Monday 28 March, 2022

What to Know About Fertility and Cancer

Dudi Warsito, PhD in Oncology, is a medical writer and researcher at cancer.se.

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This article is written in collaboration with cancer.se

A significant side effect of going through cancer treatment is the prospect of infertility. First comes first, make sure your doctor informs you if your fertility will be affected by the treatments you go through in order to know what to expect, best prepare, and know what to do in order to counteract involuntary infertility.

Regardless of your cancer diagnosis or potential treatments, make sure to bring up your potential desire to have children with your doctor and healthcare team early on. By raising your wishes and concerns, your team can take them into consideration.

Common current cancer treatments – surgery, radiation and chemotherapy – the three most common types of cancer treatment, all affect fertility. Decreased or infertility is a side effect that can affect people who have undergone these kinds of, or other, cancer treatment. In this article, we outline how the fertility of men, women, and children is affected by cancer treatment.

Treatments

Surgery and Operations

Operations can affect fertility depending on the location of the tumor. For example, if the tumor is located on reproductive organs such as the ovaries, fallopian tubes, uterus or testicles, surgery can lead to infertility. Surgery on the stomach can also lead to infertility, for example if a scar is formed which leads to the growth of a fallopian tube.

However, if the cancer is detected at an early stage in a female’s reproductive organs, it is easier to avoid infertility after surgery. If a male gets testicular cancer, the diseased testicle is removed. The remaining testicle may have lower sperm production, so it is important to freeze sperm before the operation.

Make sure to talk with your healthcare team before surgery in order to find out what you can do in order to minimize the impact of the surgery on your fertility.

Radiation

Radiation therapy aimed directly at genitals such as testicles or ovaries can also affect fertility. The same applies if the radiation treatment is directed at the pituitary gland in the brain, as the pituitary gland is responsible for hormone production that affects both the ovaries and the testicles. However, there are drugs that can replace hormone production after radiation therapy. Radiation that is directed directly at the uterus can make it difficult to get pregnant.

Cytostatic agents

Cytostatic agents are a comprehensive group of drugs that not only affect cancer cells, but also normal cells such as those that are supposed to give rise to eggs and sperm. Cytostatic treatment reduce fertility in both women and men at high doses. The health of the ovaries after chemotherapy is age-related, an older person is affected more than a younger person.

What you can do to increase your chances of having biological children after cancer

Protect eggs and ovaries

Females with cancer are offered various options to preserve fertility. One option is that the ovaries can be moved higher up in the stomach if areas around the ovaries are to be irradiated. If cancer treatment needs to be started quickly, part or all of the ovary can be removed and frozen. Then, the ovary is put back in the body once you want to initiate a pregnancy.

After a hormone-stimulating treatment, eggs can also be taken out to be frozen and saved for future in-vitro fertilization. In hormone-dependent breast cancer, anti-estrogen can be given as a supplement, and in doing so, the risk that the cancerous tumor grows during hormone stimulation becomes very small.

If you are pregnant at an early stage or become pregnant when you have cancer, the pregnancy must be terminated. It is therefore always important to use contraception during cancer treatment and for some time after. Talk to your doctor about which contraceptive is best for you.

Protect sperm and testicles

Males with cancer are offered to freeze sperm before the cancer treatment. The sperm are later thawed for use in future in-vitro fertilisation. If the semen is empty of sperm, it’s possible to leave a tissue sample from the testicle where you can, at certain times, extract sperm from before freezing.

If you’re going to receive general radiation treatment, you will receive a lead protection that is placed over the testicles. If the radiation is given near the testicles, you can shield the radiation.

Cancer as a child

Today, there are no well-established methods for protecting children from infertility after cancer treatment. For boys who have not reached puberty, there is no possibility of freezing sperm, as they only have immature stem cells in the testicles that will later develop into sperm-producing germ cells at puberty. It is not yet known how these stem cells develop into sperm. Today you can freeze testicular tissue from boys, but, at this time, it’s unknown how these can be used in the future and more research is required.

For girls, parts of or an entire ovary can be frozen. At the time that the person in question wants to get pregnant, the ovary is thawed and inserted again, with the hope that the eggs will develop so that a pregnancy can occur.

Always talk to your child’s doctor about methods used to try to preserve your child’s fertility, as this can be a difficult decision to make.

Fertility after cancer treatment

After a cancer treatment, it can be difficult to know if you are still fertile. Sometimes it takes longer to know because of side effects, while others become pregnant even though the doctor has judged it difficult to achieve.

If you still have your ovaries, it can take several months before your period returns after the treatment if it then disappears. Even if you do not have a period, you can get pregnant. Or, vice versa: you can have a period but still lose the ability to get pregnant. It’s important to go to a gynecologist if you’d like an assessment.

The information shared does not constitute a medical consultation and is not intended to replace professional medical advice, diagnosis, or treatment. Consult with your doctor or other qualified health providers for questions regarding a medical condition, especially during the active period of Corona / Covid19. Please do not disregard professional health provider advice or delay in seeking it because of something you have read here. In the event of a medical emergency, call a doctor, 112 or 911 immediately.

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