What should women and men of child-bearing years know about preserving fertility prior transplant?

What should women and men of childbearing years know about preserving fertility prior to transplant?

First off, the average age for diagnosis of myeloma is about 65 to 69 years old. For women, this will be a very selective group of patients. Very small amount. Right. It's a very difficult question for me to tell patients exactly what to do. Right. I think this is more of a personal option. Right. But there are many things that needs to be considered. Women who are able to collect eggs for thinking about, subsequent pregnancy need to balance. What are the potential risks of this pregnancy. Because we know nowadays, these young patients are going to get induction therapy, they are going to get a transplant. They are going to now go to maintenance therapy. Right. There is no medications on the maintenance algorithm that is compatible with a pregnancy. We know Revlimid, or this type of medication like IMiDs compare to pomalidomide. Like some malformation in the fetus says there's a category D, so it's a must know. Medications like that are daratumumab, bortezomib, carfilzomib. Or maybe they are a category C, meaning that there is like, evidence in animal models that it could be harmful for the baby.

So, if female patient, of childbearing age wants to have family after the initial treatment, then it potentially needs to be planned very well. Fertility preservation measures should take place. Right. So this means that, specialized in fertility preservation should be consulted. Some of the academic centers have this capability or otherwise. They need to look outside from there. But most clinics, especially myeloma clinics, will have some resources for those patients. After that the patient needs to understand as well what is their reason of, for example, stopping maintenance therapy, right. Especially if they are a high risk, myeloma patient. Right. So they need to also understand that. Right? Because, even though a pregnancy may go to an end, there is also no way of like predicting on high risk patients, you know, for how long their disease are going to be under control. They could run into issues, make pregnancy right. So I think is a very I understand why. Patients who kind of want an answer I may want to do it, but, at the same time, I think it's a very difficult question to give you a straight answer. Right.

So there are many things involved. So it has to it has to go from your disease risk or the type of therapy that you are going to receive. Having of therapy time. Right. And yes, so you asked one of the question was like, what is the chances of going through menopause, right. High chances. Right. And even those some few patients may recover the ovarian function and get pregnant. Right. Is, less likely because this is a really high dose of chemotherapy. Right. But then also I think is the may prevent. Right. So there are medications that can be given to sort of like put the ovarian into a like, hibernation status. Right? So that, that it may then wake up down the road. Right. Or they may be able to collect eggs. Right. Separate egg and then do, in-vitro fertilization. Right. Those things could happen. Right. But I think there are many things that need to be taking into consideration. But I think there are many things that need to be taking into consideration. There are other things that people may also consider, right. Like a surrogate for pregnancy. Right. So they collect their eggs before and then the eggs could be once they are, process they could be implanting into a surrogate, you know, but there are many steps and complicated scenario. That's for females, right? It's a more complicated ordeal. Right. They are. They once were going to have their baby on them right.

Now for male is a little bit more straightforward, a little bit simple I would say. Right. So sperm banking is much easier. If there is a sperm banking that can happen before transplant. Of course. Also allowing for some washout period from medications like for example, like revlimid. And then the right person for these will be also fertility specialist usually, you know, a group of urologists or other people who will help, the patient and, you know, for the sperm banking and, you know, then subsequently, how are they going to be inseminated. It's a very, like, you know, very straightforward topic. Right? We're still talking about, an incurable disease. Right. So there are many things that the patients will have to consider. And then, you know, discussing with the doctors, find the right help, right. They want to go through and then plan accordingly. Right. In multiple steps.