He said two years ago he met an oncofertility specialist Prof Dr Nao Suzuki, who is president of the Asian Society of Fertility Preservation in Japan, at an international fertility conference in India who informed him that there was no Malaysian representative in Asian (oncofertility) preservation.
“He then offered me a place to do research and training on ovarian tissue cryopreservation (OTC) in Japan and I managed to get a scholarship from UKM to pursue a three-month study on OTC in 2019,” he said.
OTC is a type of fertility preservation whereby part or all of an ovary is removed and the tissue that contains the immature egg is frozen and saved for future infertility treatment.
Dr Mohd Faizal said although OTC is still relatively new in Malaysia, Japan has been using this procedure for 10 years now.
However, before HCTM started offering OTC in August 2019, it not only had to get the approval of the Ministry of Health but also the National Fatwa Council.
“According to the National Fatwa Council, freezing of sperm and oocyte (immature egg cells) is not allowed for single people who are not ill but there is no guideline for cancer patients. After several meetings with them, we were given the green light to perform the procedure on cancer patients,” he explained.
Dr Mohd Faizal said Malaysia has good grounds to offer oncofertility services based on the National Cancer Institute’s data and survival rates among cancer patients.
"About 90 percent of haematological and breast cancer patients in Malaysia have a good remission rate due to early detection of the disease at stage 1 and 2 and they have a good quality of life after completing their treatment.
"However, the fertility preservation option is not offered to them once they are diagnosed with cancer. This is because when it comes to cancer, the top priority is given to treatment,” he said.
But by the time they complete their cancer treatment, their reproductive tissues are destroyed and there is no question of them considering any fertility preservation procedure.
Dr Mohd Faizal said the success rate for cancer patients and survivors to become pregnant through OTC is between 30 to 40 percent worldwide and that 90 percent of hormones that were lost during treatment can be replenished.
He said cryopreservation requires a surgical procedure to remove the ovary or part of it.
"The tissue containing immature eggs is frozen and stored for use later in life. This tissue can be stored up to 10 years and can be re-implanted in the body," he said.
He also said that OTC is usually only considered in certain cases when the patients do not have time to undergo controlled ovarian stimulation for embryo or oocyte cryopreservation.
"For those who are planning surgery or cancer treatment once they are diagnosed at stage 1 or 2 of the disease, we would recommend that they do the OTC first but this would depend on whether they have already done their first round of chemotherapy.
"This is because more than 40 percent of reproductive tissue cells are damaged (during chemotherapy), so we have to review the treatment first before we can offer OTC to them,” he said, adding that OTC is not recommended for women over 40 and who have a large ovarian cyst and are in the late stage of cancer.
Edited by Rema Nambiar
Malaysian National News Agency
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