For a couple to conceive a child several conditions must exist; a problem in the body at a particular moment can cause changes in fertility.
Just as it can in men, in some cases, cancer treatment can temporarily or permanently decrease fertility in women who have still not passed naturally through the menopause. The risk of infertility due to oncology treatment depends on several factors: the type and dosage of drug used, the dose of radiation administered, the site within the body at which it is targeted, the type of cancer, and the age and sex of the patient.
In the case of women who have not yet gone through the menopause, fertility problems due to cancer treatment can be caused by 2 factors:
● Damage to organs involved in reproduction, such as the ovaries, Fallopian tubes, uterus or cervix.
● Damage to organs involved in hormone production, such as the ovaries.
In women, eggs are stored in the ovaries, and damage to them can decrease ovarian reserve. Ovarian reserve is the total amount of immature eggs in both ovaries. A woman is born already with all the eggs she is ever going to have. Once these eggs are lost they cannot be replaced, causing infertility and early menopause.
As chemotherapy works by removing cells in the body which are dividing rapidly, sperm, which do divide rapidly, are an easy target in men. Permanent infertility can arise if all the immature cells in the testicles which divide to produce new sperm are damaged to the point that they cannot produce mature sperm.
Chemotherapy, radiotherapy and surgery may all have an effect on the reproductive health of children who have been diagnosed with cancer, with the possibility of causing temporary or permanent infertility.
The main European and American medical societies recommend that all patients with cancer, and parents of children with cancer, examine the risk of infertility, as well as the options for fertility preservation, with their doctors as soon as possible before cancer treatment is started.
Fortunately there are different ways to reduce or prevent this risk. It is therefore important to make an appointment with a reproduction specialist immediately after being diagnosed with cancer.
Options for women.
Standard methods for preserving fertility include:
● Oocyte Cryopreservation: the collection and freezing of unfertilised eggs.
● Embryo Cryopreservation: the process in which a woman’s eggs are obtained for use in in vitro fertilisation, the embryos produced are then frozen.
● Ovarian transposition: during this procedure the ovaries are surgically moved to another place in the body, far from the area where the radiotherapy is to be applied.
Other methods of fertility preservation which are still in the experimental phase are:
– Cryopreservation of ovarian tissue: the freezing of ovarian tissue which can then be replaced in the body after cancer treatment.
– Ovarian suppression: this is the use of certain hormones to temporarily stop the functioning of the ovaries.
Options for men.
● Sperm cryopreservation is an effective method for preserving fertility. It includes the freezing and storage of sperm. It is better if performed before starting treatment as there is a greater risk of causing genetic damage to sperm once treatment has commenced.
● Other methods, such as testicular tissue cryopreservation and reimplantation, are still being researched. This method consists of the extraction, freezing and storage of testicular tissue which can then be replaced into the body after cancer treatment.
● Hormone therapy is not effective for preserving fertility in men.
Options for parents of children and adolescents with cancer.
Standard methods for preserving fertility in adolescents who have passed through the stage of puberty include cryopreservation of semen for males and cryopreservation of oocytes for females.
Methods for preservation of fertility in children who have not passed through puberty are still being studied and include testicular cryopreservation for males and cryopreservation of ovaries for females.
If there is the probability that your cancer treatment might affect your fertility, HC Marbella suggests a series of questions which you can ask your oncologist or reproduction specialist:
● What options do I have to preserve my fertility?
● Do any of the options for preserving fertility alter the effectiveness of the cancer treatment?
● Does the use of any of these options mean that I have to delay cancer treatment? If so, what are the risks and how long do they last?
● How will each option affect my health and the health of my future children?
● Do fertility treatments or getting pregnant increase the risk of the cancer reappearing?
● Where can I find help to cope with fertility related problems?
● Where can I find more information on preserving my fertility?
Our oncologists and reproduction specialists are leaders in Spain. They will assess your case and tell you which option is best for you or your family. The team works in multidisciplinary committee groups, and their objective is to obtain the best results, in an environment which is comfortable, modern and stress free to help patients feel as relaxed as possible.
Sources: American Society of Clinical Oncology (ASCO) / Spanish Fertility Society (SEF) / Spanish Society of Medical Oncology (SEOM)
July 26, 2018
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