Survival rates among childhood cancer patients have progressively increased over the past four decades particularly due to advancements in cancer care. Presently, 3 out of 4 children diagnosed with cancer are cured from their disease. However, this success comes at a cost as nearly 60% of cancer survivors face infertility or even sterility due to effects of cancer and/or its treatment including chemo- and radiotherapy.  Chemotherapy also is often used for non-cancerous conditions such as autoimmune diseases like systemic lupus erythematosus (SLE) and hematological diseases. The American Society of Clinical Oncologists (ASCO) & American Society of Reproductive Medicine (ASRM) recommends informing cancer patients about the options available to preserve their fertility. Though fertility preservation is a gaining popularity in developed countries, it is not so in India due to lack of facilities and skilled personnel in this field.

 The Centre for Fertility Preservation (CFP) at Kasturba Medical College, Manipal is the first centre in the country to start fertility preservation and still remains one of the very few centres in the country offering male and female fertility preservation options for prepubertal and young adult cancer patients.  CFP is a global partner of the Oncofertility Consortium, USA along with active collaborations with world’s leading universities and institutes in Europe such as University of Muenster, Germany, University of Naples, Italy and University of Edinburgh, UK.

Fertility preservation services offered at CFP:

Men:

Sperm Banking: It is a simple way to preserve fertility in post pubertal and adult males, with a generally high success rate.  Semen samples are collected through masturbation, before treatment begins. Multiple collections (2-3) allow for more reproductive chances in future.

Testicular sperm retrieval: In cases of severe low sperm concentration or no sperm in ejaculate, sperm can be retrieved from the testicles of young adult males by surgical extraction and frozen for future use.

Women:

Embryo freezing: It is the most widely used fertility preservation method, and it is considered the best option for patients who are married or have a male partner. During this process, a woman’s ovaries are first hormonally stimulated to mature multiple eggs, which are then removed and fertilized through in vitro fertilization (IVF) with sperm to create embryos in the lab.  The embryos are then frozen for future use. The entire duration of the procedure can range from 2-4weeks.  

Oocyte freezing : This is a good option for single women who are unmarried/do not have a male partner/do not want to use donor sperm. It is similar to embryo banking except that the eggs are NOT fertilized before freezing. The entire duration of the procedure can range from 2-4weeks.  

Children/Adolescents:

Immature testicular tissue freezing in prepubertal boys: In children where there is no sperm production yet, immature testicular tissue freezing is offered. It is a simple surgical procedure where immature testicular tissue is removed and frozen for future use. This tissue contains stem germ cells which can be used to produce sperm in the future. While this method is currently considered experimental it is the best available option for pre-pubertal boys. When needed, the testicular tissue can either be transplanted back to the patient or used to generate sperm cells in the lab which then can be used to have a baby of their own through IVF technology.

Ovarian tissue freezing in pre & post-pubertal girls: In this procedure, an entire ovary or part of an ovary is removed laparoscopically and the outer surface (cortex) containing the immature eggs is frozen in strips for later use. Later, the patient can have pieces of the tissue transplanted back into her. A number of pregnancies have resulted from using this technique. In certain cases where a transplant is not safe because of the risk of re-seeding the original cancer, the tissue is used for maturating the follicles in the lab to harvest mature eggs. These eggs can then be used for fertilization and embryo production. Ovarian tissue freezing technique is currently experimental in prepubertal girls but may be the best available option for in small girls or women who must start their treatment immediately.

The uniqueness of the Centre for Fertility Preservation (CFP) at KMC Manipal, is that it bridges bench-to-bedside by also conducting intensive research, both clinical and fundamental, in the field of oncofertility, which is translated to patient care. CFP has received several research grants from national and international funding agencies. It also offers a vibrant PhD and postdoctoral program for young talents interested to explore various fundamental and applied aspects fertility preservation through multidisciplinary approaches. In addition, the centre has ongoing research activities in collaboration with Indian premier institutes in India like Indian Institute of Sciences (IISc), National Center for Biological Sciences (NCBS), National Institute of Immunology (NII) etc.

The primary goal of CFP is to make fertility preservation a routine practice in cancer care in India. CFP is actively collaborating with fertility clinics and cancer institutes across the country to promote and bring awareness among healthcare workers on the available options. Quoting an anonymous cancer survivor, “The goal is to bring quality to the lives we fought so hard to keep. We want lives that are rich, we want children and we want to be happy.” The Centre for Fertility Preservation aims to make this a reality for most if not all young cancer survivors in the near future.

