Fertility Issues

The effects cancer treatment may have on fertility

Having biological children in the future is something you may envision for yourself. If you want that option, it is important to understand that many cancer treatments can cause temporary or permanent infertility. Because fertility issues often arise as soon as treatment begins, it is essential to talk to your oncologist and a fertility preservation specialist before beginning treatment. Options for preserving your fertility become much more limited after treatment starts.

The effect of cancer treatment on your fertility largely depends on the type of therapies you receive.

Several treatment options, including some types of drug therapy, radiation therapy and surgery, have the potential to cause fertility-related side effects.

Your endocrine system – including the thyroid, pituitary gland, adrenal gland, ovaries and testes – releases hormones that control fertility. When cancer or cancer treatments damage one of these organs or glands, fertility issues can occur.

Surgery that damages or removes any of your reproductive organs will have fertility implications.

Radiation therapy can also affect fertility, especially if the radiation targets the area surrounding the reproductive organs, including your abdomen, pelvis and lower spine.

Other factors that affect your fertility include your age and gender, your cancer type and location, your treatment plan and your body’s response to treatment. For example, treatment-related side effects not directly related to fertility, such as a weakened heart, may also affect a woman’s ability to maintain a pregnancy or to go through labor safely.

Learn about your fertility preservation options from a fertility specialist. And, be sure to contact your health insurance provider to find out if your plan covers these expenses.

For women...

For a woman to become pregnant naturally after cancer treatment, she must have at least one healthy ovary to produce the egg, one healthy fallopian tube through which the egg travels, a healthy uterus for the baby to grow, and correct levels of certain hormones that help maintain the pregnancy. An absence or imbalance of any these factors can lead to fertility problems after cancer treatment.

The ability to have a menstrual period after treatment generally predicts whether a woman is still able to become pregnant, but that’s not always the case. Sometimes menstruation will stop and then start again several years later, and other times it will still be present even if the woman has become infertile.

Infertility for women is usually defined as not being able to get pregnant or maintain a pregnancy after actively trying for a year. It’s also important to know that in some women, cancer treatment may lead to early menopause (when menstrual periods stop).

Possible options to preserve fertility:

Before treatment:

  • Egg freezing (freezing unfertilized eggs)
  • Embryo freezing (fertilizing your eggs with sperm in a lab through in vitro fertilization (IVF) and then freezing the embryos
  • Ovarian tissue freezing (freezing tissues containing stem cells from part or all of one ovary; requires less wait time than other options)
  • Ovarian transposition (having your ovaries surgically moved higher up into your abdomen and out of the radiation field to minimize exposure and damage)
  • Radical trachelectomy (for cervical cancer patients, the cervix is removed and the uterus is preserved)

During treatment:

  • Ovarian shielding (placing external shields over your ovaries during radiation therapy to minimize exposure and damage)
  • Ovarian suppression (taking a medication that causes the ovaries to temporarily shut down during chemotherapy)

Fertility alternatives for consideration:

  • Donor eggs
  • Donor embryos
  • Surrogacy or gestational carrier (having another woman carry your baby): A surrogate gives her egg and is the genetic mother of the baby; a gestational carrier accepts an embryo (does not give her egg) and has no genetic relationship to the baby
  • Adoption
  • Assisted reproductive technologies (different fertility treatments that your doctor can use to help you get pregnant)
  • Freezing eggs/using frozen eggs
  • Freezing embryos/using frozen embryos
  • Freezing ovarian tissue/using frozen ovarian tissue

For men...

Men who are unable to produce or ejaculate healthy sperm are technically considered to be infertile. This can happen for a number of reasons and can often be a result of different types of cancer treatment.

The endocrine glands and related organs release hormones that control fertility. When cancer or cancer treatments damage one of these glands or organs, or alter the area of the brain that controls the endocrine system, issues with fertility can occur. Other factors, such as age and overall health, also play a role in male fertility problems.

Possible options to preserve fertility:

Before treatment:

  • Sperm banking (freezing and storing semen, which can be used later in intrauterine insemination (IUI) and in vitro fertilization (IVF).
  • Testicular sperm extraction (sperm cells and tissue are removed directly from the testicle)

During treatment:

  • Gonadal shielding (protecting the testicles during radiation therapy)

Fertility alternatives for consideration:

If you didn’t pursue the use of sperm banks, testicular sperm extraction or gonadal shielding prior to or during treatment, little can be done to reverse the effects afterward. However, family planning options are available, including the option of adoption.

Donor insemination is a possibility that allows you to use someone’s sperm that you know (such as a friend or relative) or the sperm of a random donor. The semen is then used to create a pregnancy via intrauterine insemination (IUI).