Cancer Treatment and Fertility in Women
Being diagnosed with cancer is a life-altering event. It brings up many questions that you may never have thought of before. Unfortunately, many questions may remain unanswered. If you are a young woman, one of those questions may involve your ability to have children. Gynecologic cancers occur about 12%-15% of women in the United States and in many cases during the reproductive years. Modern treatments include a concept known as fertility preservation. Here is a look at how a cancer treatment may affect your fertility and what you can do if you want to have children.
How Cancer Treatment Can Affect Fertility
Cancer treatments vary based on the how much the cancer has progressed and if it has spread. The affect on fertility will depend on the types of treatment you receive.
- Surgery—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 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.
Talk to your doctor or cancer treatment specialist about your concerns. Some fertility preservation options need to be taken care of before treatment.
Options for Preserving Fertility
Some procedures are being studied for their ability to preserve fertility in women with cancer. Others however, are considered experimental and their feasibility and appropriateness will vary from patient to patient. Here are some of the options you may want to ask your doctor about:
- Ovarian transposition—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.
- Radiation shielding—This involves shielding reproductive organs to reduce the radiation they receive.
Your options depend on many things. How will you know what is the best course of action?
Deciding What Is Best for You
When facing cancer—or any serious illness for that matter, it is important to remember that each person’s situation is unique. Not all options for preserving fertility may be appropriate or feasible in all women. For example, you may have to think about what it would mean to have fertility preserving surgery that may include a risk of recurrent cancer versus a more radical surgery that could eliminate cancer.
If you have been diagnosed with cancer and you are 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 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.
CANADIAN RESOURCES
Canadian Cancer Society http://www.cancer.ca/
Women's Health Matters http://www.womenshealthmatters.ca/
References
Female reproductive options. Fertile Hope website. Available at: http://www.fertilehope.org/healthcare-professionals/clinical-tools/female%5Foptions%5Fv3.pdf. Updated 2007. Accessed December 4, 2012.
Lee SJ, Schover LR, et al., ASCO Recommendations on Fertility Preservation in Cancer Patients: Guideline Summary. J Clin Oncol. 2006;24(18):2917-31.
Makar AP, Trope C. Fertility preservation in gynecologic cancer. Acta Obstet Gynaecol Scand. 2001;80:794-802.
Ovarian Cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 3, 2012. Accessed December 4, 2012.
