Cancer Infertility – FAQs
In females, once a month, from puberty to menopause, one of the ovaries releases an egg. This process is controlled by hormones produced by the pituitary gland (in the brain) and the ovaries. It’s known as the menstrual cycle. If the egg is not fertilised, it will be released about 14 days later through the neck of the womb, together with the lining of the womb, as a menstrual period. When an egg is released from the ovary, it moves along the fallopian tube, where it may be fertilised, in the presence of sperms, if one has had sexual intercourse. The egg then moves into the womb. If it has been fertilised, the lady becomes pregnant whereby the fertilised egg embeds itself into the wall of the womb to develop into an embryo, then into a feotus and then into a baby.
Some cancer treatments can stop the ovaries from producing the hormones that control the menstrual cycle, and so may cause an early menopause also known as premature ovarian failure or premature menopause.
Cancer treatment can sometimes lead to infertility.Not all cancer and cancer treatments affect fertility. Some cancer and cancer treatments affect fertility, depending on the dose, type, location, number of cycles and the way the body reacts to the treatment.
The main treatments for cancer are chemotherapy, radiotherapy, surgery, stem cell transplants and hormonal therapy. It is really important to know the risks and the issues before one starts the treatment. One has the option of making some decisions about protecting fertility.
Chemotherapy is the most common form of cancer treatment. Chemo uses toxic drugs to kill or slow the growth of cancer cells. Unfortunately while chemo can stop cancer cells growing and multiplying, it can affect normal, healthy cells including reproductive cells include eggs, hormone producing cells around the eggs and sperm in the process.
Unlike chemo, which affects the whole body, Radiotherapy uses high-energy x-rays, gamma rays or electrons to kill cancer cells in a specific part of the body that destroy the cells’ ability to grow and divide. Normal, healthy cells are better able to resist the radiation, which is why body recovers from the effects of radiotherapy faster.
For cervical cancer, ovarian cancer and some germ cell tumours in the abdomen, taking radiotherapy directly in the abdominal or pelvic area can cause infertility. Pelvic radiotherapy causes damage to the ovaries so they can no longer produce eggs, or it may damage the uterus and cervix so being able to carry a baby may be difficult. For younger girls having radiotherapy to the uterus may mean that the uterus doesn’t develop to the size it normally would, which again may make it difficult to carry a baby.
The brain contains the pituitary gland which releases hormones that work on the reproductive system that makes the ovaries work and produce eggs. If one has taken radiotherapy to the brain, then medication that replaces the hormones that the pituitary gland releases are administered.
Total Body Irradiation (TBI) involves undergoing radiation to the whole body which often precedes bone marrow transplant. It not only destroys the cancer cells throughout the body but also destroys the immune system so that it will not attack the donor’s cells during the transplant. TBI is usually given alongside high-dose chemo which has an effect on fertility as well.
Undergoing surgery of the reproductive organs like ovaries, cervix, uterus, vagina, vulva or testes may affect fertility.
There are options available for preserving fertility before the cancer treatment begins. Some are very new techniques and are still in the early experimental stages, and it is important to know that there are varied success rates of pregnancy with each of the options.
Effect of Cancer Treatment on Women and related cancer infertility
A woman is born with a limited number of eggs in her ovaries. As she ages, this supply of eggs naturally diminishes. Some chemotherapy can damage or destroy eggs, reducing the supply. The effects of chemotherapy on reproduction vary with the woman’s age, the drugs used and the total dosages. There are many chemotherapy drugs that can affect reproductive function. A group of drugs called alkylating agents is the most likely to affect eggs and ovarian function. Chemotherapy is toxic to the ovaries causing loss of eggs and destruction of the supporting ovarian tissue. This may cause temporary cessation of menstrual periods or early menopause which can develop quickly or gradually.
If menstruation stops then it does not mean that the woman is infertile. Often periods return after treatment has finished. One can still get pregnant even if periods have stopped as egg production may continue. An early menopause is a side effect of treatment. The ovaries may stop working permanently resulting in what is known as premature ovarian failure or premature menopause. If one experiences menopausal symptoms like hot flushes, insomnia, joint ache and night sweats, she can be given hormone replacement therapy (HRT) to reduce the symptoms, although this will not reverse the menopause.
