Fertility, Cancer and Fertility Preservation
A woman is born with all of the eggs in her ovaries that she will ever have. Some, or all, of a woman's eggs may be damaged or destroyed by cancer treatments, and since women do not produce new eggs, this loss of eggs can cause infertility and premature ovarian failure (early menopause).
Risks of Cancer Treatments
Infertility occurs when a woman no longer produces mature eggs for ovulation or has some other condition that prevents her from getting pregnant or maintaining a pregnancy. Premature ovarian failure, or early menopause, occurs when menopause happens prior to age 40. Some women go into menopause immediately after treatment, which also translates to being infertile. Other women will resume menstruation and are fertile. Even if menstruation returns, the egg supply may have been damaged; therefore, women may enter menopause early and/or have trouble conceiving.
Are You at Risk?
Different cancer treatments affect the body in different ways. Chemotherapy, radiation, and surgery can all affect your reproductive system. In general, the higher the dose and the longer the treatment, the higher the chance for reproductive problems. Your age, the type of drugs, the location of radiation, and other factors can influence your risk. Ask your doctor how your treatments might affect you.
Chemotherapy can damage or destroy eggs.
Radiation can kill egg cells and damage reproductive organs in or close to the target area. For example, radiation to or near the ovaries can cause infertility. Radiation to the pituitary gland or the hormone-producing areas of the brain can also cause infertility by altering normal hormone production.
Bone marrow/stem cell transplant involves high doses of chemotherapy and/or radiation. These procedures present a high risk of infertility.
Surgery that removes part or all of the reproductive system can cause infertility. If cancer involves the ovaries, uterus, or cervix, talk to your doctor about the effects of surgery on your fertility and your ability to carry a baby.
Some cancer treatments can cause infertility, but not all will. Since it is difficult to determine if you will be fertile, you might want to consider preserving your fertility prior to cancer treatment. There are various options for preserving your fertility.
Embryo freezing is a proven, successful way to preserve your fertility. It requires sperm, so it is a good option if you are married. The process usually requires hormonal stimulation to mature your eggs. Your eggs are then retrieved and fertilized with sperm to create embryos. The embryos are frozen until you are ready to use them. The process takes two to six weeks.
Egg freezing is an experimental option for single women. Pregnancy rates are lower than embryo freezing, but the techniques are improving. The process usually requires hormonal stimulation to mature your eggs. Your eggs are then retrieved and frozen until you are ready to use them. The process takes two to six weeks.
Ovarian tissue freezing may be a good option if you do not have a lot of time before treatment or if you cannot have the hormonal stimulation needed for embryo freezing or egg freezing. It is an experimental surgical procedure that can be done in one day.
Ovarian shielding and ovarian transposition are methods of minimizing radiation to your ovaries. By decreasing the amount of radiation, you can decrease the amount of damage to your ovaries and your eggs.
Fertility-sparing surgery may be an option if you have cervical or ovarian cancer. Your stage and type of cancer may determine whether you are able to have this type of surgery.
Life After Cancer Treatment
Am I fertile? If you are having periods without the aid of hormonal supplements like birth control pills, you may still be fertile. The approximate number of eggs you have in your ovaries can be measured using hormone tests and ultrasound.
Is pregnancy safe after cancer? If you are thinking about trying to become pregnant, talk to your oncologist about when it would be safe for you. Most doctors agree that pregnancy after cancer does not increase your risk of recurrence, but more research is needed in this area. Your doctor may also want to check for damage to your heart and lungs caused by chemotherapy. This damage can lead to complications with the added stress of pregnancy. If you had radiation to your pelvic area, your uterus may have been damaged. Damage to your uterus might make it difficult for you to carry a pregnancy or cause other pregnancy complications. Consider seeing a high-risk obstetrician before trying to get pregnant.
What are my options for becoming a mother?
Natural conception may be possible if you remain fertile after treatment. Many women are able to get pregnant naturally after cancer treatments.
Assisted reproduction methods such as embryo freezing, egg freezing, and ovarian tissue freezing are usually thought of as pre-treatment options. They can also be done after cancer treatment. If you are fertile, but worried that you might go into early menopause before you are ready to start a family, you may want to preserve your fertility after treatment.
Donor eggs and embryos can be used if you do not have healthy eggs after treatment. Egg donation allows you to select an anonymous donor whose traits and characteristics closely match your own. The donor eggs can be fertilized with your partner's sperm to create embryos. Donor embryos usually come from couples that created embryos but have completed their own families. In either case, the embryos are then transferred to your uterus. This means that even if you are in early menopause, you may be able to carry a pregnancy and give birth.
Surrogacy is when another woman carries a baby for you. This may be an option if your doctor feels that pregnancy is unsafe or if you are unable to carry a child. If you are not in early menopause, your eggs can be fertilized with sperm and implanted into a surrogate. The surrogate would then carry your biological child. If you cannot use your own eggs, donor eggs or embryos can be used.
Adoption is an excellent choice for anyone wanting to become a parent. Adoption agencies may look at your medical history or require a letter from your doctor about your health. It is a good idea to select an agency that is open to working with cancer survivors.
Health of Children after Cancer
You can have healthy children after cancer. The birth defect rate in children of survivors is similar to the rate in the general population. They do not appear to be at a greater risk for getting cancer themselves, unless the parent's cancer is an inherited type. Talk to your doctor to find out if your cancer is genetic.
Questions to Ask Your Doctor
- Will my treatment affect my fertility? If so, what is the best way for me to preserve my fertility?
- How will I know if I am fertile after treatment? Are there tests that I can take?
- If I do not preserve my fertility before treatment, what are my parenthood options after treatment?
- Are premature ovarian failure or hormone deficiencies possible side effects of my treatment? If so, how do I treat them?
- After my treatments are over, how long will it take for my periods to begin again? If I am not having periods, should I still use contraceptives?
- Will I have normal sexual desire and functioning after treatment?
- Is pregnancy safe for me after treatment? If so, how long should I wait after treatment to become pregnant?
- What are the risks to my children based on my cancer and the treatment I receive?
- Do you know of support options for young women who have cancer or who have lost their fertility because of cancer treatment?
- Where can I find a facility that offers these services---fertility clinics, adoption agencies, etc.?
Southeastern Center for Fertility and Reproductive Surgery Fertility Preservation Fees
For information regarding fertility preservation fees, please contact our practice manager, L.J. Robinson, at (865)777-0088, option 2.