Know Your Options for Starting a Family after Cancer
by Sarah C. Hessler, MD, and Aimee Seungdamrong, MD
The ability to start a family is now a possibility for increasing numbers of women and men after cancer treatment. If you’ve been wondering whether you’ll be able to have children after chemotherapy or radiation, you’ll be pleased to know that, thanks to advances in the field of reproductive assistance and fertility preservation, you do have several options to consider.
If your ovaries and uterus are still functioning after completing chemotherapy or radiation treatments, you can likely become pregnant without assistance. However, some women experience early menopause or a decrease in fertility caused by cancer treatments. This is where fertility preservation comes into play.
Fertility preservation options for women include freezing fertilized embryos or unfertilized eggs for future use, with embryo freezing being the most effective method. To do this, mature eggs are taken from your ovaries after a 10- to 14-day course of injectable medications. This is usually done prior to starting chemotherapy or radiation. The eggs are then fertilized in a laboratory with your partner’s or a donor’s sperm to form embryos, which are frozen for future use. When you’re ready for pregnancy, the embryos are thawed and placed in your uterus.
Fertility preservation allows a woman to freeze her eggs or embryos for future use.
Some women choose to freeze their unfertilized eggs rather than embryos. With this method, the eggs are fertilized after they have been thawed, and then the resulting embryo is placed in your uterus.
One disadvantage of egg or embryo freezing is that the ovarian stimulation required for maturation of the eggs can take two to three weeks, possibly delaying cancer treatment. In addition, this stimulation can cause estrogen levels to rise up to10 times that of their natural levels. If you have an estrogen-sensitive tumor, this may increase your risk for tumor recurrence; therefore, you will need clearance from your oncologist before attempting this procedure.
Dr. Aimee Seungdamrong
An experimental option that avoids these high doses of medications and high levels of estrogen is in-vitro maturation. For in-vitro maturation, immature eggs are taken from the ovary, matured in a laboratory, and then frozen.
If you have not yet undergone chemotherapy or radiation treatment, you have even more fertility preservation options, including shielding your ovaries from radiation, surgically moving your ovaries out of the pelvic radiation field, and medically suppressing your ovaries prior to treatment, all of which may decrease your risk of premature ovarian failure.
Ovarian tissue freezing is an experimental option that is best done prior to beginning chemotherapy or radiation to the pelvis. For this technique, ovarian tissue is removed from your body and frozen in small strips. These strips are later re-implanted into your body, where they can recover the ability to produce eggs. This method may not be appropriate for BRCA gene mutation carriers and women with leukemia, however, as their ovarian tissue may contain cancerous cells. Studies are currently being conducted to develop other ways to obtain eggs from ovarian tissue without the need for re-implantation.
If your ovaries are not working well enough for you to conceive or produce eggs to freeze but your uterus is still functioning, you can use donor eggs to achieve pregnancy. For this technique, an embryo made by combining an egg from a healthy donor with your partner’s or a donor’s sperm is placed into your uterus. If you have lost the ability to carry a pregnancy due to pelvic radiation, hysterectomy, or another condition affecting your uterus, you might consider using a gestational carrier. A gestational carrier is a woman who will carry a pregnancy conceived using an embryo fertilized from one of your eggs or from a donor egg.
Chemotherapy and radiation treatments may affect a man’s sperm count. A semen analysis can evaluate your sperm count and motility. If you haven’t yet undergone chemotherapy or radiation treatment, your sperm can be frozen for future use.
Sperm from just one ejaculate may be enough for several in-vitro fertilization cycles, as only one sperm is needed per egg. If very few sperm are present in your semen after cancer treatment, sperm can be surgically removed directly from one of your testicles. In cases where sperm production has declined substantially, donor sperm can be used to fertilize your partner’s eggs.
With the wide variety of fertility-preservation options available to both men and women, many cancer survivors can look forward to building a family after treatment. For those who are unable to or who choose not to utilize these therapies, adoption is still a viable option. Talk with your doctor before treatment begins to sort out your options and come up with a fertility preser- vation plan that works best for you.
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Dr. Sarah Hessler is a fellow at Rutgers New Jersey Medical School in Newark, NJ. Dr. Aimee Seungdamrong is a physician at University Reproductive Associates in Hasbrouck Heights, NJ, and an assistant professor in the department of Obstetrics, Gynecology, and Women’s Health at Rutgers New Jersey Medical School.
This article was published in Coping® with Cancer magazine, November/December 2013.
Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.