Egg Collecting & Freezing
After puberty, egg freezing is a fairly common procedure which has resulted in many successful births. The aim of egg collection or harvesting called cryopreservation is to collect mature eggs that can be frozen and used at a later date. The process of collecting and freezing eggs takes about 10-14 days of hormone stimulation through hormone injections. Vitrification is a newer method of freezing eggs and stops ice crystals forming in the liquid of the egg. Once the eggs are frozen, they are stored.
Pre-puberty, undeveloped or immature eggs of girls can be collected and then matured (called invitro maturation) in the laboratory and then frozen. The process is a bit different from collecting mature eggs as hormone injection that mature the eggs are not used.
The process for developing and freezing embryos is quite similar to that of egg collecting and freezing – with one additional step. An embryo is a fertilised egg, so sperm are needed in order to create an embryo. Embryo freezing is a very successful form of treatment post puberty; however it is less of an option for the younger patients.
Ovarian cortex cryopreservation is a new and experimental technique that takes a slice of outer part of the ovary and freezes it for the future. This can be done before or after the girl reaches puberty. Once the cancer treatment is complete the ovarian slices can be transplanted back into the abdomen hoping that the ovary will start to function normally again.
Effect of Cancer Treatment on Men related cancer infertility
For men, cancer treatments can affect fertility in different ways. Sperm cells can be genetically damaged from chemotherapy and radiotherapy. Some stop or slow down sperm production, while others may have problems with getting an erection and/or ejaculating normally. Sometimes sperm counts are permanently affected by chemotherapy. If low testosterone levels are contributing to infertility, testosterone replacement therapy is suggested. Having testicular cancer & Hodgkin’s lymphoma may mean that you have a low sperm count at the time of diagnosis. A low sperm count does not mean that one is infertile. Most men are given the opportunity to store their sperms in a sperm bank before chemotherapy. Storage time has no impact on the quality or the outcome of the sperm. Testicular sperm extraction is done for boys and men who are unable to produce a sperm sample.
FAQs on Cancer Infertility
- How does having cancer affect fertility?
Some cancer and cancer treatments affect the fertility, depending on the dose, type, location and the way the body reacts. Chemotherapy and radiotherapy can stop cancer cells from growing and multiplying, it can affect normal, healthy cells including reproductive cells include eggs, hormone producing cells around the eggs and sperm in the process.
- What could have happened as a result of the treatment?
Sometimes the ovaries stop functioning permanently, resulting in what is known as premature ovarian failure or premature menopause. Sperm cells can be genetically damaged from chemotherapy and radiotherapy.
- How are men affected by treatment?
Some men stop or slow down sperm production, while others may have problems with getting an erection and/or ejaculating normally. Sometimes sperm counts are permanently affected by chemotherapy.
- What is early menopause?
An early menopause is a side effect of treatment. The ovaries may stop working permanently resulting in what is known as premature ovarian failure or premature menopause. If one experiences menopausal symptoms like hot flushes, insomnia, joint ache and night sweats, she can be given hormone replacement therapy (HRT) to reduce the symptoms, although this will not reverse the menopause.
- Will my fertility return?
Your ability to have children will depend on a number of factors such as when, where, what type and how much treatment you received. It can be very hard to predict what the impact may be as everyone’s response to treatment is different.
- How do I know if my fertility has returned?
After treatment one may be in temporary or permanent ovarian failure. The tricky part is that temporary ovarian failure can last quite a long time. Your ovaries might take a while to function again. Your best option is to go and have testing done to see exactly what impact treatment has had on your fertility, as soon as you feel ready.
- How do I know if I can still have children?
For more accurate results, when the body settles back down to a more normal rhythm after the treatment, one has to undergo some tests to determine the fertility status.
- Types of cancer that can affect male fertility
Having testicular cancer & Hodgkin’s lymphoma may mean that you have a low sperm count at the time of diagnosis. A low sperm count does not mean you are infertile.
- How long can the sperm be stored?
Storage time has no impact on the quality or the outcome of the sperm.