Hope For Fertility After Cancer

Women. Wisdom. Wellness. Mar 7, 2018

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Cancer and cancer treatments can impact fertility for men, women, and children. It’s important to know how a cancer diagnosis may affect your ability to have a family – and what your options are for preserving your fertility during and after treatments.

“Patients should talk to their doctor about fertility as soon as they can,” says Julie Cuy Castellanos, WHNP-BC, women’s health nurse practitioner. “When possible, see a fertility specialist before you start cancer treatment to do a thorough review of all your options.”

Every diagnosis and every patient are different. Many factors may affect fertility, such as:

Cancer diagnosis (type, location, and stage)
Cancer surgery (type and extent)
Cancer treatments (type, dose, and number of treatments)
Existing fertility conditions
Mental and emotional strain of a cancer diagnosis
Other underlying health conditions
Time available to make fertility decisions before treatment begins
Your age

“Fertility depends on so many individual factors,” Cuy Castellanos says. “If time does not allow for a discussion prior to treatment, you can come back after treatment to do a fertility assessment and see what your options are to move forward.”

How Certain Cancers Impact Fertility

Cancers that affect the reproductive organs are more likely to affect fertility. This includes cancers of the:

Ovaries
Parts of the brain involved in reproduction
Testes
Uterus

Cancers elsewhere in the body that require higher levels of chemotherapy and radiation treatments also can cause infertility.

Risks To Fertility From Treatment

“In many cases, the treatment has more of an impact on fertility than the cancer itself,” Cuy Castellanos says.

Some key factors include:

Age. If a cancer diagnosis occurs before a child reaches puberty, risks to fertility are lower. The level of risks increases as children get older, as women get closer to menopause, and as men age and produce less sperm.
Chemotherapy. Chemo works by destroying rapidly dividing cancer cells. Egg and sperm cells become easy targets for chemo because they also rapidly divide. Higher doses of chemo or treatment with a combination of chemo medicines can increase the risk of infertility.
Chemotherapy and radiation. When given together, chemo and radiation pose a higher risk of infertility.
Radiation. Radiation uses high-energy rays to damage cancer cells and prevent growth. Radiation given to the brain or pelvic area, as well as total body irradiation, can damage the testes or brain function needed for reproduction.
Surgery. If cancer treatment requires surgery on the reproductive organs, fertility can be damaged. Scar tissue after surgery can also impact fertility.

In Men: How Cancer Treatments Affect Fertility

In puberty, the testes begin to make sperm cells. The testes continue to make sperm throughout a man’s life, although production can slow with age. Some cancer treatments can cause temporary infertility, while others may permanently damage the body’s ability to make healthy sperm.

Chemotherapy. Sperm production can slow down or stop permanently after chemo treatment. The impact on fertility depends on damage to the cells that make sperm. Men often must wait and see how the testes function after treatment.
Hormone therapy. These medicines reduce the amount of certain hormones in your body to prevent cancer cell growth. Hormone therapy can temporarily affect sperm production and fertility.
Immunotherapy. These medicines boost your immune system to help you fight cancer. How immunotherapy impacts sperm cell production is unknown.
Radiation. The high-energy treatment can damage sperm-producing cells or brain cells needed for reproduction.

In Women: How Cancer Treatments Affect Fertility

Girls are born with all the eggs they need in their lifetime. These eggs are stored in the ovaries. Monthly hormone changes that occur during menstruation cause the eggs to be released. Fewer eggs remain in the ovaries the closer you are to menopause, making infertility related to a cancer treatment more likely.

Different cancer treatments may cause temporary or permanent infertility or bring on menopause earlier than normal. How your cancer treatment impacts your fertility depends on many factors, including your age and length and type of treatment.

Chemotherapy. Chemotherapy can reduce the number of eggs stored in the ovaries. This may cause your body to release fewer eggs or no eggs during ovulation, causing irregular periods or making them stop.
Hormone therapy. Hormone therapy reduces the amounts of certain hormones in your body to prevent cancer cell growth, such as estrogen in breast cancer. Hormone therapy can temporarily affect how the ovaries release eggs.
Immunotherapy. These medicines boost your immune system to help you fight cancer. How immunotherapy impacts egg production or the uterus is not yet known.
Radiation. When this high-energy treatment is used to target cancer in the abdomen or pelvic region, the ovaries and uterus can be damaged. Total body radiation or radiation to the brain can affect brain cells needed for reproduction.

