Tuesday 12 February 2019


There is no doubt that recent improvements in prevention, detection and treatment have led to improvement in cancer survival rates, especially in developed countries. One aspect of care that is still largely ignored in this clime is the issue of fertility preservation, i.e. steps put in place to ensure that a cancer survivor can still be able to have children after going through the experience.

This aspect is however very important and could help people going through cancer treatment pull through when all appear bleak, i.e. the knowledge that they still stand a chance of conceiving after all the ordeal could provide the hope needed when it all seems hopeless.

Cancer treatments can impair fertility in a number of ways, this is a fact. Some chemotherapy medications destroy eggs and this may lead to infertility after treatment; however, the risk of infertility depends on the medications used, the doses given, and the age of the woman at the time of treatment. An older woman has fewer eggs when starting treatment. This means she is more likely to become infertile after treatment.

Unfortunately, women of reproductive age are regularly diagnosed with cancer. The common types of cancer in young women include breast cancer, cervical cancer, ovarian cancer, uterine cancer, colorectal cancer and non-Hodgkin lymphoma.  It is not unexpected that one of the concerns of women who have undergone treatment for cancer is their chances of having a baby afterwards. Such young women that have cancer often require treatment that can compromise their future fertility. For instance, chemotherapy is toxic to the ovaries and can result in loss of follicle reserve and premature ovarian failure. Chemotherapy and radiation treatments also trigger early menopause.

As a woman, there are several ways that having ovarian cancer can affect your ability to have children in the future. Cancerous tumours can damage your ovaries and your ability to produce eggs. You may also need to have one or both ovaries removed.

You would probably ask if breast cancer impacts negatively on fertility. Some treatments for breast cancer may affect fertility, particularly from chemotherapy that might damage the ovaries, which can sometimes cause immediate or delayed infertility. Still, many women are able to become pregnant after treatment.

The point is that once you are diagnosed with any form of cancer, it is a valid concern that problems arising from the cancer or cancer treatment could cause damage to your reproductive organs such as the ovaries, fallopian tubes, uterus, and cervix. Your hormone production could also be affected. While cancer can be successfully treated if detected early, certain treatment approaches have known or possible fertility-related side effects. Chemotherapy may affect fertility; radiation therapy also affects fertility if areas like the abdomen, pelvis, lower spine, ovaries and the uterus are exposed. Surgical removal of these reproductive organs may affect fertility.

There are instances in which cancer treatments stop menstrual periods. This is called premature menopause and it could cause permanent infertility. Chemotherapy has been known to cause menstrual periods to stop temporarily.

If you are having periods during or after chemotherapy, there is still a possibility that you have lowered fertility. Menstruating during cancer treatment is not a guarantee of fertility as you could have developed lowered fertility or early-onset menopause.

The ovaries store a woman’s eggs so damage to these organs can decrease the ovarian reserve which is the total number of immature eggs in the ovaries. Women are born with all the eggs they will have and once these eggs are lost, they cannot be replaced. The loss of healthy eggs usually causes infertility and early menopause.

For a diagnosis of cervical cancer or any type of cancer for that matter, the best thing to do is to consult a reproductive endocrinologist that specialises in the conditions affecting fertility, including cancer-related fertility issues.

If you are a younger woman (aged below 30), you have a larger ovarian reserve and you are less likely to experience immediate menopause and infertility after chemotherapy. However, this does not mean if you are younger you are not likely to lose your fertility.

Pregnancy after cancer treatment is dependent on specific factors. Normally, to become pregnant without reproductive assistance, you need at least one healthy ovary with enough remaining eggs, one healthy fallopian tube, a healthy uterus and an ideal level of specific hormones.

While on treatment, you may require some waiting time before trying to become pregnant, however, the amount of time depends on the type and stage of cancer, the treatment and your age. If you are taking hormonal treatment, it is often advisable that you delay pregnancy.

The issue here is that delay is likely to further reduce fertility because eggs are lost through ageing. If you are experiencing delay, fertility-preserving options are worthwhile.

Part of the recommendations for preserving fertility is an assessment of their risk of infertility and fertility preservation options. The earlier this is done, the better, preferably before cancer treatment begins.

The rapid development of Assisted Reproductive Technology over recent years has brought a wide range of fertility preservation options to young (and old) women diagnosed with cancer. The benefits of investigational ART for fertility preservation are widely recognised.

Two of the most successful methods of fertility preservation are egg freezing and embryo freezing and some types of surgery can be fertility sparing.

There are instances in which the cervix can be removed (in the case of cervical cancer), while the uterus is left intact. This allows a woman to deliver a baby by C-section. It’s an option for some women with early-stage cervical cancer.

One other option for you, if you are a woman with early-stage ovarian cancer, is the removal of the affected ovary. This preserves the healthy ovary for reproduction and prevents early menopause.

Fertility preservation can also be done with ovarian tissue preservation. This involves surgical removal and freezing of ovarian tissue. Then, it is transplanted after cancer treatment. If you are worried about the risk of infertility from the recommended treatments, you would benefit from counselling for fertility-related decisions.

After cancer treatment, your body may recover naturally and produce mature eggs that can be fertilised. But you may be required to wait for six months or more before trying to get pregnant. Waiting may reduce the risk of birth defects from eggs damaged by chemotherapy or other treatments. The long waiting period is generally based on the fact that the risk of the cancer coming back is usually highest in the first couple of years after treatment. The length of time depends on the type of cancer and the treatment used.

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