If you're being treated for cancer, you might have questions about fertility preservation. Find out how cancer treatment can affect your ability to become pregnant or father a child, as well as what fertility preservation steps you can take before you begin cancer treatment.
How does cancer treatment affect fertility?
Certain cancer treatments can harm your fertility or cause sterility. The effects, which might be temporary or permanent, can occur immediately or at some point after treatment. The likelihood that cancer treatment will harm your fertility depends on several factors, including the type of cancer, cancer treatment and your age at the time of treatment.
Male fertility can be harmed by the surgical removal of the testicles or by chemotherapy or radiation that damages sperm quantity, quality or DNA.
Female fertility can be compromised by cancer treatments that involve the surgical removal of the uterus or ovaries. Cancer treatment can also affect eggs, hormone levels, or the functioning of the ovaries, uterus or cervix. The risk of developing premature menopause after certain cancer treatments increases as you age. Older women are also more susceptible to permanent ovarian damage.
The effects of chemotherapy and radiation therapy also depend on the drug or size and location of the radiation field. The most severe damage is caused when radiation is applied to the ovaries or testicles and by chemotherapy drugs called alkylating agents.
When should I talk to my doctor about fertility preservation?
If you're planning treatment for cancer and want to take steps to preserve your fertility, talk to your doctor, oncologist or a reproductive specialist about your options as soon as possible. Keep in mind that your fertility can be damaged by one cancer therapy session and, for women, some methods of fertility preservation are typically done during certain phases of the menstrual cycle.
How can women preserve fertility before cancer treatment?
Women who are about to undergo cancer treatment have various options when it comes to fertility preservation. For example:
- Embryo cryopreservation. In this procedure, eggs are harvested from your ovaries, fertilized through in vitro fertilization (IVF), frozen and stored. Typically, at the beginning of your menstrual cycle you'll begin daily injections of synthetic hormones to stimulate your ovaries to increase the likelihood that multiple eggs can be collected during a cycle. Mature eggs are removed, combined with sperm — provided by a partner or sperm donor — and frozen. This method has the highest chance of success for women. Timing ovarian stimulation can delay the start of cancer treatment by two to four weeks, but research suggests that random ovarian stimulation can be successful.
- Egg freezing (oocyte cryopreservation). Similar to embryo cryopreservation, you'll get injections of a medication to stimulate your ovaries and have your eggs harvested. Then your unfertilized eggs are frozen. This method requires the same amount of time as embryo cryopreservation.
- Gonadal shielding. If you're having radiation applied to an area far from your pelvis, carefully placed shields can reduce your reproductive organs' exposure to scatter radiation.
- Ovarian transposition (oophoropexy). During this procedure — recommended if you're having radiation applied to your pelvis and no chemotherapy — your ovaries are surgically repositioned just before radiation therapy so they're as far away as possible from the planned radiation field. However, due to scatter radiation, the procedure doesn't always protect the ovaries. After treatment, you might need to have your ovaries repositioned again or use IVF to conceive.
- Radical trachelectomy. If you have early-stage cervical cancer, this procedure — which involves the surgical removal of the cervix — can help preserve your fertility.
Other methods of fertility preservation for women still being researched include ovarian tissue cryopreservation — in which ovarian tissue is surgically removed, frozen and later reimplanted — and ovarian suppression before cancer therapy, in which hormonal therapies are used to suppress ovarian function and protect eggs during cancer treatment.
What can men do to preserve fertility before cancer treatment?
Men can also take steps to preserve their fertility before undergoing cancer treatment. For example:
- Sperm cryopreservation. Before you begin cancer treatment, you'll provide semen samples through masturbation or another method, such as testicular sperm extraction via a needle. Samples are frozen and can be stored for years. Depending on the amount of sperm available, samples might be used with intrauterine insemination, where the sperm is thawed and placed in a woman's uterus, or with in vitro fertilization.
- Gonadal shielding. Carefully placed shields can reduce your testicles' exposure to radiation.
Other methods of fertility preservation for men still being researched include testicular tissue cryopreservation — in which testicular tissue is surgically removed, frozen and later reimplanted.
Can fertility preservation interfere with successful cancer therapy or increase the risk of recurring cancer?
Research on whether taking fertility preservation steps can affect the success of cancer therapy or the risk of recurring cancer is limited. There's no evidence that current fertility preservation methods can directly compromise the success of cancer treatments. However, you could potentially compromise the success of your treatment if you delay surgery or chemotherapy to pursue fertility preservation.
While there appears to be no increased risk of cancer recurrence associated with most fertility preservation methods, further research is needed to determine whether ovarian stimulation can harm women who have hormone-sensitive tumors, as in some types of breast cancer.
Can cancer treatment or fertility preservation methods increase the risk of health problems in children conceived afterward?
As long as you don't expose your baby to cancer treatments in utero, cancer treatments don't appear to increase the risk of congenital disorders or other health problems for future children.
However, if you receive a cancer treatment that affects the functioning of your heart or lungs or if you receive radiation in your pelvic area, talk to a specialist before becoming pregnant to prepare for possible pregnancy complications.
What can parents do to preserve the fertility of a child who has cancer?
Taking steps to preserve the fertility of a child who has cancer can be difficult because he or she might not understand the consequences of impaired fertility. If your child has begun puberty, options might include oocyte or sperm cryopreservation. Your consent and your child's might be required. However, efforts to preserve the fertility of a child who hasn't begun puberty are considered experimental.