January 6, 2022
Numerous malignancies and cancer treatments have a considerable effect on human fertility. Unfortunately, many patients are unaware of how these medicines affect their fertility. Generally, your clinician will talk with you if cancer treatment increases your chance of infertility or even causes infertility.
What is Fertility, and How Do Cancer Treatments Affect Fertility?
Fertility refers to the capacity to conceive and sustain a pregnancy. Infertility is a term that refers to a woman’s inability to conceive. It might involve female or male factors. The cancer treatment has a very unpredictable effect on fertility and is circumstance based. These include the following:
- Chemotherapy dose
- The chemotherapy treatment itself
- Radiotherapy location
- Surgery site
- The patient’s age
Many cancer medicines are associated with a greater risk of infertility than any other class of drugs. Therefore, if you are planning chemotherapy, talk to your treating doctor (oncologist) about medicines that have a lower risk of impairing your fertility.
Cancer Treatments that Affect Fertility
Some cancer treatments can cause temporary or permanent infertility; however, this also depends on the type of the cancer, its stage and grade, along with the overall condition of the patient.
Chemotherapy: It has the potential to drastically weaken or eliminate spermatogenesis and ovulation, thus reducing your chance of biologically parenting a kid. Additionally, hormone therapy for cancer usually impairs sperm and egg production. Specific anti-cancer drugs are found to have a negative impact on your fertility. You can consider talking to your doctor regarding the medication that will be administered to you and its impact on your fertility.
Radiation therapy: Radiation therapy, when given to specific body parts, can lead to temporary or permanent infertility. These body parts include:
- Ovaries and the regions around them
- Testis and the areas around it
- Pituitary gland
Surgery: Surgical removal of some reproductive organs may negatively impact fertility. Hysterectomy involves surgical removal of the uterus, whereas oophorectomy removes one or both ovaries. All these procedures affect the fertility of females.
Recommendations for Preserving Fertility
It is essential to think about what you can do if your treatment causes infertility before you begin your treatment. Following are some of the fertility preservation options available:
Women: Women preparing to receive treatment for cancer have a variety of fertility preservation choices.
- 1. Embryo Cryopreservation: This procedure involves retrieving eggs, fertilising them, and freezing them until transplanted later. According to research, embryos can survive up to 90% of the time during freezing.
- 2. Egg Freezing (Oocyte Cryopreservation): During this procedure, the unfertilised eggs are extracted from the patient’s ovaries and stored in a freezer for future use.
- 3. Radiation Shielding: Radiation treatment involves using x-rays to destroy or weaken cancer cells, preventing them from growing and multiplying. It will depend on where and how much radiation therapy you get. Therefore, radiation shielding (covering the sensitive area with a small shield) helps protect individuals’ reproductive organs.
- 4. Ovarian Transposition (Oophoropexy): This procedure relocates ovaries within the pelvis to keep them out of the radiation field. Shielding ovaries from scatter radiation treatment does not always provide protection. Therefore, you may require repositioning of your ovaries to conceive.
- 5. Surgical Removal of the Cervix: A large cone-shaped piece of the cervix, including the malignant region, is removed to treat early-stage cervical cancer. Alternatively, a surgeon can remove the cervix and connective tissues around the uterus and cervix partly or entirely.
Men: Damage to the testicular lining is the leading cause of infertility in men who have received cancer treatments. However, men can consider the following measures to maintain their fertility before treatment:
- 1. Sperm Cryopreservation: This process requires freezing and preserving sperm at a reproductive clinic or sperm bank for future usage. Deep freezing stores the sample over an extended period. For the majority of post-pubescent males, sperm banking is a possibility.
- 2. Radiation Shielding: If you are undergoing radiation therapy, your expert team may be able to protect your gonads from radiation through shielding.
Role of Parents in Preserving Fertility of a Child with Cancer
Cancer therapy might result in a temporary loss of fertility for some children and teens, while for others, treatment can result in permanent infertility. If your kid has attained puberty, cryopreservation of oocytes or sperm may be a possibility.
What about Cancer Treatment during Pregnancy?
Avoid getting pregnant during your cancer treatment, as a few anti-cancer medications and radiation can cause side effects, such as birth malformations, stillbirths, miscarriages or spontaneous abortions.
Many people may not believe in the use of birth control because of religious or cultural beliefs or fear that they would become infertile due to treatment, making this their ‘final opportunity’ for a kid.
Regardless, you must avoid pregnancy while receiving chemotherapy treatment. It is because chemotherapy has the potential to harm an unborn child.
Condoms and spermicides are the two most commonly used forms of contraception for men and women, respectively, which help in pregnancy prevention.
The Treatment Team for Fertility Issues
You may consult various health specialists to discuss fertility issues, including a cancer specialist, such as a medical or gynaecological oncologist or someone who will address potential reproductive effects before treatment.
For example, a fertility specialist detects, treats, and handles infertility. A fertility counsellor offers advice and support to individuals experiencing fertility problems. A paediatric endocrinologist or gynaecologist specialises in fertility care for children with cancer.
Ask Questions to the Doctor
Consider the following questions to discuss with your expert team:
- How likely is it that the prescribed therapies will result in infertility?
- Is infertility a temporary or permanent condition?
- Are there any successful alternative therapies that are less risky?
- What fertility-preservation alternatives do I have?
- Will any of these choices cause a delay in the start of my treatment?
- How would this delay affect my chances of recovery if this is the case?
- Will fertility preservation measures increase the likelihood of a recurrence of cancer?
- Should I consult a reproductive endocrinologist or a fertility specialist?
Certain cancer treatments do have a negative impact on fertility. However, there are numerous fertility preservation options available today, with which cancer patients will be able to have children after their treatment. Cancer patients, at any cost, should not skip their treatment fearing the possible infertility that the cancer treatments may cause.
- National Cancer Institute. Fertility Issues in Girls and Women with Cancer. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-women. Accessed on: 28th December 2021.
- American Cancer Society. How Cancer and Cancer Treatment Can Affect Fertility in Females. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/fertility-and-women-with-cancer/how-cancer-treatments-affect-fertility.html. Accessed on: 28th December 2021.
- Bates GE, Taub RN, West H. Fertility and Cancer Treatment.JAMA Oncol. 2016;2(2):284.