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For anyone, being diagnosed with a serious illness is a major life event in itself, inevitably accompanied by fears and uncertainties about the future. For a woman who has not started or completed her family and wishes to do so, an added burden may be the knowledge that the necessary treatment could itself cause further problems by compromising her future fertility. Cancer treatments in particular are known to carry this risk.
In this article we look at fertility after cancer treatment, different types of cancer treatment and their possible impact on female fertility. We then set out the options for safeguarding it. Sometimes it is possible to reduce the effects of treatment on future fertility, or to take advance measures to combat this difficult situation. In particular we address the frequent concerns about IVF after cancer, pregnancy after radiation therapy and the chances of getting pregnant after chemotherapy.
What are the different types of cancer treatment that can affect fertility?
In any individual case doctors may not be able to predict exactly how the patient’s fertility will be affected, though age, the nature of the cancer and the planned treatment can help give them an idea. This is unfortunately not the only unknown. The treatments themselves can vary in their composition and nature from patient to patient. For example, the term ‘chemotherapy’ covers a whole range of protocols and combinations of drugs which are prescribed by an oncologist specifically for a particular patient and their individual circumstances. However, we can summarise the most common types of cancer treatment and give an indication of their possible or probable effect on female fertility, as follows.
Chemotherapy
Chemotherapy destroys cancer cells with the use of anti-cancer drugs. This is one of the most common causes of loss of fertility after cancer treatment. Chemotherapy reduces the number of eggs stored in your ovaries. Your periods may become irregular or cease for a time, or sometimes it can even cause permanent infertility and early menopause. The level of risk depends on your age, the drugs you have been prescribed and their dosage.
Radiotherapy
Radiotherapy destroys cancer cells with high-energy rays. It can cause fertility problems by affecting the eggs, damaging the uterus, ovaries or hormone production. If radiotherapy is administered directly to the womb and ovaries, it causes permanent infertility and the onset of menopause. Radiation to other areas of the pelvic region could indirectly damage the womb or ovaries, which could cause temporary or longer-term infertility. As with chemotherapy, the risk depends on your age and the necessary dose.
Surgery
Clearly some types of surgery such as hysterectomy or removal of the ovaries will cause complete infertility. But if only one ovary is removed and your womb is intact, the remaining ovary continues to release eggs and you may still become pregnant naturally. The outcome can be similar for surgery of the cervix, which in some instances can leave the womb and ovaries functioning, meaning that there is still a possibility of pregnancy. These fertility-preserving techniques are only possible in certain cases.
Hormone therapy
Some types of cancers require hormone therapy to discourage the growth of cancer cells. The treatment reduces the levels of your hormones or blocks their effect. It is frequently used in the treatment of breast cancer. Hormone therapy can affect your fertility, but this is usually temporary. Your periods may change their pattern or cease completely during the treatment, but they usually return to normal when treatment finishes or a few months later.
How can a woman’s fertility be safeguarded before cancer treatment?
Naturally it all depends on the nature of the diagnosed illness and the specifics of the prescribed treatment, but broadly speaking there are several options available. Factors to take into account include the site of the cancer, type of treatment, time available and the age of the patient. In many cases, pregnancy after radiation therapy is possible and the chances of getting pregnant after chemotherapy can be good. It could all depend on taking the preparatory steps that are now available through assisted reproduction techniques. We at IVI have a wealth of experience in helping women who are about to undergo cancer treatment to safeguard their fertility for the future. Here are some of the options.
Vitrification of oocytes
This could be described as a part of the better-known IVF fertility treatment, but with a time delay built in. It follows the same process as IVF as far as ovarian stimulation and gathering of oocytes is concerned. At this point, however, the mature eggs are cryopreserved so that they can be used at a later date, with the same prognosis as at the point when they were vitrified. Due to the fact that ice crystals do not form, this technique results in high oocyte survival, meaning there is a reasonable chance of success. In this way, IVF after cancer treatment can fulfil your hopes of parenthood in spite of the setback of serious illness. You can see for yourself more about how the process works in the video about vitrification of oocytes on our IVI YouTube channel.
Vitrification of oocytes is the most commonly recommended treatment for patients who are at risk of losing their ovarian function. As well as women who have been diagnosed with cancer and are going to undergo chemotherapy or radiotherapy treatment, these include women with autoimmune diseases which require chemotherapy, bone marrow transplants, and for those who are at risk of needing successive ovarian surgery procedures, for example in the treatment of endometriosis.
Freezing of the ovarian cortex
A different cryopreservation technique is the freezing of the ovarian cortex. This technique can enable ovarian function to be restored so that spontaneous pregnancy might be achieved. In addition, since the patient would have normal levels of hormones, early menopause with its secondary effects such as osteoporosis, hot flushes and cardiovascular problems can be avoided.
This technique is the method of choice when treating pre-pubescent girls, although it is also used for adult cancer patients who are due to have chemotherapy or radiotherapy, among other circumstances. The treatment can be compatible with the vitrification of oocytes if the circumstances allow adequate time for carrying out both techniques, but for patients who need to start chemotherapy immediately or when ovarian stimulation is inadvisable, it can be used on its own.
Ovarian transposition
The medical term for transposition of the ovaries is oophoropexy. This a preservation of fertility technique that involves removing the ovaries from the field of irradiation to avoid their direct exposure to radiotherapy, and in this way preventing the damage that this treatment can cause to the ovaries when they are within the radiation field. It cannot be used in all cases, as there are certain specific indications. It can also be compatible with other techniques. Ovarian transposition preserves ovarian function in around 83 – 88% of cases, depending on the surgical method which is used.
In vitro maturation of oocytes
For some patients, such as those with hormone-dependent tumours, it is necessary to avoid ovarian stimulation. In these circumstances, an alternative can be in vitro maturation of oocytes, known as IVM. In this method, immature oocytes are recovered from small antral follicles either without stimulation or with only minimal stimulation. They are then cultivated in a suitable medium until they reach maturity.
This way ovarian stimulation is avoided, making IVM a potential alternative to a standard IVF cycle. As such, it represents another option for pregnancy after radiation therapy.
More information about IVI
If you are concerned about the chances of getting pregnant after chemotherapy or you would like to know more about how cancer treatments can affect fertility or how IVF after cancer can be most effective, do browse our website for the full facts. We feature articles about a whole range of assisted fertility issues and we publish up-to-date analyses of the latest reproductive techniques. For a general introduction to who we are, what we do and the services we can offer, have a look at the video about IVI on our YouTube channel. Overall, we at IVI have one of the best success rates per patient Some 9 out of 10 couples that consult IVI due to problems with infertility and put their trust in us achieve their goal of becoming parents. One of our proudest and most significant statistics is that over 160,000 babies have been born to date with the help of IVI.
When you feel ready, do contact us for an appointment, without obligation. You can phone us on 08 000 850 035 if calling from the UK, or on +34 960 451 185 from all other countries. Alternatively you could use our online contact form to get in touch and one of our specialists will contact you. At IVI, you are our first priority and we are here to help.
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