If your findings are a malignant tumor, your findings will be discussed in the tumor conference, a group of specialists from various disciplines, and a treatment recommendation will be put on record. The treatment recommendation is based on the latest scientific findings and takes into account concomitant illnesses and the special circumstances of women.

The next steps regarding the treatment plan will then be discussed with you in a consultation at the oncology clinic.

The type of follow-up treatment depends on the size of the tumor, whether lymph nodes are affected and whether the tumor is hormone-sensitive.

Antibody therapy and/or chemotherapy and/or radiotherapy may also be necessary.

• Radiotherapy can be carried out in the MHH Clinical Department for Radiotherapy,
• Drug-based tumor therapy, such as chemotherapy, is usually carried out on an outpatient basis in the Gynecological Oncology Department of the Women's Clinic.

Cancer is a widespread disease. The period of diagnosis, treatment and aftercare is often very stressful for those affected and their relatives.

Family planning despite cancer? Prof. Dr. Dr. C. Schippert, Clinical Department for Gynaecology and Obstetrics, Gyn. Endocrinology, Reproductive Medicine MHH

What influence do chemotherapy or radiotherapy have on fertility in men or women?

Both chemotherapeutic drugs and radiotherapy can affect ovarian function in women and sperm production in men.

This means that a woman may have reduced ovarian function or even be unable to have children after chemotherapy. Unfortunately, chemotherapy drugs are not clever enough to kill or attack only the malignant cells, but can also affect all other rapidly growing cells in the body. Unfortunately, this also affects ovarian function and sperm production in men.

What measures can be taken before starting oncological therapy to preserve fertility?

For men it is relatively simple, i.e. we can freeze sperm in advance, i.e. cryopreserve them. This means that the man concerned then goes to a Clinical Department or practice, gives a sperm sample there and then this can be frozen for later fertility treatments.

For us women it is a little more complicated. But there are also several options here: firstly, in the case of radiotherapy in the lower abdomen, the ovaries can be lifted out of the radiation field before treatment by means of an operation in which they are fixed to the pelvic wall under the diaphragm, so to speak.
As a second option, parts of the ovaries can be removed and frozen. This is a fairly new method, practiced for the first time in 2004. In other words, I save half an ovary before chemotherapy and can then transplant it back into the woman's body afterwards if she no longer has ovarian function.
As a third method, we can retrieve the woman's eggs before chemotherapy and fertilize them with the man's sperm if she is in a stable partnership or freeze unfertilized eggs in order to be able to carry out fertility treatment later. However, this requires a period of around two weeks.
And as a last option, we can carry out an injection therapy called menopause therapy. The women concerned are given an injection once a month, which puts the ovaries to rest, i.e. puts them into menopause, so to speak.

With this method, we have to ask the oncologists beforehand how much time they will give us to take these possible measures. Because if chemotherapy or radiotherapy is very urgent and has to be carried out in a few days' time, then we can no longer carry out egg retrieval because we need a certain time window for this.

What are the chances of being able to have children afterwards?

If we have frozen the sperm of an affected man in advance, then the woman of the affected man usually only has the option of becoming pregnant afterwards via artificial insemination, i.e. fertilization outside the body in a test tube, because the sperm quality can suffer a little after we have frozen it - and it depends entirely on how old the affected woman is.
About 30% of women become pregnant per treatment attempt. If we have treated women before starting chemotherapy or radiotherapy, it depends on what methods were used. We reckon that if we have cryopreserved frozen eggs in advance, i.e. frozen them, around 25-40% of women can become pregnant afterwards if we use all the eggs.

If a piece of ovary has been frozen in advance, this is still a fairly new therapy, first carried out in 2004. Worldwide, 120 children have been born after ovarian re-transplantation, in Germany around 20. This is a fairly new method, but very promising and can also be used, for example, in patients who were still minors before the cancer diagnosis and were even children before puberty.
There is a lot going on at the moment and we hope that, by combining the various options, we can help some of the patients to become pregnant and have a child afterwards.

Where can I get more information on this topic?

The best place for patients to go is the FertiPROTEKTnetwork website -www.FertiPROTEKT.com. There is a lot of information there for both patients and physicians. This is a network from German-speaking countries, Germany, Austria and Switzerland, where you can find comprehensive information and contacts in the relevant regions.

Do health insurance companies cover the costs?

Unfortunately, the costs have not yet been covered by health insurance companies. And these are sometimes considerable costs. If we freeze egg cells, for example, it can easily cost €3 - 5,000, if we remove a piece of ovary, it can cost around e1,500. The cheapest option is the cryopreservation of sperm, which costs around €350. However, politicians are making efforts to ensure that some of the costs will hopefully be covered by health insurance in 2019. We and those affected are desperately waiting for this, because some couples have not yet been able to afford it. Which is an extreme shame, especially as chemotherapy drugs and radiation are many times more expensive than fertility-preserving measures. We are desperately waiting for a signal from politicians.

Status 2019