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People in the young adult age group can be in many different stages of life. You may have children; you may want children in the future; you may not want children now, but may change your mind; or you may not have given it much thought at all.
Cancer treatment can affect fertility in both women and men, making it difficult to conceive a child in the future. A cancer diagnosis may require you to think seriously about children.
Not all cancer treatments affect fertility. Your risk depends on several factors, including:
- Your age at the time of diagnosis
- The type and dosage of chemotherapy drug(s) you receive. Alkylating agents—for example, cyclophosphamide or procarbazine—have the most significant effect on fertility. Other drugs are generally less toxic to sperm-forming cells and eggs, but can also cause infertility, especially when used as part of a combination of therapies.
- The location and dosage of radiation:
- Exposure to the testes may destroy cells that form sperm
- Exposure to the ovaries may destroy eggs
- Exposure to the pituitary gland in the brain may cause changes in secretion of hormones that regulate puberty and fertility
- Whether you received a blood or marrow stem cell transplantation, which is associated with a high risk of infertility
Talking with members of your oncology team
Talk with your oncology team members about the effects treatment may have on you or your child's fertility. If possible, gather this information before treatment begins. The American Society of Clinical Oncology recommends that patients interested in fertility preservation consider their options as soon as possible to maximize the likelihood of success. Your oncology team members may not be able to answer all your questions, but they can refer you to fertility specialists who can help you understand and explore your options.
As you consider your treatment and fertility options, you may want to also talk with:
- A genetic counselor
- An obstetrician-gynecologist or urologist
- A reproductive endocrinology specialist
Cancer treatment-related infertility may also be associated with emotional distress, so counseling may be beneficial for some individuals.
Questions for your doctor
Ask your oncology team about the fertility effects of your treatment. By having this information before treatment begins, you can consider the options most likely to preserve your fertility. You can also ask for a referral to a fertility specialist to help you understand and explore your options. Some questions you may want to ask are:
- What are the chances the treatment will affect my fertility?
- Have other people been able to get pregnant or father a child naturally after receiving this treatment?
- What can we do to protect fertility before treatment begins, during treatment and/or after treatment ends? Can you recommend a fertility specialist that I can speak with?
- How will I know if treatment has affected my fertility?
- If I have a period of infertility after treatment, should I have my fertility status re-evaluated in the future? If yes, how soon should I have a follow-up evaluation?
Learning that you have cancer-treatment-related infertility may bring on feelings of sadness, anger, or grief. Some people find it helpful to talk about this. Consider asking your healthcare team the following questions:
- Can you suggest a local support group of people who have been through the same challenges?
- Can you recommend a mental health specialist I can speak with?
Family-planning options
Once you've spoken with your doctor about whether your treatment can affect fertility, you may want to know more about family-planning options. There are several options for both people assigned male at birth and people assigned female at birth that may help you, or your child, preserve the ability to have children in the future.
Your options depend on several factors, including:
- Your age at the time of diagnosis and treatment
- The type of cancer
- The type of treatment
- Your family planning objectives
Many people will be able to conceive naturally after cancer treatment. Patients are generally recommended to wait at least two years after treatment is completed before attempting conception. Check with your doctor to find out how long after treatment you should wait. If you are not able to conceive naturally, there are a number of other ways to build a family. For some people, adoption is a good option after cancer treatment. Generally, people free of disease after treatment are eligible to adopt infants or children, but policies vary from state to state. For more information, contact an organization such as Livestrong Fertility or Resolve.
You can take certain steps and precautions to preserve fertility before, during, and after treatment.
Options to preserve embryos and ovaries before treatment
Embryo Freezing: This involves about 10 days of hormone injections to stimulate the ovaries followed by retrieval of mature eggs performed under anesthesia. The eggs are fertilized in the laboratory with sperm from a partner or donor to create embryos (IVF, or in vitro fertilization). The embryos are then frozen and stored for possible future use. Embryo freezing is the option with the highest likelihood of success. The process typically takes at least two to three weeks.
Egg freezing: This involves about 10 days of hormone injections to stimulate the ovaries, followed by retrieval of mature eggs performed under anesthesia. The eggs are then frozen and stored for possible future use without being fertilized. The process typically takes at least two to three weeks.
Ovarian tissue freezing: Girls who have not yet gone through puberty have no mature eggs, and women who must start treatment quickly do not have the two to three weeks required to undergo egg or embryo freezing. They may be able to undergo a procedure in which part of the ovary (or the entire ovary) is removed and frozen for possible future use. Only a small number of pregnancies have resulted from re-implanting tissue, and this may not be safe for patients with certain types of cancer. Further research is needed.
Ovarian transposition: If the ovaries will be in the radiation treatment field, patients may undergo this minor surgical procedure in which a doctor moves the ovaries outside of the radiation field to minimize exposure and radiation damage.
