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Fertility and Cancer

Know Your Options for Becoming a Mother after Treatment

by Lisa Kolp, MD

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When you hear the news that you have cancer, you may feel as if your life is spinning out of your con­trol. You wonder whether you will survive. And what about all the side effects of cancer treat­ment? Will you be able to manage them? Then your doctor drops another bomb, sending your sense of control hurtling even further from your reach: the treatments intended to save your life may leave you infertile.

Fortunately, the majority of young women diagnosed with cancer are surviving the disease and living longer, healthier lives. Acknowledging this fact, the American Society of Clinical Oncology has declared achiev­ing quality survivorship a priority in cancer treatment, and for many young survivors, that includes the ability to start or grow a family.

How does cancer affect fertility?
Women are born with all the eggs they will ever have. Each egg is located in a micro­scopic cyst in the ovary called a primordial follicle, and each follicle is part of the ovarian reserve from which eggs are released over the course of a woman’s lifetime. When a woman’s ovaries run out of eggs, she enters menopause. Menopause occurs in women naturally, usually around age 50; however, certain cancer treatments can accelerate the process of egg loss. Both chemotherapy and radiation to the pelvis can destroy the eggs in the ovarian reserve. Radiation and surgery can also affect fertility by damaging reproduc­tive structures, leaving a woman unable to carry a pregnancy.

If all of a woman’s eggs are destroyed, she will experience ovarian failure; her menstrual periods will end, and she may develop menopausal symptoms, like hot flashes and night sweats. If some of the eggs survive, the menopausal side effects will be temporary, and the woman’s menstrual cycle will resume. The number of eggs that will survive treatment depends on individual factors, including your age and the type and dose of treatment you receive.

Author of Article photo

Dr. Lisa Kolp

Is it safe to have a baby after cancer treatment?
It’s important to avoid conceiving during treatment. It’s also best to wait for several years after treatment to give your body time to recover and to make sure your cancer is in a sustained remission before considering pregnancy. However, after a reasonable length of time, pregnancy is safe. The risks of birth defects, prematurity, or other complications of pregnancy are no higher in cancer survivors than in otherwise healthy women. A caveat: if the uterus has received significant radiation, it may not be able to sustain a pregnancy, resulting in a higher risk of miscarriage, pre­maturity, and stillborn births.

What can I do to preserve my fertility?
Ideally, as part of your cancer treatment planning, your oncologist will send you to a repro­ductive endocrinologist to discuss your fertility preservation options prior to treatment. You may have time to consider cryopreservation, a technique that involves freezing embryos (fertilized eggs) or oocytes (unfertilized eggs) for future use, with embryo freezing being the most effective method.

If you’re facing chemotherapy, your doctor may suggest a gonadotropin-releasing hormone (GnRH) agonist, such as Lupron Depot, which may offer some protection to your ovaries during treatment.

Do I still have options after treatment?
If your menstrual periods resume after treatment, you have a good chance of con­ceiving naturally. Although some of your eggs have been destroyed, the prognosis for pregnancy in a young woman who has a decreased ovarian reserve but otherwise nor­mal fertility is very good.

If treatment destroyed your ovarian reserve, resulting in premature menopause, you may still be able to achieve pregnancy with in vitro fertilization (IVF) using your frozen eggs or embryos, if you were able to bank them before treat­ment, or with a donated egg. If your uterus was damaged by surgery or radiation, or if it was removed completely, you can enlist a gestational carrier, or surrogate, to carry a preg­nancy conceived with your egg and your partner’s or a donor’s sperm. Using fertilized donor eggs is also an option. And, regardless of your repro­ductive status, adoption is another way to build a family.

Starting a family is a real possibility for many women after cancer treatment. Meeting with a reproductive endocrin-ologist early in the treatment planning process will allow you to take advantage of the most optimal fertility sparing techniques. Be sure to ask your doctor if you are at risk for infertility, and find out what options are available to pre­serve your fertility.

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Dr. Lisa Kolp is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine – Green Spring Station in Lutherville, MD, where she has developed a fertility preservation program for women facing cancer treatment.

This article was published in Coping® with Cancer magazine, May/June 2015.