What Can Be Done to Prevent Infertility After Cancer Treatment?
Women can be diagnosed with cancer during their child-bearing years. It is estimated that about 8% of women with cancer are less than 40 years of age, such as breast or colon cancer, and a variety of blood-related cancers such as leukemia.
Regardless of the type of cancer, treatment with radiation or chemotherapy can affect a woman’s ovaries and result in infertility as well as premature menopause, or the loss of hormones coming from the ovaries before it would occur normally.
Protection from x-ray damage can be accomplished by shielding the ovaries if they are not close to the cancer. There is also surgery to temporarily move the ovaries away from their normal position so that nearby areas can receive radiation without irradiating (or exposing) the ovaries.
Chemotherapy is the more common danger to fertility. Chemotherapy drugs are aimed at rapidly-dividing cancer cells, and almost always damage normal cells that are rapidly dividing. Ovarian follicle, which produce mature eggs, are in this group. If all the follicles and eggs are damaged, future pregnancy will not be possible, and the ovaries may not be able to make normal amounts of female hormones.
Removing and freezing eggs before chemotherapy would be ideal, similar to freezing sperm. However, eggs do not usually survive freezing. Researchers are trying to find a way to allow eggs to be frozen and thawed later. If this could be done successfully, it would mean delaying cancer treatment briefly in order to stimulate the ovaries to produce eggs. Some women do not want to delay treatment, even if only for a couple of weeks. Additionally, ovarian stimulation with hormones cannot be done if a woman has a hormone-sensitive tumor, like certain breast cancers.
Another possibility is to remove and freeze a piece of ovarian tissue, which could be put back in place at a later date. This has the advantage of potentially preserving both fertility and female hormone production. The ovarian tissue would first be examined for any obvious tumor. One concern with this procedure is that there could be undetectable small numbers of cancer cells in the piece of ovary.
Another way to preserve fertility after chemotherapy is through the use of in vitro fertilization. After ovarian stimulation, eggs can be removed and fertilized in the lab, and the resulting embryos frozen. Embryos can survive freezing for very long periods of time, so they can be used in the future when a woman is healthy enough to carry a pregnancy. Obviously, there has to be sperm to fertilize the egg, so this is not necessarily a good choice for a woman without a partner, or a woman who does not want to use a sperm donor. There is also the concern over a brief treatment delay. Again, women with certain hormone-sensitive cancers should not have their ovaries stimulated.
Treatment with what are called “gonadotropin-releasing hormone analogs” can also be used to preserve fertility. These medications are thought to protect the ovaries by stopping the follicles from growing. There have been successes using this treatment. Researchers are trying to determine the best medications, and best way, to do this.
There is no perfect way for a woman to ensure that she will still be fertile after treatment for cancer. Nevertheless, it is important to explore all possible options and give patients the best, available choices to make future pregnancy possible, if desired. If you have cancer and do not want to lose the ability to have a baby later on, you should discuss this at the first possible moment with your doctor, before you have any treatment.