Publications:

1.       Poojary, Keerthana Karunakar and Nayak, Guruprasad and Vasani, Ashna and Kumari, Sandhya and Dcunha, Reyon and Kunhiraman, Jyolsna Ponnaratta and Gopalan, Divya and Rao, Rajat Radhakrishna and Mutalik, Srinivas and Kalthur, Sneha Guruprasad and Adiga, Satish Kumar and Kalthur, Guruprasad (2021) Curcumin nanocrystals attenuate cyclophosphamide-induced testicular toxicity in mice. Toxicology and Applied Pharmacology, 433. pp. 1-15. ISSN 0041-008X

2.       Kalthur, Guruprasad and Adiga, Satish Kumar (2021) Mitochondrial Dysfunction and Oxidative Stress Caused by Cryopreservation in Reproductive Cells. Antioxidants, 10. pp. 1-23. ISSN 2076-3921

3.       Kumari, Sandhya and Dcunha, Reyon and Sanghvi, Sahil Piyush and Nayak, Guruprasad and Kalthur, Sneha Guruprasad and Raut, Sushil Yadaorao and Mutalik, Srinivas and Adiga, Satish Kumar and Kalthur, Guruprasad (2021) Organophosphorus pesticide quinalphos (Ekalux 25 E.C.) reduces sperm functional competence and decreases the fertilisation potential in Swiss albino mice. Andrologia, 53 (8). pp. 1-13. ISSN 0303-4569

4.       Meitei, Huidrom Yaiphaba and Uppangala, Shubhashree and Sharan, Krishna and Chandraguthi, Srinidhi Gururajarao and Kalthur, Guruprasad and Adiga, Satish Kumar (2021) A Simple, Centrifugation-Free, Sperm-Sorting Device Eliminates the Risks of Centrifugation in the Swim-Up Method While Maintaining Functional Competence and DNA Integrity of Selected Spermatozoa. Reproductive Sciences, 28. pp. 134-143. ISSN 1933-7191

5.       Kalthur, Guruprasad and Adiga, Satish Kumar (2021) Sperm oxidative stress during In vitro manipulation and its effects on sperm function and embryo development. Antioxidants, 10 (7). pp. 1-24. ISSN 2076-3921

6.       Kumari, Sandhya and Adiga, Satish Kumar and Hegde, Padmaraj and Kalthur, Guruprasad (2021) Structure‑based redesigning of pentoxifylline analogs against selective phosphodiesterases to modulate sperm functional competence for assisted reproductive technologies. Scientific Reports, 11 (1). pp. 1-7. ISSN 2045-2322

7.       Kumari, Sandhya and Adiga, Satish Kumar and Kalthur, Guruprasad (2021) The synthesis of a novel pentoxifylline derivative with superior human sperm motility enhancement properties. New Journal of Chemistry, 45. pp. 1072-1081. ISSN 1144-0546

8.       Gollavilli, Hemanth and Hegde, Aswathi R and Managuli, Renuka S and Bhaskar, Vijaya K and Dengale, Swapnil J and Reddy, Meka Sreenivasa and Kalthur, Guruprasad and Mutalik, Srinivas (2020) Naringin nano-ethosomal novel sunscreen creams: Development and performance evaluation. Colloids and Surfaces B: Biointerfaces, 193. pp. 1-12. ISSN 0927-7765

9.       Nayak, Guruprasad and Salian, Sujith Raj and Agarwal, Pooja and Poojary, Pooja Suresh and Rao, Arpitha N and Kumari, Sandhya and Kalthur, Sneha Guruprasad and Shreya, Ajjappla B and Mutalik, Srinivas and Adiga, Satish Kumar and Kalthur, Guruprasad (2020) Antidiabetic drug metformin affects the developmental competence of cleavage-stage embryos. Journal of Assisted Reproduction and Genetics, 37. pp. 1227-1238. ISSN 1058-0468

10.   Salian, Sujith Raj and Uppangala, Shubhashree and Cheredath, Aswathi and D’souza, Fiona and Kalthur, Guruprasad and Nayak, Vinod C and Adiga, Satish Kumar (2020) Early prepubertal cyclophosphamide exposure in mice results in long-term loss of ovarian reserve, and impaired embryonic development and blastocyst quality. PLos One, 15 (6). pp. 1-12. ISSN 1932-6203

