Fertility Preservation: Here's how cancer patients can fulfill their dream of parenthood

It is quite common that people suffering from cancer might be uncomfortable to talk about the complications in their sexual lives or their prospect of having children (fertility) in the future. Most of the time when people are diagnosed with cancer, fertility is the last thing that comes to their minds. The entire focus relies on the treatment and the procedures. Certain cancer treatments do affect sexuality and fertility. Therefore, it is imperative that people should ask questions to the cancer care team about their fertility, sex, and sexuality when they opt for certain procedures. 

The knowledge about the fertility preservation is relatively a new concept and many of the doctors and medical personnel are unfamiliar or unclear about the subject, there are high chances that they might not impart the patient with such knowledge. So, there is nothing wrong if you have prior information about how cancer and its treatment can affect fertility. Prior information can help to deal with any doubts, feelings, and expected fertility problems such as early menopause and birth defects. 

A person's fertility depends on below-mentioned factors: 

Reproductive organs working properly  

Frequency of having sex

Hormone levels

Partner’s fertility index

If any of the above-mentioned factors are at fault then the person cannot have a child. And, this is called infertility or being infertile. In Vitro Fertilisation (IVF) experts suggest that they consider a person infertile if they haven't been able to conceive a child after 12 or more months of regular sexual activity, or after 6 months if the female is more than 35-year-old. In many cases, cancer itself interferes with some parts of the reproductive process and affects your ability to have children. 

Effect of Surgery on Fertility 

In many critical cases, surgeries including hysterectomy (removal of the uterus), oophorectomy (removal of ovaries) and trachelectomy (removal of the cervix) are suggested by a doctor for a tumor that's in or near another reproductive organ, such as an ovary and uterus. Sometimes certain organs of the reproductive system need to be removed to curb the spread of the cancer cells. These surgeries can be done either through the vagina (laparoscopy) or through a cut (incision) made in the abdomen. Sometimes other types of cancer surgery are done for tumors in the abdomen or pelvis can cause scarring in and around reproductive organs. They might block the ovaries, or uterus, preventing eggs from traveling to meet the sperm. This means the eggs can’t become fertilized and implant in the uterus.

Effect of radiation therapy on fertility 

Radiation treatments use high-energy rays to kill cancer cells. Radiation that's aimed at or around a woman’s reproductive organs can affect fertility.

Radiation at Pelvis 

In a woman, the amount of radiation absorbed by the ovaries will determine if she becomes infertile. High doses can destroy some or all of the eggs in the ovaries and might cause infertility or early menopause. Most women getting pelvic radiation will lose their fertility. But, some eggs might survive if the ovaries are moved further from the target area in minor surgery to preserve them that might be able to be done before radiation begins. Sometimes, radiation in the uterus also makes a woman more prone to miscarriage, low birth-weight infants and premature birth because it disables the uterus to stretch to a full size during pregnancy. 

Radiation to the brain

Radiation to the brain affects the pituitary glands, which are responsible for sending signals to the ovaries to make hormones. That’s how radiation in the brain can affect the release of the eggs from the ovaries. This is not true always, it also depends upon the amount of radiation.  So, if you are fertile and your fertility might not be affected by radiation treatments, you should immediately talk to the doctor to understand how long you should wait to resume unprotected sexual activity or to try for a pregnancy.

Chemotherapy 

Chemotherapy (chemo) kills cells in the body that are dividing quickly. The hormones, such as estrogen, needed to release eggs each month and prepare the uterus for a possible pregnancy are made in the cells of the ovaries (oocytes). Oocytes tend to divide quickly, so they are often affected by chemo. This can lead to the loss of those important hormones and can affect fertility. Sometimes a woman will go into premature or early menopause. Some of the chemo drugs also increase the chances of risk of infertility. 

Hormone therapy 

Hormone therapies are also one of the ways to treat breast cancer or other cancers. These can affect your ability to have a child. Some of these drugs might not cause problems getting pregnant, but can cause birth defects. Other hormone therapies may block or suppress hormones, causing infertility by putting a woman into early menopause.

Yes, cancer survivors can be parents too

Just because an individual undergoes cancer-related treatments, doesn’t necessarily mean that they have to refrain from planning to start a family post-treatment. Various options are available for both women and men, who are suffering from cancer. Before starting the treatment, a woman can freeze her eggs. Doing this is a way of preserving fertility. The eggs are then fertilized in a laboratory with the sperm of her partner. Fertilized eggs, called embryos, are then transferred into the uterus of the women to help her conceive once the fertility specialist and her oncologist deem her fit to carry a pregnancy.

Similarly, a woman can also preserve her embryos before treatment. In the case of men, they can also store their sperm before the cancer treatment begins. Secondly, there is a procedure called testicular sperm extraction in case he has not been able to preserve his sperms. A man may have no sperm in his semen after cancer treatment, but he may still have healthy sperm in his testicles. During a testicular sperm extraction, the doctor removes small pieces of testicular tissue. Any healthy sperm cells found in this tissue can be used in the process to help his partner conceive. 

However, one should visit a fertility consultant prior to beginning cancer treatments who will suggest the right course of a treatment plan for you to go ahead and fulfill the dream of parenthood after battling cancer.

By Dr. Aswati Nair, Fertility Consultant, Nova IVF Fertility

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