Gynecologic Cancer

Effects of Cancer Treatment on Fertility

For women who want the option of having children, cancer treatments can unfortunately cause temporary or permanent infertility (the inability to start or maintain a pregnancy). Therefore, before you begin any type of treatment, talk to your health care team about fertility. Your options become much more limited after treatment starts. In some circumstances, you may want to consult with a fertility expert about storing your ova prior to chemotherapy, in case sterility results from treatment.

Fertility requirements

The endocrine glands and related organs (ovaries, thyroid and adrenal gland) 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, fertility issues can occur.

For women to become pregnant after cancer treatment (without reproductive assistance), they must have at least one healthy ovary (to produce the egg), a healthy fallopian tube (through which the egg travels), a healthy uterus (for the baby to grow), and the correct levels of specific hormones.

The ability to have a menstrual period after treatment generally predicts whether a woman is still able to become pregnant, but that is not always true. 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. It is also important to know that in some women, cancer treatment may lead to early menopause (when menstrual periods stop).

In general, if a woman receives treatment before she turns 30, she has a better chance of remaining fertile than her older counterparts. However, several other variables also play a role in fertility, including the type of treatment received.

Treatments and their effects

The effect cancer treatment has on your fertility largely depends on the type of treatment you receive. Other factors that play a role include your cancer type and location, your age and gender, and your body’s response to treatment.

Several treatment options have the potential to cause fertility-related side effects. If your doctor recommends surgery, be aware that the removal of your uterus, pelvic lymph nodes, or one or both ovaries has fertility implications. If radiation therapy is recommended, fertility may also be affected, especially if the radiation will target the pituitary gland in the brain or your reproductive organs, including the abdomen, pelvis, lower spine, ovaries or uterus.

Several chemotherapy drugs have been linked to fertility issues as well, including cisplatin, cyclophosphamide (Cytoxan, Neosar), chlorambucil (Leukeran), busulfan (Busulfex, Myleran), procarbazine (Matulane), carmustine (BiCNU), lomustine (CeeNU), mechlorethamine (Mustargen) and melphalan (Alkeran). It is also not safe to become pregnant while taking hormone therapy drugs that lower hormone levels after primary treatment, including selective estrogen receptor modulators (SERMs), luteinizing hormone-releasing hormone (LHRH) analogs, and aromatase inhibitors (AIs). For your specific treatment-related fertility implications, talk to your doctor.

Your feelings about parenthood

If your cancer treatment plan poses a risk to your fertility, it is important to think about how significant parenting is to you. Consider whether you want children, and think about your feelings regarding adoption. Also consider whether donor sperm or embryos are options, and whether you would be ethically and legally agreeable with using assisted reproductive technologies. If you are in a relationship, make sure you consider your partner’s feelings on these issues as well.

Understanding your feelings on parenthood will help you determine which options are worthwhile to pursue. Talk to your doctor about all of your options and don’t make any snap decisions, as they may affect your parenting options for the rest of your life.

Questions to ask your doctor about fertility

  • Will the recommended cancer treatments affect my fertility?
  • What are my fertility preservation options?
  • If I choose not to preserve my fertility, what are my parenthood options after treatment?
  • How will I know whether I’m fertile after treatment?
  • How long should I wait after treatment before trying to become pregnant?
  • Will my cancer treatment pose any potential risks to my future children?
  • Can you recommend a fertility specialist?
  • Where can I find support?
Fertility preservation and parenthood options
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 created 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
  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 the site of 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)
After treatment
• 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
• Natural conception
• 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