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Fertility and Cancer Treatment

Know how cancer and its treatment impacts your reproductive system.

Reproductive health issues including fertility conservation, contraception, and pregnancy in cancer patients are difficult but necessary conversations. These challenging issues are critical to providing a complete continuum of care for women with cancer.

- American Cancer Society.

Women of child bearing age diagnosed with cancer today have a greater chance of long-term survival than ever before.

The quality of survivorship after diagnosis and completion of treatment is important and cancer treatments including chemotherapy, radiation and surgery can negatively impact this level of quality by compromising reproductive and endocrine health.

In addition to hundreds of thousands of adult survivors in the reproductive age group, there are more than 270,000 survivors of pediatric cancer and more than 1 million survivors of young adult cancer in the United States today. However, the same life-saving treatments that increase the cancer survival rate can also cause temporary or permanent infertility in cancer survivors.

Cancer treatments can affect fertility in women in a number of ways.

  • Some chemotherapy medications (especially alkylating agents) destroy eggs in the ovaries. This decrease in the number of eggs may lead to infertility after treatment. The risk of infertility depends on the medications used, the doses given, and the age of the woman at the time of treatment. Older females have fewer eggs when they start treatment. This means they are more likely to become infertile after treatment.

  • Radiation therapy to the pelvic area destroys eggs in a similar way to chemotherapy. Radiation may also damage the uterus, causing scarring.

  • Surgery or radiation therapy to the brain may affect the pituitary gland, which releases hormones that stimulate egg maturation and ovulation but doesn’t directly damage the eggs in the ovaries. There are medications that replace these hormones that may help you become pregnant.

  • Surgery involving a single ovary, both ovaries, or the uterus can directly affect fertility.

  • Hormone therapy also known as endocrine therapy used to treat cancer can disrupt the menstrual cycle which may affect your fertility. Side effects can include hot flashes, night sweats, and vaginal dryness.

  • Bone marrow or peripheral stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.

In men, cancer treatment can affect fertility in the following ways:

  • Chemotherapy (such as alkylating agents) can damage sperm in men and sperm producing cells (germ cells) in young boys.

  • Hormone therapy also known as endocrine therapy can decrease the production of sperm.

  • Radiation therapy to the reproductive organs as well as radiation in the pelvic area may lower sperm counts and testosterone levels, causing infertility.

  • Radiation therapy to the brain in the region of the pituitary gland can decrease the production of testosterone and sperm.

  • Surgery for pelvic cancers (such as bladder, testicular, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.

  • Bone marrow transplants and peripheral stem cell transplants involve receiving high doses of specific chemotherapy and/or radiation. These treatments can damage sperm and sperm producing cells.

Because of the many factors that can affect fertility, it’s hard to know how you may be affected by your treatment and whether a cancer patient will still be able to get pregnant after treatment is finished or not. There are also several factors that affect how long a woman will be fertile after her treatment.

Although cancer treatment can negatively impact fertility, there are a number of options available that can preserve fertility and increase a patient’s chances to have a biological child in the future.

Not all women starting cancer treatment will need or want to consider these options. Similarly, not all men may want to use available options. The decision whether to pursue fertility preservation is a personal one. It is absolutely important for you to know what options are available so you can make the right decision for yourself.

Fertility preservation options for women include:

  • Egg or Embryo Freezing

  • Ovarian Tissue Freezing

  • Ovarian Suppression

  • Ovarian Transposition

  • Radical Trachelectomy

  • Treatment with GnRHa, which is a hormone agonist.

Fertility preservation options for men include:

  • Sperm Banking

  • Testicular Tissue Freezing

  • Radiation Shielding

  • Testicular Transposition

If you have questions about your risk of infertility based on the treatment you will receive, it is important to speak with your oncologist as early in the treatment as possible. A handy checklist of the right questions to ask your cancer care team/oncologist goes a long way to clearing your doubts and helping you prepare for what lies ahead.

There is no optimal time to have a child after cancer treatment because every case of cancer is biologically unique.

It varies between patients and types of cancer. Generally, women should wait at least two years before trying to conceive. This gives sufficient time for a woman’s body to get beyond the window of an early cancer recurrence and allows her body to recover from the impact of treatment. The protocol is completely different if cancer is detected after a pregnancy is confirmed. Deciding when it is the right time to conceive needs a thoughtful and thorough discussion between you and your cancer care team.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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