Gonadotropin-releasing jormones (GnRHs): This is a medication used during chemotherapy to suppress ovarian function and possibly protect the eggs from damage. Further research is needed.
Options for having a family after treatment
Use of your frozen eggs or embryos: If you freeze eggs, they will first be fertilized in the laboratory with your partner’s sperm to create embryos. The embryos are transferred to your uterus.
In vitro fertilization (IVF): If you have a low ovarian reserve (low egg count) you may want to consider undergoing an IVF cycle to remove mature eggs so they can be fertilized in the laboratory with your partner’s sperm. The embryos created are transferred to your uterus.
Donor eggs: Eggs provided by a donor who undergoes an IVF cycle can be fertilized in the laboratory with your partner’s sperm. The embryos created are transferred to your uterus.
Donor embryos: Embryos are generally donated by couples who have undergone IVF for infertility. They now have families and choose to donate their remaining embryos rather than discard them. The embryos are transferred to your uterus.
Surrogacy: If you are unable to carry a child, you can arrange for a gestational carrier to carry for you. Embryos created by your eggs or donor eggs are transferred to her uterus.
You can take certain steps and precautions to preserve fertility before, during and after treatment
Options to preserve sperm before treatment
Sperm banking (Cryopreservation): This involves the collection of semen through masturbation. If there is sperm in the semen, it is frozen and stored for possible future use. This is the fertility preservation option with the highest likelihood of success.
Electroejaculation: People who are unable to ejaculate by masturbation because of religious beliefs, pain, or embarrassment, for example, semen can be collected under anesthesia. An electrical current is used to stimulate ejaculation.
Testicular sperm extraction (TESE): For people who have no sperm in the semen specimen, this surgical procedure performed under anesthesia can be considered. The doctor removes pieces of tissue from the testes, which are then examined for mature sperm. These can be removed from the tissue and frozen for possible future use.
Testicular tissue freezing: Young people who have not yet gone through puberty do not produce mature sperm, so they cannot sperm bank. They may be able to undergo an experimental surgical procedure in which a doctor removes tissue from the testicle to be frozen for possible future use. This technique, however, has not yet resulted in a pregnancy. Further research is needed.
Radiation testicular shielding: If the testes are exposed to radiation, the doctor may be able to cover them with external shields. This must be planned before treatment begins, and the shields must be used each day of treatment. Not all patients will be able to use shields, as sometimes there is a need to treat the testes with radiation.
Options for having a family after treatment
Use of your frozen sperm: Depending on the number of vials you have stored and the number and quality of the specimens, this may be used for artificial insemination (the injection of semen into part of the female reproductive tract by a method other than sexual intercourse). For many men, your female partner can undergo an IVF cycle to remove mature eggs so they can be fertilized in the laboratory with your sperm. The embryos created are transferred to her uterus.
In vitro fertilization (IVF): If you have a low sperm count, your female partner can undergo an IVF cycle to remove mature eggs so they can be fertilized in the laboratory with your sperm. The embryos created are transferred to her uterus.
Testicular sperm extraction (TESE): If no sperm is present in your semen, this surgical procedure performed under anesthesia can be considered. The doctor removes pieces of tissue from your testes, which are then examined for mature sperm. If sperm are found, your female partner can undergo an IVF cycle to remove mature eggs so they can be fertilized in the laboratory with your sperm. The embryos created are transferred to her uterus.
Donor sperm: Donated sperm is used to produce a pregnancy through artificial insemination.
Pregnancy
Most women and people assigned female at birth who have been treated for cancer and are able to conceive (are fertile) can go on to have normal pregnancies and healthy babies. They should be able to become pregnant if treatment did not affect the ovaries or uterus. Before you try to become pregnant, talk with your oncologist about your medical readiness for pregnancy. You may also want to consult with a reproductive endocrinologist for a fertility assessment.
Even though some drugs used to treat cancer are not usually associated with infertility, they are not recommended to be taken by anyone who is pregnant. Patients, however, should not stop medication without medical advice. Someone who is taking a cancer drug should consult their oncologist before trying to conceive or if they think they are pregnant.
Health of children born to cancer survivors
Most children born to cancer survivors are healthy. The percentage of babies with birth defects born to cancer survivors is similar to that of babies born to parents without a cancer history. When a parent is diagnosed with cancer, it does not mean that their child is at a greater risk for cancer. Very few cases of cancer are inherited (passed on from a parent to a child). You may want to ask members of your healthcare team if your cancer is a type that can be passed on to your children. If it is, you may want to ask for a referral to a genetics counselor.
Breastfeeding
Talk with the doctor about whether you will be able to breastfeed after treatment. If you have had radiation to the breast area, your ability to produce milk may be affected. Some medicines should not be used while you are breastfeeding. Tell your healthcare team if you are starting treatment and are breastfeeding.
Visit the following organizations for more fertility resources:
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