Cancer Treatment and Fertility in Women
Being diagnosed with cancer is a life-altering event. One of the first questions people diagnosed with cancer may ask is, “Will I live?” For many people, the answer to that question is “yes,” thanks to advances in the detection and treatment of several cancers. But undergoing treatment can bring with it a whole host of new questions, including, for many people, “Will I still be able to have children?”
Here’s a look at how a cancer diagnosis may affect a woman’s fertility and what women with cancer can do if they want to have children.
How Cancer Treatment Can Affect Fertility
There are a variety of ways in which cancer treatment can affect fertility:
- Surgery—Surgical removal of cancerous lesions in the areas of the cervix, ovaries, endometrium, and uterus may result in infertility. Factors such as the stage and spread of the cancer often dictate how extensive the surgery is, and, therefore, how much of an impact it may have on fertility.
- Radiation—In some cases, cancerous lesions on reproductive organs, such as the ovaries, are not surgically removed, but rather treated with direct radiation. In addition to killing the cancer cells, radiation may also damage healthy cells, thereby disrupting the function of the organs and possibly causing infertility.
- Chemotherapy—Unlike radiation, which is generally targeted directly to the area of the body with cancer, chemotherapy travels throughout the body in the bloodstream to kill cancer cells. As a result, it can also damage the reproductive system (even if the cancer is not present in the reproductive organs). Risk will vary based on several factors, including the type and dose of chemotherapy drug being administered.
Options for Preserving Fertility
According to Fertile Hope, a nonprofit organization whose mission is “to be a comprehensive fertility preservation resource for patients whose medical treatments present the risk of infertility,” there are some procedures being studied for their ability to preserve fertility in women with cancer. Some are still experimental and their feasibility and appropriateness will vary from patient to patient. Talk to your doctor to see if any of these procedures may be an option for you.
- Oophoropexy—This involves moving one or both ovaries away from the radiation field prior to treatment to minimize radiation exposure and damage to the ovaries. Sometimes the ovaries can be transposed behind the uterus or even onto the woman’s thighs.
- Radical trachelectomy—This procedure, used for patients with early stage cervical cancer, involves removal of the cervix while preserving the uterus. The problem here is that the cervix is the lowest portion of the uterus and removal of this portion of the uterus will likely result in the inability of the uterus to maintain the pregnancy.
- Freezing of embryos—This procedure involves the removal of eggs, which are then fertilized via in vitro fertilization and then frozen for future implantation.
- Freezing of unfertilized eggs—This procedure involves administering hormones to foster the development of follicles, after which unfertilized eggs are removed and frozen for future use.
- Freezing of ovarian tissue—This procedure involves removing an ovary and freezing small pieces of the ovarian tissue as a way to preserve eggs.
- Hormonal treatment—This involves taking hormones in the form of birth control pills or gonadotropin-releasing hormone along with chemotherapy, which may reduce the damage the chemotherapy does to the reproductive system.
Deciding What’s Best for You
When facing cancer—or any serious illness for that matter, it’s important to remember that each person’s situation is unique. Not all options for preserving fertility may be appropriate or feasible in all women.
If you’ve been diagnosed with cancer and you’re concerned about your fertility, talk to your doctor and discuss in detail all the potential risks and benefits of certain treatments, including, but not limited to, the treatment’s potential effects on your fertility. Your doctor may be able to offer you ways of possibly preserving your fertility during your treatment. You may also want to ask for a referral to a social worker or other family planning specialist who can help you learn about other parenthood options as well, such as adoption.
Fortunately, many cancer caregivers recognize that successfully treating cancer means not only longer life, but quality of life as well. And for many cancer patients, the potential for parenthood is vital to their quality of life.
American Cancer Society
American College of Obstetrics and Gynecology
National Cancer Institute
Makar AP and Trope C. Fertility preservation in gynecologic cancer. Acta Obstet Gynaecol Scandinavia . 2001;80:794-802.
Plante M. Fertility preservation in the management of gynecologic cancers. Curr Opin Oncol . 2002;12:497-507.
Shahin MS and Puscheck E. Reproductive sequelae of cancer treatment. Obstet Gynecol Clin North Am . 1998;25:423-433.
Last reviewed October 2007 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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