Annually, more than 150,000 Americans are diagnosed with cancer during their reproductive years (younger than age 45). This diagnosis can quickly derail any plans to start a family and in some cases can make it physically impossible to get pregnant. Cancer treatment – surgery, radiation, chemotherapy or hormonal therapy – can directly or indirectly lead to infertility. This means it is extremely important for cancer patients to gather information on the technological advances in fertility preservation prior to receiving treatment.
How cancer treatment can affect fertility
In women, cancer treatment can affect eggs, hormone levels, or the functioning of the ovaries, uterus or cervix. There is also a risk of developing premature menopause. Multiple factors compound the issue, like age and type of treatment.
The long-term effects of chemotherapy and radiation also depend on the drugs used and the size and location of the radiation field, says Amal Masri, M.D. with Piedmont Physicians Gynecologic Oncology Athens. “Radiation therapy can be detrimental to fertility when the radiation field is near the ovaries,” Dr. Masri explains. “Radiation causes tissue fibrosis and DNA damage which prevents normal ovarian function.”
Many chemotherapy drugs are toxic to the follicles that house the eggs in the ovaries and can interfere normal ovulation, Dr. Masri adds. “Chemotherapy can impede the ovaries' ability to produce estrogen. This can then lead to premature menopause in young women.”
Fertility after cancer
Women are encouraged to protect their choices for the future, including the ability to start or grow their family after cancer treatment. “It is our hope and goal that every patient has the ability to resume normal life after treatment,” Dr. Masri says. “For some, this means starting a family, and for others, it means adding to their family through infertility treatment or exploring the possibility of adoption. Whatever the choice may be, we encourage patients to set goals for a hopeful future. Fertility preservation is a very viable option, so it is important for women to be educated about these options.”
Fertility preservation options
Women can preserve their fertility in one of the following ways:
Embryo cryopreservation - eggs are harvested from ovaries, fertilized through in vitro fertilization, frozen and then stored. This method has the highest chance of success for women.
Egg freezing - unfertilized eggs are frozen for later use.
Gonadal shielding - if radiation is applied to an area far from the pelvis, a shield can be strategically placed to protect reproductive organs from radiation.
Ovarian transposition - if radiation is being applied to the pelvis area, ovaries can be surgically repositioned prior to radiation therapy.
Radical trachelectomy - with early-stage cervical cancer, the surgical removal of the cervix can help preserve a woman's uterus.
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