The American Cancer Society (ACA) estimates that 1,762,450 new cases of cancer will be diagnosed in the United States in 2019. Roughly one out of every three women will be diagnosed with cancer in her lifetime.
While less than 25 percent of these cases occur before a patient turns 45, fertility can be compromised by cancer treatments such as chemotherapy. The option to consider fertility preservation is an important part of an overall cancer treatment plan.
Learning about the potential impacts of cancer treatments on female fertility can help you educate your patients about the fertility preservation options available to them.
The Impact of Cancer Treatments on Fertility
Any cancer of a reproductive organ can impact a woman's fertility. According to the ACA, women under 35 are more likely to keep at least some fertility following cancer treatment. Cancer patients in their twenties may even continue to have their menstrual periods.
The impact of cancer on a woman's fertility depends on a variety of factors, including the type of cancer, their age and the specific drug and dosage they receive. Here's how different treatments may impact fertility:
- Chemotherapy and Fertility: Chemotherapy can damage a woman's oocytes and result in premature ovarian insufficiency (POI). This impact is sometimes only temporary, but doctors should always advise patients to delay pregnancy until at least six months after discontinuing treatment.
- Radiation: Radiation near the abdomen, pelvic region or spine can harm the ovaries, pituitary gland and uterus.
- Surgery: Operating on the reproductive system or pelvic region may cause scarring and otherwise harm reproductive tissue in those areas. Hysterectomies and some cervical surgeries remove a woman's ability to carry a pregnancy.
- Hormone therapy: This treatment is often prescribed for breast cancer, but it may be suggested for other cancers as well. Hormone therapy may impact a woman's menstrual cycle.
- Bone marrow or stem cell transplant: Because they involve high doses of chemotherapy drugs or radiation, these therapies can damage the ovaries.
- Targeted and immune therapy: Not much is known about these relatively new treatments' impact on fertility. One exception is bevacizumab, which the journal Molecular and Clinical Oncology warns may cause permanent ovarian failure.
Fertility Preservation For Cancer Patients
Speaking with a reproductive endocrinologist during the cancer diagnosis process can help patients keep their fertility options open. According to the Journal of Clinical Oncology, some of the following treatments may be feasible:
- Embryo or oocyte freezing: After egg retrieval, mature eggs are either frozen or fertilized in a lab with a partner's or donor's sperm. The resulting blastocysts are cryopreserved.
- Fertility-sparing surgery: For women with slow-growing cancer in one ovary, removing just the impacted ovary may be an option.
- Gonadotropin-releasing hormone (GnRH) agonist treatment: This causes a woman to temporarily enter menopause, shutting down her ovaries in an effort to protect them from the effects of cancer treatment.
- Ovarian tissue freezing: All or part of one ovary is removed, cut into strips and cryopreserved. After cancer treatments are finished, the tissue is transplanted back into the patient's body in the hope that it begins functioning again.
- Ovarian transposition: The ovaries are moved away from the target zone before pelvic radiation treatment.
- Radical trachelectomy: When cervical cancer tumors are small and localized, the cervix can be removed and replaced with a band or stitch wrapped around the bottom of the uterus.
- Progesterone therapy: Women with Stage I Grade 1 uterine cancer may be treated with progesterone, allowing them to become pregnant before beginning cancer treatment.
Connect with oncologists in your area and suggest they refer interested female patients to a reproductive endocrinologist as soon as possible. Having a family after treatment can still be an option for many women.