Cancer treatment and certain treatments for long-term disorders can have a major impact on fertility, which can impact the ability for people to become pregnant in the future. Fertility preservation is a procedure, or group of procedures, done to help keep a person’s ability to have children. Some examples of fertility preservation are sperm banking, egg freezing, in vitro fertilization with embryo freezing, and certain types of surgical intervention for cervical and ovarian cancers. Here you can learn about the different types of fertility preservation.
Cancer & Medical Treatments and Fertility
Certain cancer treatments and medications can inhibit your ability to reproduce. These effects may be temporary, or last through the life of the patient. The chances of a cancer treatment harming your fertility truly depends on the type and stage of the cancer, type of treatment selected by your medical care team, and your age at the time of treatment. Some treatments and their subsequent effects could include:
- Surgery. Fertility can be altered by the surgical removal of the testicles, uterus or ovaries.
- Chemotherapy. The effects depend on the drug and the dose, and method of delivery. The most damage is caused by drugs called alkylating agents and the drug cisplatin. Younger women who receive chemotherapy are less likely to become infertile than are older women.
- Radiation. This can be more damaging to fertility than chemotherapy, depending on the location and size of the radiation field. The dosage of radiation also plays a heavily role in determining fertility. The higher the dosage, the more damage to the body, and to the eggs in the ovaries will happen.
- Other cancer-centered medications. Those hormone therapies and treatments used for certain cancers, including breast cancer in women, can directly affect fertility. In these cases, the effects are often reversible, and once treatment stops, fertility may be able to be restored. Although this is never guaranteed.
Discussing Fertility Preservation with your Medical Care Team
If you know you will be undergoing cancer or medical treatment that might place your fertility in jeopardy, talk with your doctor and schedule a meeting with a fertility specialist as soon as possible. A fertility specialist can help you to better understand your options, answer all of your questions and serve as your fertility advocate during your medical treatment duration.
In humans, both male and female, fertility can be damaged by a single cancer therapy session, radiation session, or likewise. For women, some methods of fertility preservation are typically done during certain phases of their menstrual cycle. If your specialist thinks you might need a delay in your treatment to take fertility preservation precautions, they will let you know the steps, work with your cancer and illness doctors, and help guide you through each stage.
How can Women preserve fertility?
Women who are soon-to-be going through cancer treatment or medical treatment do have various options for fertility preservation. While some options may not be available for all women, your medical care team will be able to point you in the right direction.
Some of the options are:
- Embryo cryopreservation. This procedure involves harvesting eggs, fertilizing them, and freezing them so they can be implanted later. Research shows that embryos can survive the freezing and thawing process up to 90% of the time.
- Egg freezing (oocyte cryopreservation). In this procedure, you will have your unfertilized eggs harvested and frozen. Human eggs do not survive freezing as well as human embryos.
- Radiation shielding. In this procedure, small lead shields are placed over the ovaries to reduce the amount of radiation exposure they receive.
- Ovarian transposition (oophoropexy). During this procedure, the ovaries are surgically re-positioned in the pelvis, so they are out of the radiation field when radiation is delivered to the pelvic area. However, because of scatter radiation, ovaries are not always protected. After treatment, you might need to have your ovaries re-positioned again to conceive.
- Surgical removal of the cervix. To treat early-stage cervical cancer, a large cone-shaped section of the cervix, including the cancerous area, is removed (cervical conization). The remainder of the cervix and the uterus are preserved. Alternatively, a surgeon can partially or completely remove the cervix and the connective tissues next to the uterus and cervix (radical trachelectomy).
How can Men preserve fertility?
There are also steps men can take to help preserve their fertility during cancer and medical treatment. Some of these options are:
- Sperm cryopreservation. This procedure involves freezing and storing sperm at a fertility clinic or sperm bank for use later. Samples are frozen and can be stored for years.
- Radiation shielding. In this procedure, small lead shields are placed over the testicles to reduce the amount of radiation exposure they receive.
Options for Parents to help Preserve the Fertility of a Child who has Cancer
Fertility should be discussed with their children as soon as the children are old enough to understand. Your consent, as well as your child’s, may be required before any preservation procedures may be able to be done. If your child has already begun the stages of puberty, options might include oocyte or sperm cryopreservation.
Females who have cancer treatment before puberty can opt for ovarian tissue cryopreservation. This procedure allows for ovarian tissue to be surgically removed, frozen and later thawed and reimplanted.
A method currently being researched for males, is a procedure where testicular tissue is surgically removed and frozen.
While none of these procedures are one hundred percent for saving fertility, they at least allow a chance for family planning later in life.
Does fertility preservation interfere with cancer therapy, or increase chances for recurrent cancers?
There is no direct evidence or studies that show current fertility preservation methods can compromise the success of your cancer or medical treatment. However, by delaying the start of your treatment, or altering the treatment schedule, this could alter the success of your surgery, chemotherapy or radiation treatment- which may have an impact on your therapy.
Fertility preservation has no direct link of increasing the risk of recurrent cancer diagnosis. Although, there has been a noted concern by some fertility specialists that when reimplanting frozen tissues, this could reintroduce cancer cells, if they were present at the time of the cryo-therapy freeze. Many specialists also note that this would also be dependent on the type and stage of cancer at the time of freezing.
Cancer Treatment & Increased Risk of Health Problems in Children Conceived After
As long as your fetus and baby are not exposed to your cancer treatments while in utero, the cancer treatments do not appear to raise the risk of congenital defects or disorders, or other health problems. However, if you receive cancer treatments that affect the functioning of your heart or lungs, or if radiation is done in your pelvic area, it is recommended that you discuss your options and potential risks with a specialist before becoming pregnant to prepare for possible complications.
The Best Fertility Preservation Options
Fertility preservation is never a guaranteed procedure, and options will be different for every human, and every situation. Your medical care team and specialists will help you to determine the best options for your situation, cancer or illness, and desired outcome. They will take into account your treatment plan, amount of time you have before treatment begins, and create the best approach for you.
Dealing with a cancer diagnosis or long-term medical illness is overwhelming in itself. Adding in the worry of being able to create and carry a child after treatment can make it that much more stressful. If you are concerned about your treatment and how it might affect your fertility, do not wait to meet with a fertility specialist. You do have options. Getting this information as soon as you get your cancer diagnosis can be very helpful and ease your mind about your plans for the future.
Alliance for Fertility Preservation