A young couple, young man or woman diagnosed with cancer, being faced with the devastating diagnosis, don’t always think about or know whom to ask about their options for future pregnancies.
Cancer treatment can affect a patient’s fertility temporarily or permanently. Survival rates have improved dramatically in childhood cancers and also in young women who undergo cancer treatment. Expert advice and help from fertility specialists alongside the oncology team is needed in order to give the patient the best chance of future childbearing. Sometimes the balance between chances of compromising survival and preserving fertility is a fine one.
It is important to clearly educate the patient about the need to prevent a pregnancy during the course of treatment specially during the chemotherapy or radiation phase of cancer treatment. If an unplanned pregnancy occurs, the embryo has a high probability of having serious defects due to the medication and radiation leading to a higher chance of miscarriage or leading to birth of a baby with serious and fatal birth defects.
Not all cancer treatment causes infertility, and though it is usually difficult to predict beforehand whether the treatment will have a lasting impact on fertility in the future, the patient should have an informed discussion about the probability of this. It varies depending on the age of the patient, hormonal status, ovarian reserve, the type and extent of cancer treatment planned, type of chemotherapy, dose and site of radiotherapy, from patient to patient and depends on various other factors. For example, total body irradiation, whole abdominal or pelvic radiation, brain irradiation or alkylating chemotherapy usually result in high rates of infertility. In cases when a woman’s ovaries have to be removed, she will lose her ability to have her own genetic child. Men with testicular cancer are at a high risk of becoming infertile if they have to have both testicles removed, or if the testicles get a high dose of radiation.
The chemotherapy medication and radiation that are used to target and kill cancer cells also cause harm to healthy cells and organs in the body. This is why the patients experience health complications and side effects during chemotherapy. The same mechanism damages the gametes including the sperm and eggs.
Better treatment modalities and more targeted cancer therapies that minimize the side effects on the body, have made several forms of cancers today curable, especially if they are detected in the early stages. A lot of people today are surviving cancer and leading healthy lives. This has led to patients considering options for preserving their fertility. Fortunately today, there are options to try to preserve fertility before you begin cancer treatment, though the practice is yet to gain popularity.
If you are concerned about this issue, it is recommended that you meet a fertility specialist and discuss the issue with your oncologist to be sure that you have enough time to go through the procedure before starting the cancer treatment. Remember, the first priority here is to fight cancer and have a good quality of life.
What are the Options?
Embryo Freezing: In this procedure, eggs are taken from the woman, fertilized in laboratory with the partner’s sperm and the embryo is then frozen for future use. If the patient successfully fights cancer and desires to have children, this embryo can then be thawed and implanted into the woman’s uterus. However, it takes almost two weeks from the start of the woman’s menstrual cycle to extract eggs, and the patient should be extremely cautious about whether she can afford this delay in starting cancer treatment. In slow growing cancers, it may be an option, but not in case of rapidly growing cancers.
Egg Freezing: This option is more suitable for single women who desire to preserve their eggs for future use. In this procedure, eggs are harvested and frozen in an unfertilized state. The same can be fertilized with sperm in the lab later, and the embryo transferred to the woman’s uterus, when the woman has recovered and is ready to have a baby. As with embryo freezing, the egg harvesting takes two weeks from the start of menstrual cycle. This process is also preferred by people who are not in favor of creating and freezing an embryo.
Ovarian Tissue Freezing: In cases of women who likely to suffer irrepairable damage to their ovaries, this is a possible option, though still in the experimental stages. The woman can have her ovarian tissue removed surgically and frozen before starting cancer treatment. The tissue may be transplanted after the cancer treatment and recovery. This procedure is still in experimental stages across the world and very few live
births have been reported.
Ovarian Protection: Using radiation shields to reduce radiation exposure to the ovaries may be an option in certain cases. A hormone to put the ovaries into temporary menopause during chemotherapy is an option that is still being debated. However, the medical community is yet to arrive at a conclusion on its efficacy.
Sperm Freezing: sperm can be frozen in vials following repeated ejaculation prior to commencing any treatment.
Donor Gametes and Surrogacy: If it is not possible to preserve one’s ability to have their genetic child, donor sperm, donor eggs and donor embryos may be considered. Sometimes surrogacy or adoption may need to be considered.