Focus On Fertility Preservation

There are numerous ways that adults, adolescents, and children can still have or expand their family when faced with cancer. “Options vary depending on the cancer and recommended treatments, but many times it is possible to preserve fertility,” Cuy Castellanos says.

While fertility preservation does not guarantee your ability to have biological children in the future, it does increase your chances.

About 15 percent of healthy couples are impacted by infertility caused by any number of factors. There can be underlying fertility factors unrelated to your cancer and treatment that affect your ability to have biological children, such as the quality and quantity of eggs or sperm preserved.

For Women: Fertility Preservation

A good time for women to think about their fertility is at their annual gynecological exam, Cuy Castellanos says.

“You can talk with your doctor about ways to minimize cancer risk, catch it at an early stage, and outline a general plan for your family planning and when you want to have children,” she says.

If faced with a cancer diagnosis, you will be better prepared to think about a fertility preservation plan that meets your needs.

Women preparing for cancer treatment can consider several ways to preserve their fertility, depending on their age and type of cancer. Common options include egg retrieval and freezing and ovary shielding.

Egg retrieval and freezing. Before treatment begins, you take medicines to stimulate the ovaries to release a group of eggs. Those eggs are removed and frozen for future use. When you are ready to start a family, the eggs can be thawed, fertilized, and implanted to begin a pregnancy.
Ovary shielding. Girls or women facing cancer treatment can take steps to protect their reproductive organs from the damaging effects of treatments. Medicines can be used to shut down the ovaries to protect the eggs. Ovaries and the uterus can also be protected from radiation with a lead shield or with special surgeries.

Ovarian tissue freezing is an experimental technique being used in young girls facing cancer before puberty. Ovarian tissue that contains immature eggs is removed and frozen. After treatment, the tissue is thawed and returned to the ovary. Pregnancies have occurred after this technique is used, but it only works for certain types of cancer.

For Men: Fertility Preservation

Sperm banking is often used to preserve fertility in men facing many types of cancer, not just testicular cancer. You may know that you want a family of your own, or you may be unsure. Preserving sperm lets you make the decision later on.

Sperm banking. You work with a sperm bank and provide a sperm sample that is frozen for future use. If you decide to have biological children, the sperm can be thawed and used for intrauterine fertilization or in vitro fertilization
Radiation shielding. If you need radiation to one testicle or the pelvic area, one or both testes can be covered with a lead shield to prevent cell damage.

Testicular tissue freezing is an experimental option for boys diagnosed with cancer before puberty. A tissue sample of sperm-producing cells is taken and frozen. After treatment, the tissue is thawed and returned to the testes. The hope is that this procedure preserves the ability to make sperm.

What Else Affects Fertility During a Cancer Journey?

People handle the stress of a cancer diagnosis and cancer treatment in different ways.

“The mental and emotional strain of a cancer diagnosis or side effects from treatment — like chronic fatigue or depression — can affect the desire to have a family,” Cuy Castellanos says. “It can be difficult to manage and have a high impact.”

Individuals and couples may find themselves being forced to make quick decisions about future family plans and fertility preservation at a time when it is not a top priority. Parents can also be faced with making a decision for their child about their future fertility.

“In some couples, the experience might strengthen them, but in others it can push them further apart,” Cuy Castellanos says.

Consider Other Options For Building a Family

Sometimes fertility for men or women does not return after cancer treatment. The ovaries may no longer release eggs, the testes may not produce sperm, or you may not be able to carry a pregnancy.

“Fortunately, there are various methods to help you build a family,” Cuy Castellanos says.

Options include:

Egg or sperm donation. Egg or sperm from anonymous or known donors can be used to make an embryo with your own egg or sperm. The embryo or embryos are then implanted in the uterus for pregnancy.
Embryo adoption. Some couples who go through assisted reproduction for themselves have additional embryos remaining. Couples often donate these embryos once they complete their families. You can adopt embryos that are then transferred to the uterus for pregnancy.
Gestational carriers. If you are unable to carry a pregnancy, you can work with a surrogate. Your embryo is placed in the surrogate’s uterus and she carries the pregnancy to term.

“Lastly, adoption is always a great option,” Cuy Castellano says. “There is a lot of uncertainty when dealing with cancer and fertility, but there are also a lot of options to complete your family.”