Fertility Preservation Toolkit

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Fertility Preservation for Gene Therapy

How does gene therapy affect fertility?

Chemotherapy is an essential step in gene therapy. Chemotherapy depletes the stem cells in the bone marrow to make room for the modified blood stem cells. Chemotherapy can harm the reproductive system by damaging or destroying reproductive cells (eggs or sperm). This could prevent the ability to have children in the future.1

Women are born with all the eggs they will ever have.2 Eggs destroyed by chemotherapy cannot be restored.3 While men make sperm throughout their lifetime,4 chemotherapy can destroy sperm in the body and the cells that create sperm.5 If sperm in the body are destroyed, this may cause temporary infertility. But if the cells that create sperm are destroyed, fathering a child may not be possible.6 Patients who may want to have children in the future, should talk with their doctor about options for fertility preservation before starting gene therapy.7

What is fertility preservation?

Fertility preservation is a way to collect, freeze and store eggs or sperm for potential future use before starting gene therapy treatment.8

What are the options for fertility preservation?

For women and girls:

Egg Freezing

  • This process takes about 2 to 3 weeks9
  • The patient receives a series of hormone shots to prepare the eggs
  • Eggs are collected in an outpatient procedure
  • The collected eggs are then frozen and stored

Ovarian Tissue Freezing

  • This is a surgical procedure
  • One ovary (or a part of an ovary) is removed
  • The ovarian tissue is frozen and stored
    When the patient wants to have a baby, the ovarian tissue is reimplanted into the body and is expected to produce eggs naturally
  • This is the only option for girls who have not started puberty11

For men and boys:

Sperm Banking

  • This process does not require a medical procedure
  • Sperm is collected, frozen, and stored
  • This can be done at a sperm bank, a clinic, or at home using a mail-in kit
  • If needed, sperm can be collected by surgery

Testicular Tissue Freezing

  • This is a surgical procedure
  • A small section of tissue is removed from a testicle
  • The testicular tissue is frozen and stored
  • When the patient wants to father a child, the testicular tissue is reimplanted into the body
  • This is the only option for boys who have not started puberty
  • This technique is investigational, and studies on maturing sperm from stored tissue are ongoing11

Questions for your doctor

The decision to be a parent is very personal. Young people may not have thought about this yet. Because gene therapy may cause infertility, patients should talk to their doctor and people close to them. Here are some questions to ask the doctor or healthcare team:

Will my treatment keep me from being able to have children?
What choices do I have to save my eggs or sperm? Do all of these have the same results?
Will fertility preservation be covered by my insurance? If not, how much will it cost?
Are there other ways to help me pay for this?
If I don’t save my sperm or eggs, are there other ways to have children later?
How long can my eggs or sperm stay frozen?
Can you refer me to a fertility specialist and genetic counselor so I can learn more?

Important Notice

This information was provided through a collaboration with the Alliance for Fertility Preservation, a 501c3 charitable organization. They are a team of professionals who have come together to advance the field of fertility preservation. Its mission is to increase information, resources and access to fertility preservation for cancer patients and the healthcare professionals who treat them.

References

1 Fertility Issues in Girls and Women with Cancer. NCI. 2024. https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women
2 Infertility and Fertility. National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/factsheets/infertility
3 Fertility Preservation Before Cancer Treatment: Options for People Born with Ovaries and a Uterus. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/patient-education/fertility-preservation-females-starting-treatment
4 Sohni A, Tan K, Song H, et al. The Neonatal and Adult Human Testis Defined at the Single-Cell Level. Cell Reports. 2019;26, 1501. Doi: https://doi.org/10.1016/j.celrep.2019.01.045
5 Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(19):1994. doi:10.1200/JCO.2018.78.1914
6 Fertility Issues in Boys and Men with Cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-men#cancer-treatments-may-affect-a-males-fertility
7 Loren A, Senapatti S. Fertility preservation in patients with hematologic malignancies and recipients of hematopoietic cell transplants. Blood 2019; 134 (9): 754. Doi: https://doi.org/10.1182/blood.2018846790
8 What is Fertility Preservation? National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/fertilitypreservation
9 Han E, Seifer D. Oocyte Cryopreservation for Medical and Planned Indications: A Practical Guide and Overview J. Clin. Med. 2023, 12(10), 3542; https://doi.org/10.3390/jcm12103542
10 Loren A, Senapatti S. Fertility preservation in patients with hematologic malignancies and recipients of hematopoietic cell transplants. Blood 2019; 134 (9): 749. Doi: https://doi.org/10.1182/blood.2018846790
11 Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. 2019. Practice Committee of the American Society for Reproductive Medicine. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-preservation-in-patients-undergoing-gonadotoxic-therapy-or-gonadectomy-a-committee-opinion-2019/