Es gibt zwei unterschiedliche Zellarten im Hoden, die unterschiedlich  geschädigt werden können durch eine Krebstherapie. Die sogenannten  Leydig-Zellen sind für die Testosteronproduktion verantwortlich und in  den In den sog. Sertoli-Zellen findet die Spermienproduktion und-  reifung statt. Die Leydig-Zellen sind robuster gegenüber Chemo- oder  Strahlentherapie. Daher kann es sein, dass zwar die Testosteronwerte  normal sind, aber dennoch keine Spermien mehr vorhanden sind. Ob noch  Spermien vorhanden sind nach der Krebstherapie hängt vor allem von dem  Überleben von spermatogonalen Stammzellen ab, also den Reservezellen,  aus den immer wieder Spermien heranreifen. Dies kann man jedoch  herausfinden, indem ein Spermiogramm, also eine Analyse der  Samenflüssigkeit ( Ejakulat) durchgeführt wird.

Being fertile means you have eggs and a uterus which is capable of  coping with a pregnancy. Hormone tests can be carried out on a blood  sample to check how many eggs are left. This should take place at the  beginning of your cycle, in other words shortly after your period has  finished. Here, the Anti-Müllerian hormone (AMH for short) is crucial,  as is the follicle-stimulating hormone (FSH) together with estradiol.  AMH is produced by the “dormant” follicles and can give an indication of  how many eggs are still there that cannot be seen in an ultrasound.  It’s important to know that your AMH value first increases with age up  until you are 24 and then drops. Furthermore, it is also influenced by  your general state of health, whether you take hormones etc. That is why  it is important to see this value in combination with other tests. FSH  tells you how much your own body needs to stimulate your ovaries for an  egg to mature. Since estradiol inhibits FSH, it is important that this  value is always determined at the same time so a reliable statement can  be made. The best time to do this is two to five days after the start of  menstruation when your cycle is still in its initial stages. An  ultrasound can also be carried out to count the follicles that get ready  in each cycle. This is most easily done with an ultrasound through the  vagina as the ovaries are located close to the vagina and are best  visible this way. If you do not like the idea of this kind of ultrasound  or you are still a virgin, an ultrasound of the stomach would be an  alternative. In this case, you should ensure that your bladder is full  as this improves visibility and also reduces obstructions from the  bowel. These tests tell you how many eggs are left, not how fertile you  are. Because you can get pregnant with only a few eggs. It therefore  makes sense to have these tests if you want to know your current status  and are perhaps considering freezing eggs. You should also know that the  costs of determining AMH are not covered by all health insurance  companies and total between around CHF 50 – 80. All other examinations  are covered by your basic insurance. If you have had radiation treatment  of the uterus, it is important that you know how high the dosage was.  An ultrasound can be used to measure the thickness of the endometrium  (the lining of the uterus) which is needed, among other things, for the  implantation of an embryo.

It is important to know that you should not get  pregnant during cancer therapy or until six months after your cancer  therapy has been concluded so make sure you use birth control when  having sex during this time. If you get pregnant after this time the  risk of having a healthy or unhealthy child is just as high as for  patients who have not had cancer. There is also no indication that  children of people affected by cancer have a higher risk of getting  cancer themselves. Naturally, the situation is different if your cancer  has a genetic cause. But that is also something that needs to be  discussed on an individual basis.

The costs for testing your fertility are covered by your basic  insurance, the only exception is the determination of AMH (see “How do I  know if I am still fertile? Are there tests that can find that out?  What kind of tests are they?”). Unfortunately, the costs of freezing egg  and sperm AFTER completed cancer therapy are not yet covered. Your  fertility clinic will be able to provide you with details of the costs.

There are several centres in Switzerland that have specialised in  freezing eggs/sperm. They are fertility clinics, in other words  specialists for fertility issues in both men and women. There is also a  list of centres that have specialised in these issues with a particular  focus on cancer patients, especially on preserving fertility before  cancer therapy. You will find this list of centres here: https://www.sgrm.org/de/kommissionen/fertisave-main-de/fertisave-zentren . We would be happy to offer first testing or counselling and you can  then decide if, and where, you would like to have your eggs/sperm  frozen. You can of course contact the relevant centres directly  yourself.