Patients' fertility can be affected both during cancer treatment – when an unplanned pregnancy could be a serious problem – and later, if the cancer treatment causes infertility. For patients who want to have children, this can be devastating. But new advances are giving hope – and options – to patients who want to have children.
Here Terri Woodard, M.D., who leads the MD Anderson Oncofertility Consult Service, answers 10 questions she often gets about fertility and cancer.
1. Can cancer treatment cause infertility?
Some cancer treatments can, while others do not. The most common types of treatments that affect fertility include surgery that involves removal of the reproductive organs, certain types of chemotherapy and radiation to the abdomen and pelvis. We do not know how some newer treatments may affect fertility.
2. How will cancer treatment affect my fertility?
How cancer treatment affects your fertility depends on many things, including the type of treatment you receive, your age and your current fertility status. Some people might be temporarily infertile while others may have permanent infertility. Your doctor can help estimate your individual risk.
3. How long will we need to prevent pregnancy during cancer treatment?
You should abstain or use a reliable form of birth control while you are receiving cancer treatment. You also shouldn’t try to conceive within six months of finishing chemotherapy because it may increase the chances of miscarriage or having a baby with a genetic complication.
4. After cancer treatment, how long should I wait to conceive?
Determining when it is OK to conceive requires thoughtful discussion between you and your health care team. The timing varies between patients and types of cancer. Generally, women should wait at least two years before trying to conceive. This allows enough time for you to get beyond the window of an early cancer recurrence and allows your body to recover from the effects of treatment. If your cancer treatment has caused late effects that might make handling pregnancy more difficult, it may be recommended that you see a maternal-fetal medicine specialist prior to trying to conceive.
5. My partner is pregnant. Is there any reason to avoid sex during my cancer treatment?
Chemotherapy can be excreted in semen and vaginal secretions, so a condom should be used to prevent your partner from being exposed to it. It is possible that exposure could cause fetal abnormalities. If your white blood cell counts or platelet counts are low, your oncologist may advise you to abstain from intercourse because you may be at increased risk for infection or bleeding.
6. What fertility preservation options are available for women preparing for cancer treatment?
There are several different ways that we can preserve fertility for women. The most common and accepted way to do this it to use assisted reproductive technologies (ART) to freeze eggs and/or embryos. For patients who will receive high doses of radiation to the abdomen and pelvis, ovarian transposition is a surgical procedure that moves the ovaries out of the radiation field so that they are not harmed.
Another option is suppressing the ovaries with medication to make them more resistant to the effects of chemotherapy; this is considered experimental.
Freezing ovarian tissue is the only option for girls who have not gone through puberty yet. It is also considered experimental, though children have been born using this method.
7. What fertility preservation options are available for men preparing to undergo cancer treatment?
For men, the most common and accepted way to preserve fertility is to bank sperm before starting cancer treatment.
For boys who haven’t gone through puberty yet, the only option for fertility preservation is to freeze pieces of testicular tissue. This is considered an experimental procedure.
8. I stopped having my period. Could I still get pregnant?
It depends. Some cancer treatments cause women to stop having periods, but this may be temporary or permanent. Thus, a woman may become pregnant if she ovulates (releases an egg) before her periods come back. If her periods stop permanently, she is in premature menopause, and it is highly unlikely that she will become pregnant.
9. What should I ask my doctor about cancer and fertility?
You should ask if your treatment might cause infertility and, if so, what your personal risk is. You should also ask about ways to preserve or protect your fertility before you start treatment. If you would like to learn more, ask your doctor to refer you to a fertility specialist, who can counsel you about your risk and provide fertility preservation treatments. If you’re a patient at MD Anderson, ask for a referral to the MD Anderson Oncofertility Consult Service.
10. When should I talk to my doctor about my fertility?
You should talk to your doctor about your fertility concerns as early as possible in the course of diagnosis and definitely before you start treatment. The earlier you have the conversation, the more options you have if you decide to pursue fertility preservation treatment. However, even if you did not have the opportunity to discuss your concerns prior to treatment, you should still talk to your doctor about them because you can still think about your plans for parenthood after cancer.