Fertility preservation: Understand your options before cancer treatment

If you're being treated for cancer, you might have questions about fertility preservation. Find out how cancer treatment can affect your ability to become pregnant or father a child, as well as what fertility preservation steps you can take before you begin cancer treatment.

How does cancer treatment affect fertility?

Certain cancer treatments — including the surgical removal of your reproductive organs or chemotherapy or radiation that affects your reproductive organs — can harm your fertility or cause sterility. The effects, which may be temporary or permanent, can occur immediately or at some point after treatment. The likelihood that cancer treatment will harm your fertility depends on several factors, including:

• Type of cancer and cancer treatment. Male fertility can be harmed by the surgical removal of the testicles, or chemotherapy or radiation that damage sperm quantity, structure, motility or DNA. Certain cancer treatments can also cause ejaculation or hormonal problems. Female fertility can be compromised by cancer treatments that involve the surgical removal of the uterus or ovaries. Cancer treatment can also affect the development of eggs, hormone levels, or the functioning of the ovaries, fallopian tubes, uterus or cervix. Women who are initially fertile after cancer treatment may experience premature menopause. The effects of chemotherapy and radiation therapy depend on the drug or size and location of the radiation field, the dose, intensity of the dose and how treatment is given — orally or intravenously. The most severe damage is caused when radiation is applied to the ovaries or testicles and by chemotherapy drugs called alkylating agents.
• Age at the time of treatment. The risk of developing premature menopause after certain cancer treatments increases as you age. Older women are also more susceptible to permanent ovarian damage.

When should I talk to my doctor about fertility preservation?

If you're planning treatment for cancer and want to take steps to preserve your fertility, talk to your doctor, oncologist or a reproductive specialist about your options as soon as possible. Keep in mind that your fertility can be damaged by one cancer therapy session and, for women, some methods of fertility preservation can only be done during certain phases of the menstrual cycle. Research also suggests that taking steps to protect fertility can improve coping and potentially prevent emotional distress.

How can women preserve fertility before cancer treatment?

Women who are about to undergo cancer treatment have various options when it comes to fertility preservation. For example:

• Embryo cryopreservation. In this outpatient surgical procedure, eggs are harvested from your ovaries, fertilized through in vitro fertilization (IVF), frozen and stored. At the beginning of your menstrual cycle, you'll begin daily injections of synthetic hormones to stimulate your ovaries and increase the likelihood that multiple eggs can be collected during a single cycle. The injections are typically given for up to two weeks. Eggs are removed just before ovulation through a needle inserted into your ovary through your vagina. You may be sedated during this procedure. Then the eggs are combined with sperm — provided by a partner or sperm donor — and frozen. This method of fertility preservation has the highest chance of success for women. Embryos can survive the freezing and thawing process about 95 percent of the time. However, the need to time egg retrieval can delay the start of cancer treatment by two to six weeks.
• Oocyte cryopreservation. Similar to embryo cryopreservation, you'll get injections of a medication to stimulate your ovaries and then have your eggs harvested during an outpatient surgical procedure. Then your unfertilized eggs are frozen. Oocyte cryopreservation is a newer technique and still considered experimental by some experts. Unfertilized eggs survive the process 50 to 60 percent of the time. When possible, women are often encouraged to use the more effective embryo cryopreservation instead of oocyte cryopreservation — even if it requires using donor sperm from a sperm bank.
• Gonadal shielding. Carefully placed shields can reduce your reproductive organs' exposure to radiation.
• Ovarian transposition (oophoropexy). During this outpatient surgical procedure — recommended if you're having radiation applied to your pelvis and no chemotherapy — your ovaries are surgically repositioned just before radiation therapy so they're as far away as possible from the planned radiation field. After treatment, you may need to have your ovaries repositioned again or use IVF to conceive.
• Trachelectomy. If you have early-stage cervical cancer, this inpatient surgical procedure — which involves the surgical removal of the cervix— can help preserve your fertility.

Other methods of fertility preservation for women still being researched include ovarian cryopreservation — in which ovarian tissue is surgically removed, frozen and later reimplanted — and ovarian suppression before cancer therapy, in which hormonal therapies are used to suppress ovarian function and protect eggs during cancer treatment.

What can men do to preserve fertility before cancer treatment?

Men can also take steps to preserve their fertility before undergoing cancer treatment. For example:

• Sperm cryopreservation. Before you begin cancer treatment, you'll provide semen samples through masturbation or another method, such as testicular aspiration — the use of a needle to extract sperm directly from the testicle. Samples are frozen and can be stored for years. Typically, three collections are taken with an interval of 48 hours between collections.
• Gonadal shielding. Carefully placed shields can reduce your testicles' exposure to radiation.

Other methods of fertility preservation for men still being researched include testicular tissue cryopreservation — in which testicular tissue is surgically removed, frozen and later reimplanted — and testicular suppression before cancer therapy — the use of hormonal therapies to protect testicular tissue during cancer treatment.

Can fertility preservation decrease the chance of having successful cancer therapy or increase the risk of recurring cancer?

Research on whether taking fertility preservation steps can affect the success of cancer therapy or the risk of recurring cancer is limited. There's no evidence that current fertility preservation methods can directly compromise the success of cancer treatments. However, you could potentially compromise the success of your treatment if you delay surgery or chemotherapy to pursue fertility preservation. While there appears to be no increased risk of cancer recurrence associated with most fertility preservation methods, further research is needed to determine whether ovarian stimulation can harm women who have hormone-sensitive tumors, as in some types of breast cancer.

Can cancer treatment or fertility preservation methods increase the risk of health problems in children conceived afterward?

As long as you don't expose your baby to cancer treatments in utero, there's no evidence that cancer treatments or fertility interventions increase the risk of congenital disorders or other health problems for future children.

What can parents do to preserve the fertility of a child who has cancer?

Taking steps to preserve the fertility of a child who has cancer can be difficult because he or she may not understand the consequences of impaired fertility. If your child has begun puberty, options might include embryo, oocyte or sperm cryopreservation. Your consent and your child's may be required. Efforts to preserve the fertility of a child who hasn't begun puberty are considered experimental.

How do I determine the best fertility preservation option for me?

If you're considering taking steps to preserve your fertility before cancer treatment, talk to your doctor, oncologist or a reproductive specialist about your options. Your medical team will consider the type of cancer you have, your treatment plan and the amount of time you have before treatment begins to help determine the best approach for you.

The diagnosis of cancer and the treatment process can be overwhelming. However, if you're concerned about how cancer treatment might affect your fertility, you have options. Don't wait. Getting information about fertility preservation methods before you begin cancer treatment can help you make an informed choice.

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