Cancer treatment and fertility at a glance
- Cancer treatments such as radiation, chemotherapy and surgery can sometimes damage the fertility of men, women and children.
- Before undergoing chemotherapy or radiation therapy, men and woman can preserve their sperm and eggs, or a couple may create and preserve embryos, for later use with assisted reproductive technologies like in vitro fertilization (IVF).
- Fertility preservation techniques have made it possible for men and women to conceive biologically related children after fertility-damaging cancer treatments for indefinite periods of time.
- After freezing reproductive cells prior to cancer treatment, IVF and intrauterine insemination (IUI) can assist couples to obtain pregnancy.
For more information on fertility preservation options, contact us today or request an appointment online.
Preserving fertility before cancer treatments
Oncofertility, the field of medicine where oncology intersects with reproductive endocrinology, is the medical practice of preserving the fertility of individuals who have been diagnosed with cancer. Cancer treatments, such as chemotherapy and radiation, are known to damage the cells in the human reproductive system. Some surgeries can also remove reproductive organs. These can make it more difficult for some individuals who have been treated for cancer to conceive.
Whether the patient is male or female, single or married, young or of reproductive age, cryopreservation techniques, such as egg, sperm or embryo freezing, can offer individuals the ability to conceive biological children later in life.
Impacts of cancer treatment on fertility
Though not all cancers or cancer treatments affect fertility, it is important to have a candid discussion with an oncologist prior to undergoing cancer treatment. The risk of infertility from cancer treatment depends on the type and stage of cancer, the type of treatment or treatments selected, and the individual’s age.
Fertility considerations for men
Certain cancer treatments, or cancer locations and types, can be harmful to a man’s sperm count, the genetic quality of the sperm, or even damage his reproductive organs. Cancer treatments and their potential effects on male infertility include the following.
Surgery that removes one or both testicles may cause infertility. The location and scope of surgery influences risk.
Radiation kills rapidly dividing cells in or around its target area. For example, radiation to or near the testicles can cause infertility or genetic damage to the sperm, but radiation to the chest will not. Radiation to the pituitary gland or hormone-producing areas of the brain may cause infertility by interfering with normal hormone production.
Chemotherapy also kills rapidly dividing cells throughout the body – both cancer cells and healthy cells. The man’s age, the type of chemotherapy, and the dose of the drugs can influence the risk. Certain chemotherapy agents are more damaging than others.
Bone marrow and stem cell transplants generally involve high doses of chemotherapy with or without full body radiation and, therefore, present a high risk of infertility.
Medication that targets certain cancer proteins can endanger fertility but some cancer medications appear to have no effect on male fertility. Patients should be sure to talk about all of these issues with their physicians.
Before a man begins chemotherapy, radiation therapy or undergoes other treatments that may affect his fertility, he can work with a fertility specialist to freeze his sperm.
Fertility considerations for women
Cancer treatments can decrease a woman’s ovarian reserve (the number of eggs in her ovaries), hormone levels and organs. Additionally, surgical treatments of some cancers can involve the removal of reproductive organs. Various cancer treatments and the ways they affect female fertility include the following approaches.
Surgery for gynecologic cancers such as uterine, ovarian and cervical that remove all or part of the reproductive system can eliminate the possibility of bearing a child.
Radiation can also damage the reproductive system if it is directed toward the pelvic area. The location and dose of radiation will influence the risk. In some cases, if a woman’s cancer therapy requires radiation to the pelvis, her ovaries may be repositioned surgically to protect her eggs from the radiation.
Chemotherapy can damage or destroy eggs. The patient’s age, the type of chemotherapy and the dose of the medications will affect the outcome.
Bone marrow and stem cell transplants involve high doses of chemotherapy sometimes combined with full body radiation. This presents a very high risk of infertility due to ovarian and uterine damage that may eliminate future childbearing capacity.
Medication that targets certain cancer proteins can endanger fertility, though some cancer medications appear to have no effect on female fertility. However, these may impact pregnancy. Women should talk about all of these issues with their physicians.
Timing plays a crucial role for women looking to preserve their fertility in the face of a cancer diagnosis. Egg retrieval can be time consuming to coordinate and, depending on the diagnosis and recommended cancer treatment protocol, may not be realistic for the health and well-being of the patient. The woman must decide if delaying cancer therapy is worth the risk.
The freezing of ovarian tissue can also be considered, but these techniques are still experimental and, according to the American Society for Reproductive Medicine, may only be offered in an experimental study with proper oversight.
Fertility considerations for children
Parents may act to preserve fertility of cancer patients who are minors if the child assents and the intervention is likely to provide net benefits to the child. Consultation with a doctor, oncologist or reproductive specialist is advised.
Getting pregnant after cancer
Frozen sperm, eggs, and embryos can be used years after they were cryopreserved. Years after freezing their reproductive cells and tissues, men that have frozen their sperm can have a biologically related child via IUI, IVF or IVF with intracytoplasmic sperm injection (ICSI).
Women who have frozen their eggs and couples that have frozen their embryos can achieve pregnancy via IVF.
Couples concerned about passing genetic predispositions for cancer (BRCA gene mutations that have been connected to breast and ovarian cancer for example) can test their embryos for particular mutations using preimplantation genetic testing.