Fertility Issues

Take control of your reproductive health

Parenthood is an integral part of life that many individuals, including cancer patients, envision for themselves. However, for women, cancer treatments can unfortunately cause temporary or permanent infertility (the inability to start or maintain a pregnancy), and for men, aggressive cancer treatment can cause gonadal (or reproductive organ) failure. For both genders, fertility options become much more limited after treatments start, so it’s wise to talk to your doctor about safeguarding your fertility before you begin any type of treatment.

What causes fertility issues?

Several factors can impact fertility, including your age and gender, your cancer type and location, your treatment plan, and your body’s response to treatment.

Your endocrine system – including the thyroid, pituitary gland, adrenal gland, ovaries and testes – releases hormones that control fertility. When cancer or cancer treatments damage one of these organs or glands, fertility issues can occur.

If your doctor recommends surgery, be aware that damage to or the removal of any of your reproductive organs will have fertility implications. If radiation therapy is recommended, your fertility may also be affected, especially if the radiation will target the area surrounding your reproductive organs, including your abdomen, pelvis and lower spine.

Several chemotherapy drugs have been linked to fertility issues as well, including busulfan (Busulfex, Myleran), carmustine (BiCNU), chlorambucil (Leukeran), cisplatin, cyclophosphamide, lomustine (CeeNU), mechlorethamine (Mustargen), melphalan (Alkeran) and procarbazine (Matulane). It’s also not safe for you or your partner to become pregnant while either of you are taking hormone therapy drugs, including selective estrogen receptor modulators (SERMs), luteinizing hormone-releasing hormone (LHRH) analogs, and aromatase inhibitors (AIs).

Who is at risk for fertility issues?

Men and women who receive certain chemotherapy drugs, have radiation to their abdominal and/or pelvic areas, or have surgery to remove any of their reproductive organs have the highest risk for fertility issues. Older women also have an increased risk; in general, women who receive treatment before they turn 30 have a better chance of remaining fertile than older women.

When do fertility issues occur?

Fertility issues often arise as soon as treatment begins. The effects of chemotherapy or radiation therapy on the ovaries or testicles may be reversible, with function returning gradually a few months after treatment ends. In contrast, loss of function – and therefore loss of fertility – is permanent when these organs are surgically removed.

Fertility is especially important for people who are considering having children. If this includes you, ask your doctor for a referral to a fertility specialist before you begin treatment. Fertility preservation needs to happen before any chemotherapy or hormonal therapy begin.

How are fertility issues managed?

To date, only limited options are available for fertility preservation in men. The most commonly used is sperm banking. Women have a few more options (Table 1); however, many of them are still experimental.

If your cancer treatment plan poses a risk to your fertility, it’s important to think about how significant parenting is to you. Consider whether you want children, and think about your feelings regarding adoption. Also consider whether donor sperm or embryos are options, and whether you would be agreeable with using assisted reproductive technologies. If you’re in a relationship, make sure you consider your partner’s feelings on these issues as well.

Table 1. Women’s fertility preservation and parenthood options

Before treatment
Egg freezing: Freezing unfertilized eggs.

Embryo freezing (cryopreservation): Fertilizing your eggs with sperm in a lab through in vitro fertilization
  (IVF) and then freezing the created embryos.

Ovarian tissue freezing: Freezing tissues containing stem cells from part or all of one ovary; requires less
  wait time than other options.

Ovarian transposition: Having your ovaries surgically moved higher into your abdomen and out of the
  radiation field to minimize exposure and damage.

Radical trachelectomy: For cervical cancer patients, the cervix is removed and the uterus is preserved.
During treatment
Ovarian shielding: Placing external shields over the site of your ovaries during radiation therapy to
  minimize exposure and damage.

Ovarian suppression: Taking a medication that causes the ovaries to temporarily shut down during
  chemotherapy.
After treatment
Donor eggs / donor embryos

Surrogacy or gestational carrier (having another woman carry your baby): A surrogate gives her egg and is the genetic mother of the baby; a gestational carrier accepts an embryo (does not give her egg) and has no genetic relationship to the baby.

Adoption

Natural conception

Assisted reproductive technologies: Different fertility treatments that your doctor can use to help you get
  pregnant.

Freezing eggs/using frozen eggs

Freezing embryos/using frozen embryos

Freezing ovarian tissue/using frozen ovarian tissue

When should I talk to my doctor about fertility issues?

Talk to your doctor as soon as possible about all of your fertility options and life goals, and don’t make any snap decisions, as they may affect your parenting options for the rest of your life. Also, inquire about a possible referral to a doctor who specializes in fertility preservation.

Questions to ask your doctor about fertility

  • How will the cancer treatments recommended for my type of cancer affect my fertility?
  • How and where can I preserve my eggs? What is the process?
  • How do I find out if I am fertile before and after treatment?
  • How long should I wait before trying to become pregnant after treatment?
  • Will my cancer treatment pose any potential risks to my future children?
  • If I choose not to preserve my fertility, what options for parenthood do I have after treatment?
  • Where can I find support with fertility issues?

Additional Resources

 

 



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