CANCER AND FERTILITY PRESERVATION
CANCER AND FERTILITY PRESERVATION
Many cancer treatments can affect fertility for both men and women and the affects may be temporary or permanent. Knowing the options for preserving your fertility can help you choose what’s right for you.
Common questions asked are:
How is my fertility affected by the cancer treatment?
When should I raise my concerns about preserving fertility?
How can I preserve my fertility before starting cancer treatment?
Can preserving my fertility interfere with a successful cancer therapy or increase my risk of the cancer reoccuring?
What happens after cancer treatment-will my child be affected?
Which fertility preservation option is best for me?
HOW IS MY FERTILITY AFFECTED BY CANCER TREATMENTS?
The likelihood of a cancer therapy harming your fertility depends on 3 factors:
The type and stage of cancer
The cancer treatment itself
The age when the cancer treatment occurs
For women, fertility can be compromised by cancer treatments that surgically remove the ovaries, and uterus, or by affecting the eggs (in the ovaries) or hormones produced by the ovaries. The ovaries contain all the eggs for a woman’s lifetime. Any reduction in the number of available eggs decreases a woman’s ovarian reserve and may cause infertility or early menopause. Older women are more susceptible to permanent ovarian damage.
For men, fertility can be compromised by chemotherapy and radiation or by the surgical removal of the testicles. These treatments can decrease sperm quantity, quality, or damage the DNA.
The effects of chemotherapy or radiation on fertility, for both men and women, depend on the medication used for chemo or the size and location of the radiation field. The most severe damage results from direct exposure of the ovaries or testicles to radiation or from chemotherapy medications called alkaylating agents such as Busulfan, Camrustine, Chlorambucil, Cyclophosphamide, Doxorubicin, Lomustine, Mechlorethamine, Melphalan, or Procarbozine.
WHEN SHOULD I DISCUSS MY CONCERNS ABOUT PRESERVING MY FERTILITY?
Fertility can be damaged with one cancer treatment session so fertility preservation methods must be done before the cancer treatment begins. As you plan the cancer treatment, let your physician know you’re interested in preserving your fertility. At TFC, we realize the time constraints and will meet quickly (same day or next day) with you to discuss the various preservation methods. Preservation options depend upon your age, relationship status, and personal preference.
HOW CAN I PRESERVE MY FERTILITY BEFORE CANCER TREATMENT?
Embryo freezing is a proven fertility preservation method when the man/woman has a partner with whom to create embryos. The woman takes fertility medications for about 10 days to stimulate multiple eggs to grow and the eggs are collected and fertilized with sperm in the laboratory to create embryos. The embryos are then frozen until pregnancy is desired. Embryo freezing is most successful if the woman is in her 20’s and 30’s; men’s ages can be 20’s -50’s.
Egg freezing is an option for women with no male partner. The woman takes fertility medications for about 10 days to stimulate multiple eggs to grow and the eggs are collected. The mature eggs are frozen (vitrified) for future use. When desired, the eggs will be thawed, fertilized with sperm and placed into the uterus (IVF - in vitro fertilization). Egg freezing is most successful if the woman has a larger ovarian reserve (in her 20’s or early 30’s), but may also be successful through the 30’s.
Sperm freezing is a proven fertility method for men. Before cancer treatment is started semen sample(s) are collected and the sperm isolated and frozen in multiple vials for future use. The sperm sample is usually obtained through masturbation, but may also be obtained via a needle inserted into the testes (testicular sperm extraction or TESE). Depending on the numbers of sperm available, the sperm samples may be used with intrauterine inseminations (sperm is thawed and placed directly into the uterus) or IVF.
Ovarian transposition involves repositioning the ovaries out of the planned radiation field (tacking them up and out of the way). However, the ovaries may still be exposed to scatter radiation. When pregnancy is desired, the ovaries can be returned to the original position or IVF may be needed to conceive.
Gonadal shielding involves careful placement of shields to reduce exposure to the ovaries/uterus or testes from scatter radiation. This is most effective if radiation is applied to an area far from your pelvis.
CAN PRESERVING MY FERTILITY INTERFERE WITH SUCCESSFUL CANCER THERAPY OR INCREASE MY RISK OF THE CANCER REOCCURRING?
There is no evidence that fertility preservation methods increase the risk of cancer reoccurring or directly compromise the success of the cancer therapy. However, success may be compromised if cancer treatment is delayed to pursue fertility preservation. As you plan your cancer treatment, your physician will discuss the amount of time available before treatment.
WHAT HAPPENS AFTER THE CANCER TREATMENT- WILL MY CHILD BE AFFECTED?
Planning for a pregnancy will occur after the cancer therapy is complete so there is no risk to the baby (fetus) from chemotherapy or radiation treatments. The risk of congenital disorders or other health problems in children born after cancer treatments doesn’t appear to be increased.
WHICH FERTILITY PRESERVATION OPTION IS BEST FOR ME?
If you're concerned about how cancer treatment might affect your fertility, don't wait; talk with your oncologist/urologist. Dr. Troché, in consultation with your oncologist, can provide information about fertility preservation options and recommend the optimal method before you begin cancer treatment. Whichever method you choose, TFC will expedite treatment to help preserve your fertility options.