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She was 32 years old when breast cancer got in the way of her desire to become a mother. The cursed year of the pandemic had just begun when Rocío Reina (born in Malaga in 1987) had to face her own harsh reality: a lump in her right breast during a self-examination in the shower sowed more uncertainty into her plans for 2020. At that moment she drew on her experience as a family doctor, knowing that, at her age and with no family history of breast cancer, there was a good chance that it was a fibroadenoma (a non-cancerous breast nodule). However, subsequent tests (mammography, ultrasound and a biopsy) confirmed that the tumour was malignant. "I felt that life was coming to a full stop", says Reina, who recalls those days when she asked about the prognosis of her illness at the oncology clinic, but also asking whether she would be able to become a mother one day if everything went well.
It was then that she was referred to the assisted reproduction clinic at the Hospital Materno Infantil in Malaga to inform her of the effects that treatments such as chemotherapy and radiotherapy have on fertility. It was still too early to know which treatment she would undergo, but she needed to know all the options available to her in order to fulfil her desire to become a mother.
This is not always the case. Fear of the disease can create mental blocks for patients, all their thoughts are focused on the disease and they do not realise that, after overcoming it, they can resume the life projects they had put on hold. "A few years ago, being a cancer patient was to think that you had very little time left to live, but fortunately nowadays many cancers are in remission and have a very long survival rate," says embryologist Ana Ruiz, who highlights the effort made between specialities to inform patients that in the public health system it is possible to preserve their fertility (by freezing eggs or sperm) before undergoing cancer treatment completely free of charge and without a wait-list. "It is done immediately, whatever day of the week it is," states Ruiz, who works side by side in the unit with Isabel Castro, also an embryologist and doctor specialising in clinical analysis.
The process is different depending on the sex and age of the patient. The Materno Infantil hospital in Malaga is a pioneer and leading light in Andalucía in the cryopreservation of ovarian tissue in girls diagnosed with cancer. "In this case, the patient is referred from paediatrics to paediatric surgery, the case is studied, a committee meets and, if the case meets the requirements, then the paediatric surgeon extracts an ovarian wedge, sends it to the tissue bank and freezes it," explains Ruiz.
"If she is an adult woman over 16 years of age, who has developed [physically] and there is a possibility of a vaginal examination, depending on the time she has until she starts her cancer treatment, she can decide whether or not to undergo the vitrification process." This, explains the doctor, involves a hormonal treatment with FSH to stimulate the ovary and thus increase the production of oocytes (the cells in the human ovary that can divide to produce an egg (ovum)). It is injected and administered in a similar way to insulin. "The patient has to take this medication at the same time daily for 10 or 11 days, but every three days she has to go to the hospital so that the gynaecologist can carry out an ultrasound check to see how the ovary is responding and if it is necessary to increase the dose or introduce any other medication. During this follow-up, the gynaecologist will check if the ovary has enough follicles (the cavity where the oocyte is located) for the extraction to be viable. If this is the case, the last dose is administered and two days later the patient enters the operating theatre where the puncture-like extraction is performed, always under anaesthesia. With the help of a transvaginal ultrasound, the follicles are punctured, their contents are aspirated and in the laboratory, in the follicular fluid, we look for the oocytes, collect them, cultivate them and freeze them," explains Ruiz.
Ana Ruiz
Embryologist
In the case of males, if it is a boy who has not yet developed and does not ejaculate, "we can't do anything," says Ruiz. "In the case of an adult male, semen freezing is done in the tissue bank after we have assessed him here."
Time is precious in these cases, because cancer treatment takes priority, "which is why we shorten the deadlines as much as possible." This is the reason, according to Ruiz, why more and more women are opting to preserve their fertility. This is always done with the consent of the oncologist, "because if, for example, it were a breast cancer with positive receptors and the woman were to become pregnant, the rise in hormones could reactivate the tumour."
For this reason gynaecologist Ana Cerezo warns that cryopreservation is not a total guarantee that these patients will become parents, "but it is a possibility that is offered to them and it is a trump card that they have in store in case they want to use it one day", she says. Pregnancy rates are between 38-40%.
