Is Parenthood Possible after Cancer Treatment?
by Joanne Frankel Kelvin, RN, MSN, AOCN
Many young people with cancer have not yet started or completed their families at the time of their diagnosis. If this describes you, and you are wondering if having children after cancer treatment is possible, the answer is yes. Many survivors will be able to conceive naturally, but for some it will be more complicated.
Cancer treatment can affect fertility in a number of ways. Surgery to resect a tumor may result in removal of or injury to reproductive structures. Some types of chemotherapy can destroy a woman’s eggs or impair sperm production in men. For men, sperm production may recover over time, sometimes years after chemotherapy treatment is completed. For women, however, even with resumption of monthly periods after treatment, loss of eggs may lead to early menopause and infertility at a young age. Radiation therapy can also destroy eggs and impair sperm production if the ovaries or testes are in the field of treatment. In addition, high-dose radiation to the pelvis may damage the uterus, leaving a woman physically unable to carry a pregnancy.
Not all survivors will develop these problems after treatment, however. The risk is based on your diagnosis, type and dose of treatment, age, and pretreatment fertility. To understand your personal risk, talk to your doctor.
If your fertility evaluation results indicate that it may be difficult for you to conceive naturally, you have a number of options to consider.
Most survivors are encouraged to wait at least one to two years after cancer treatment ends before attempting to conceive. Ask your doctor how long you should wait. A fertility evaluation at that time may indicate the likelihood you will be able to conceive naturally. A reproductive endocrinologist can check a woman’s hormone levels and use ultrasound to count the number of developing follicles (fluid-filled sacs, each containing a single egg) in the ovaries. Men can have a semen analysis, which reports on the number of sperm present, as well as their motility (ability to swim). If your results indicate that it may be difficult for you to conceive naturally, you have a number of options to consider.
Women may be able to have in vitro fertilization, or IVF. This involves hormone injections to stimulate the ovaries, retrieval of mature eggs, fertilization of the eggs with sperm, and transfer of the resulting embryos into the uterus several days later. Women who were able to freeze embryos or eggs before treatment can use these frozen embryos or eggs. These can be thawed (and fertilized if needed) and transferred into the uterus. Another option is to use donor eggs fertilized with your partner’s sperm to create embryos. For women who are unable to carry a pregnancy, embryos can be transferred to the uterus of a gestational carrier, or surrogate.
Some women who are fertile after treatment but are at risk for loss of fertility may not be ready yet to start a family. These women have the option of fertility preservation with IVF and freezing of eggs or embryos for future use.
Men who have no sperm in their semen but who were able to collect sperm before treatment can use their banked sperm. After thawing, your sperm are used to fertilize your partner’s eggs. IVF, as described above for women, is the most commonly used technique. Men who did not bank sperm can go to a reproductive urologist to consider testicular sperm extraction. This is a minor surgical procedure in which pieces of testicular tissue are removed to look for sperm that may be present in very small numbers. Another option is to use donor sperm to fertilize your partner’s eggs.
Adoption is another way to build a family after cancer. Having a history of cancer does not prevent you from being eligible to adopt as long as you are healthy and have been cancer free for a number of years.
If you have not yet started treatment for cancer and want to have a biologic child in the future, ask your doctor if you are at risk for infertility from your treatment and find out what options are available to preserve your fertility. Ask for a referral to a reproductive specialist if you want to know more.
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Joanne Frankel Kelvin is a clinical nurse specialist and the leader of the Cancer and Fertility program at Memorial Sloan-Kettering Cancer Center in New York, NY.
All of this may be overwhelming at first. But keep in mind that many people have gone through this before you and have been successful in building a family after cancer treatment.
This article was published in Coping® with Cancer magazine, November/December 2012.