Starting a Family After Cancer: What Chemotherapy Means for Your Fertility
A cancer diagnosis on its own can be life-changing news, but for many young women there is an added concern: the effect of cancer on fertility. The same cancer treatments that destroy cancer cells can destroy healthy cells too, along with other unwanted side effects. Even if you have been diagnosed with cancer before you are ready to start a family, there is hope, and a few different options could help you have a child after your cancer treatment.
How cancer treatments affect fertility
Even if cancer is not directly affecting your reproductive organs, the cancer treatment can affect your fertility. This can happen through direct damage to the eggs or ovaries, or through damage to the pituitary gland, the organ that controls reproductive hormones. The effect of cancer treatments on fertility can vary from person to person, with some people going on to have children without special intervention and others finding themselves infertile. It is best to speak to your doctor, although they are not always able to predict who will remain fertile after cancer treatments and who will suffer from infertility.
Sometimes you have cancer affecting reproductive organs, such as ovarian cancer. In this case, your doctor may have to remove your ovaries to prevent the spread of the cancer. This will remove your eggs, or at least half your eggs if only one ovary is affected. With no eggs, there is no chance an egg will be released and fertilized to produce a baby.
There are a wide variety of chemotherapy drugs, and a wide variety of combinations, that doctors use for cancer treatment. Some of these drugs are more likely to cause infertility than others, such as Cytoxan. The higher the dose, the more likely these drugs will affect fertility. Older patients are also more likely to lose their fertility from chemotherapy than younger patients. As chemotherapy drugs destroy cancer cells, they can also kill other cells such as eggs, leaving none available for ovulation when the cancer treatments are finished.
Sometimes radiation is aimed at or near the reproductive organs. This radiation can damage the ovaries, sometimes causing temporary infertility but sometimes permanently affecting a woman’s fertility. Radiation can also affect fertility if it is directed at the head, since it may damage the pituitary gland. This gland is responsible for making hormones that control reproduction, such as the hormones that trigger ovulation. When there are no hormones to trigger ovulation, no egg is released that can be fertilized.
Options for fertility after cancer
Transposition and shielding
In radiation treatments, radiation may be directed near reproductive organs such as the ovaries. To prevent damage to the ovaries, including loss of fertility, your doctor may be able to move the ovaries out of the path of the radiation, in a procedure called transposition. Your doctor may also be able to shield the ovaries during radiation treatment, making sure the radiation hits the cancerous areas but is blocked from hitting the ovaries themselves. Both of these methods can help protect the ovaries from being damaged by radiation therapy, helping to preserve fertility.
One relatively new and controversial method of preserving fertility during cancer treatment is ovarian suppression. During chemotherapy, certain drugs or groups of drugs might damage the ovaries, destroying eggs so that none are available after the treatment. Other medications, such as Zoladex or Lupron, can reduce ovary function during the chemotherapy treatment, and since the ovaries are dormant, they are less likely to be damaged by the cancer treatment. This will hopefully leave eggs available after the cancer treatment that can be fertilized to produce a child. However, some doctors have concerns that these drugs for ovarian suppression could interfere with the action of cancer drugs, reducing the effectiveness of chemotherapy.
Egg freezing is one way of preserving your fertility during cancer treatments. Even if chemotherapy and other cancer treatments do destroy all the eggs inside your body, you have a back-up plan. Before beginning your cancer treatments, you can visit your local in vitro fertilization clinic to retrieve eggs and preserve them until you are ready to start your family.
How egg freezing works
First, you will take fertility drugs, similar to an IVF protocol. If there is time before you start your chemotherapy treatment, this may include hormone injections or birth control pills to prevent ovulation. Next, you will use different hormone injections to produce follicles and mature the eggs, which can then be retrieved by the IVF clinic. Normally for IVF the next step would be to fertilize the eggs and implant them, but in this case the IVF clinic will simply store the eggs for later. Since eggs are filled with plenty of water which can form ice crystals, the IVF technician will remove the water and replace it with a sort of anti-freeze, helping to preserve the eggs as they are either frozen slowly or flash frozen. The IVF clinic can continue to store your eggs until your cancer treatments are finished and you are ready to start your family, even if it is many years in the future.
The cost of egg freezing
The cost of freezing your eggs will vary from clinic to clinic. For fertility drugs, tests, and the procedure to extract the eggs, it can cost around $10,000. Storage can be around $500 per year, with an additional $5,000 at the end to thaw and implant the eggs. This can vary depending on your situation and the particular IVF clinic you visit. Although the cost of freezing eggs can be expensive, it helps preserve your eggs away from the harsh chemotherapy drugs, preserving your fertility for the future.
Similar to egg freezing, you can also freeze a fertilized embryo. The IVF technician will harvest your eggs and fertilize them with your partner’s sperm, then halt development of the embryo at an early stage as the egg is frozen.
Freezing ovarian tissue
Freezing ovarian tissue is a relatively new technique, but researchers have had some success. In this case, doctors remove tissue from the ovaries before cancer treatment. When the cancer treatment is complete, doctors place the tissue back in the woman’s body, hoping that the tissue will begin to function normally. If all goes well, the tissue will produce eggs that can be fertilized naturally or with IVF.
For males, the procedure for preserving sperm is relatively simple. Similar to donating at a sperm bank, males can collect and store their sperm for use after their cancer treatments. For teens or boys, doctors may be able to remove immature sperm cells to preserve their fertility during cancer treatment.
Egg or embryo donation and adoption
Even if you have lost your fertility through cancer treatments already, you do still have other options to start a family. Other women are willing to help someone in your situation by donating their own eggs. Although the egg may come from a different woman, you can carry the baby to term yourself. The same is true of embryos: some couples will donate an extra embryo after their IVF treatments are successful, and you can then carry this embryo to term. You can also consider adoption, helping an infant, an older child, or a child with special needs by giving them a loving home.
How to preserve fertility during cancer treatments
When you, your doctor, and your entire medical team are focused on treating your cancer, fertility may not be at the top of everyone’s mind. It is up to you to speak up and ask your oncologist about how your treatments will affect your fertility and what options you have to ensure you can one day have a family. You may be able to use medical interventions to help preserve your fertility during cancer treatment. Even if having a baby is not the first thing on your mind during cancer treatment, you can keep your options open for your future family.
More information about fertility after cancer