Preservación de la fertilidad en pacientes con cáncer.

Este post es a próposito de la nueva guía de recomendación de la asociación americana de medicina reproductiva (ASRM), publicada en el mes de diciembre en el prestigioso journal Fertility & sterility órgano divulgativo de esta sociedad.

Iniciamos resaltando la importancia de sensibilizar a médicos y pacientes con respecto a este tema. Cada año  sólo en estados unidos se diagnostican más de 200 mil personas menores a 50 años, afortunadamente los avances de la ciencia han permitido lograr una mejor sobrevida de estos pacientes y la posibilidad de una paternidad futura.

El paso inicial es informar a los pacientes con respecto a sus posibilidades futuras de paternidad que incluyen el uso de gametos donados, el vientre subrogado ó en alquiler y la adopción.

Posteriormente deben ser referidos a centros especializados en el manejo de estos pacientes que les garanticen un rápido acceso. Existen algunos requerimientos los cuales pueden observarse en la siguiente ilustración:

fertilidad y cancer

 

 

PRESERVACIÓN DE LA FERTILIDAD: MUJERES.

Para las mujeres que serán sometidas a quimioterapia o cirugía de sus órganos reproductivos las opciones de preservación incluyen:

  • Criopreservación (congelación) de embriones: Esta puede ser una opción en mujeres adultas que posean pareja.
  • Criopreservación de óvulos: los mismos pueden obtenerse por ecografía transvaginal.
  • Preservación de tejido ovárico, se realiza a través de una cirugía la extracción del mismo.
  • Estimulación ovárica controlada inmediata: terapia farmacológica que induce la producción de más de un óvulo durante un ciclo menstrual.
  • Transposición ovárica: en pacientes que recibirán radioterapia se realiza un procedimiento quirúrgico en el cual se colocan los ovarios fuera del área de radiación.
  • Bloqueo hormonal con análogos gnRh, estos medicamentos “detienen” la actividad de las gónadas
  • Manejo conservador de la patología oncológica ( en lo casos en que es posible).

preservación de la fertilidad mujeres

 

PRESERVACIÓN DE LA FERTILIDAD: HOMBRES

En el caso de los hombres las opciones incluyen congelación de semen, recuperación espermática quirúrgica, además la criopreservación de tejido testicular y el uso de análogos Gnrh. ( ver lámina).

hombres fertilidad preservación

 

 

Como se mencionó anteriormente es importante informar a médicos y pacientes al respecto, además de formar unidades capacitadas con los recursos humanos y tecnológicos necesarios para el manejo de estos escenarios.

De la misma forma abrir la ventana de una posible paternidad futura podría ser quizás esa luz al final del túnel que muchos de estos pacientes necesitan y lo mejor es una posibilidad real.

Al final de este post las conclusiones del comité posterior a la discusión de este tópico, no lo olvides seas paciente ó médico, el presente puede ser obscuro pero existe un futuro que gracias a la ciencia es prometedor y en el cual ser padre podría ser una opción.

preservacion conclusiones uno

preservación conclusiones dos

 

 

 

 

 

Links de interés.

Fertility preservation and reproduction in cancer patients. The Ethics Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama

https://oncofertility.northwestern.edu/sites/oncofertility/files/legacy_files/uploadedfilecontent/ASRM_FP_in_Cancer_2005.pdf

ASRM fertility preservation sección.

https://www.asrm.org/topics/topics-index/fertility-preservation/

 

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