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Cancer Therapy and Your Fertility

by Carolyn R. Kaplan, MD

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Cancer Therapy and Women’s Fertility
Each year, cancer occurs in about 113 out of every 100,000 women under age 50 in the United States. Complicating matters, the trend toward delaying childbearing means that many women will not have had children when they are diagnosed. While it is known that cancer therapy can affect a woman’s fertility, fewer than 25 percent of oncologists inform women about their risks and options.

Women who undergo chemotherapy or radiation may experience early menopause. Treatment often results in premature ovarian failure and infertility. However, there are several methods to preserve fertility in women diagnosed with cancer.

Fertility preservation requires individualization. The optimal approach depends upon the type of cancer treatment you received, the time available, your age, your cancer type, and whether you have a partner.

Any woman who has gone through puberty and still has regular menstrual cycles may be a candidate for embryo freezing.

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Dr. Carolyn Kaplan

One option includes in vitro fertilization and embryo cryopreservation. In vitro fertilization and embryo freezing can allow you to delay conception until you have completed treatment, even if treatment causes early menopause. This process involves several steps, including hormone therapy, egg retrieval, fertilization of the egg, laboratory development of the embryo, and freezing of the embryo. Frozen embryos can survive for many years, and once you are in remission and ready to use the embryos, the process of transferring the embryos can begin.

Any woman who has gone through puberty and still has regular menstrual cycles may be a candidate for embryo freezing. However, success rates decline as women get older and are best for women younger than 38 years old. Some women may have poor ovarian function even at a young age, but fertility tests can predict success rates. It’s important to note that in vitro fertilization is suitable for women who have partners or who accept donor sperm.

Women who do not have a partner may have the option to freeze their eggs, called oocyte cryopreservation. This new technology has led to live births, but it is still considered experimental and requires a specialized embryology laboratory.

Egg donation is another option. Egg donation allows a woman who has gone through menopause to carry a pregnancy. The process is similar to in vitro fertilization, except that a fertile woman (a relative, friend, or anonymous donor) is given fertility drugs to stimulate multiple eggs to develop. The eggs are then harvested and fertilized with your partner’s sperm, or with donor sperm. The embryos are grown in the laboratory for several days.

You will receive hormone therapy to develop a normal uterine environment, and then the resulting embryos are placed in your uterus. Some women treated with radiation therapy can have abnormal uterine function, so testing is necessary. Hormone therapy is maintained for several weeks, and then pregnancy progresses normally.

Cancer Therapy and Men’s Fertility
Men with cancer have long been able to preserve their fertility by freezing their sperm. Unfortunately, sperm quality is often affected by cancer, and there may be poor sperm quality at the time of diagnosis.

Sperm banking is a great option for men. Most large cities have sperm banks that can freeze sperm. If a sperm bank is not located near your home, you can find sperm banks across the country that can provide long-term sperm storage.

Options for fertility treatment depend on how cancer therapy has affected your fertility, and how normal your semen analysis is after treatment. Options may include artificial insemination with washed sperm if the sperm is relatively unaffected by cancer treatment, or if frozen sperm are available from before cancer therapy.

Insemination with donor sperm can allow conception when there are no sperm present after cancer treatment. If there are any sperm available, even very poor quality sperm or extremely low numbers of sperm, then in vitro fertilization can allow conception. Once the eggs have been harvested from your partner, an embryologist can pick up a single sperm and inject each egg to ensure normal fertilization. Live birth rates are excellent with this procedure and are largely dependent on your partner’s age.

Several viable options are available for cancer survivors who wish to have a family. As the oncology community becomes more aware of fertility preservation options, these will be offered to more people with cancer.

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Dr. Carolyn Kaplan is the director of In Vitro Fertilization at Georgia Reproductive Specialists. She specializes in the initial diagnosis of infertility, the holistic approach to infertility treatment, recurrent pregnancy loss, and egg donation. Visit IVF.com for more information.

Numerous advocacy organizations, such as Fertile Hope (fertilehope.org), are available to help you as you negotiate treatment options in your quest for a family.

This article was published in Coping® with Cancer magazine, September/October 2011.

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