11.   Hegde, Shweta and Poojary, Keerthana Karunakar and Rasquinha, Rhea and Crasta, Daphne Norma and Gopalan, Divya and Mutalik, Srinivas and Adiga, Satish Kumar and Kalthur, Guruprasad (2020) Epigallocatechin-3-gallate (EGCG) protects the oocytes from methyl parathion-induced cytoplasmic deformities by suppressing oxidative and endoplasmic reticulum stress. Pesticide Biochemistry and Physiology, 167. pp. 1-12. ISSN 0048-3575

12.   Nayak, Gurudas and Rao, Arpitha and Mullick, Prashansha and Mutalik, Srinivas and Kalthur, Sneha Guruprasad and Adiga, Satish Kumar and Kalthur, Guruprasad (2020) Ethanolic extract of Moringa oleifera leaves alleviate cyclophosphamideinduced testicular toxicity by improving endocrine function and modulating cell specific gene expression in mouse testis. Journal of Ethnopharmacology, 259. pp. 1-2. ISSN 0378-8741

13.   Rao, Arpitha and Nayak, Guruprasad and Kumari, Sandhya and Kalthur, Sneha Guruprasad and Mutalik, Sadhana P and Mutalik, Srinivas and Adiga, Satish Kumar and Kalthur, Guruprasad (2020) Exposure to first line anti-tuberculosis drugs in prepubertal age reduces the quality and functional competence of spermatozoa and oocytes in Swiss albino mice. Environmenal Toxicology and Pharmacology, 73. pp. 1-9. ISSN 1382-6689

14.   Adiga, Satish Kumar and Tholeti, Prathima and Uppangala, Shubhashree and Kalthur, Guruprasad (2020) Fertility preservation during the COVID-19 pandemic: mitigating the viral contamination risk to reproductive cells in cryostorage. Reproductive BioMedicine Online, 41 (6). pp. 991-997. ISSN 1472-6483

15.   Daddangadi, Akshatha and Uppangala, Shubhashree B and Kalthur, Guruprasad and Adiga, Satish Kumar (2020) Germinal stage vitrification is superior to MII stage vitrification in prepubertal mouse oocytes. Cryobiology, 93. pp. 49-55. ISSN 0011-2240

16.   Rao, Arpitha and Satheesh, Aparna and Nayak, Guruprasad and Poojary, Pooja Suresh and Kumari, Sandhya and Kalthur, Sneha Guruprasad and Mutalik, Srinivas and Adiga, Satish Kumar and Kalthur, Guruprasad (2020) High-fat diet leads to elevated lipid accumulation and endoplasmic reticulum stress in oocytes, causing poor embryo development. Reproduction, Fertility and Development, 32. pp. 1169-1179. ISSN 1031-3613

17.   Adiga, Satish Kumar and Tholeti, Prathima and Udupa, Karthik S (2020) Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic. Journal of Assisted Reproduction and Genetics, 37. pp. 1567-1577. ISSN 1058-0468

18.   Ganapa, Manikanta Sai and Mhatre, Saurabh Shekhar and Raut, Sushil Yadaorao and Pandey, Abhijeet and Kalthur, Guruprasad and Mutalik, Srinivas (2020) Novel Oral Drug Delivery Systems for Steroids: Overview and Recent Updates. Indian Journal of Pharmaceutical Education and Research, 54 (3). pp. 541-549. ISSN 0019-5464

19.   Tholeti, Prathima and Uppangala, Shubhashree and Bhat, Vasudeva and Udupa, Karthik S and Kumar, Vijay and Kalthur, Guruprasad and Adiga, Satish Kumar (2020) Oncofertility: knowledge, attitudes, and barriers among indian oncologists and gynecologists. Journal of Adolescent And Young Adult Oncology. pp. 1-7. ISSN 2156-5333

20.   Uppangala, Shubhashree and Fernandes, Gail and Salian, Sujith Raj and Kumar, Pratap and Kalthur, Guruprasad and Adiga, Satish Kumar (2020) Reduced ovarian response to controlled ovarian stimulation is associated with increased oxidative stress in the follicular environment. Reproductive Biology, 20. pp. 402-407. ISSN 1642-431