She assures us that it is always a good idea to wait a while following cancer treatment. "There are women who completely recover their ovarian function and others whose ovarian reserve is reduced, so as we don't know how each person will respond to the treatment, the ideal is to act before they receive treatment in order to anticipate possible side effects."
In any case, more men decide to freeze their reproductive cells than women, "perhaps because of the ease and speed of the process or because the incidence of cancer is increasing," says Ruiz.
3 laboratories are based in the assisted reproduction unit.
Andrology, cryobiology and embryology. Each one maintains very strict access and environmental conditions (temperature, sterility, humidity or particle level). In addition, there are two 'time lapse' incubators, with video cameras that record any incident in embryo development, which facilitates the selection of the best embryos for subsequent freezing.
This clinic's portfolio of services is broader than the aforementioned service and it offers all types of assisted reproduction techniques as long as they are due to a medical cause, be it cancer, severe endometriosis, occult ovarian failure (POI) or transgender people. In addition, the unit's team of specialists performs artificial insemination and in vitro fertilisation, and oocyte and sperm donation, "because, if a woman has run out of ovarian reserve, she can also receive donor oocytes before the age of 40." That is the age limit for taking on patients in the clinic, "although, in the case of oocyte preservation, the ideal is to do so before the age of 35," adds Cerezo.
Turning to the data, the cryolab currently has 679 oocytes frozen to preserve the fertility of 98 patients. The annual average since they started doing so in 2015 (only five patients) has increased to 26 patients last year, partly for oncological reasons, but also because of the addition of transgender patients to the programme. For men, the average of 25-30 patients per year doubled in 2024.
With regard to the use of these cryopreserved gametes (eggs or sperm) to preserve fertility, five women used them last year, three of whom became pregnant. For their part, 49 patients used cryopreserved sperm, resulting in 13 pregnancies.
Once frozen, these gametes have no shelf life. They can be stored for years and there is no problem with that. "The limit is set by the oncologist, who decides when the patient is ready to try to get pregnant, and the woman's own age. In the past, it was necessary to wait at least five years after finishing cancer treatment to undergo fertility treatment, but now the waiting time is getting shorter," says Ruiz.
Once the disease has been overcome, comments gynaecologist Ana Cerezo, the first thing patients are told is to try to get pregnant naturally. "Although when they come to us because they have not managed to get pregnant, they do so with hope and optimism because they know that now they have a real chance of achieving it thanks to the preservation they did back in the day." So, when the magic happens within the four walls of this leading laboratory in Malaga and pregnancy occurs, it is not only a success to be noted as a credit to the efforts of these professionals, but an "emotional and gratifying achievement, because it will mean that the patient has left the disease behind," says Cerezo.
Rocío Reina
Now a mother of two after beating breast cancer
More and more men and women are thinking about their fertility before undergoing aggressive treatments such as chemotherapy or radiotherapy. While the aim is to procure the possibility of having offspring with their eggs or sperm, "there are psychological aspects that come into play in the preservation that improve the patient's quality of life", according to Encarnación A. Hijano, psychologist at the Spanish fertility society (SEF).
This was the case with Rocío Reina, who overcame the fear and emotional impact of her cancer diagnosis and lived her recovery with hope after freezing her eggs. It was her dream and her motivation to move forward. She knew that if she overcame the cancer she would still have the opportunity to fulfil her dream of becoming a mother. Two years after finishing treatment, her oncologist gave her the green light to try.
She did not achieve it naturally and so, after being referred to the assisted reproduction unit in Malaga where she had her oocytes frozen, she became pregnant through in vitro fertilisation with her partner's sperm. "After implanting two embryos, we succeeded on the first try," she says joyfully. In July 2023, her twins were born after a "very good" gestation period. Today Rocío continues to go for check-ups. The fear of a possible relapse never goes away, but she feels lucky and "I thank life and health for being healthy and having two wonderful children."
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