Fertility preservation for women with cancer

When a young woman is diagnosed with cancer, getting pregnant is probably the last thing on her mind. But if she wants children in the future, it's something she should think about. The chemotherapy and radiation treatments used to treat cancer can hurt a women's fertility. Nearly 10 percent of the 1.5 million diagnosed with cancer each year are of childbearing age, according to the National Cancer Institute, Dr. Melissa M. Yates, an assistant professor of gynecology and obstetrics at the Johns Hopkins Fertility Center, says these women need to think about fertility preservation before they begin treatment for cancer.

What are the risks of infertility among women undergoing cancer treatment?

Many types of cancer treatment can affect a woman's fertility. Women under the age of 40 have a higher risk of premature menopause if they have certain kinds of chemotherapy and radiation. Surgery and hormonal treatments that follow a cancer diagnosis can also threaten fertility. Some chemotherapy drugs pose more risk than others.

How do chemotherapy and radiation damage a women's reproductive system?

Chemotherapy specifically damages cells that are dividing because that is what the drugs are designed to do — to kill cancer cells that divide more rapidly than normal cells. Unfortunately, that is also how it damages the egg cells in the ovary. Unlike many tissues that are damaged by chemotherapy, a woman does not continue to make eggs; she is born with all she will ever have, and once they are damaged or destroyed, there are no replacements. Radiation works in basically the same way, except that it is usually used in a more targeted area of the body. The ovaries and eggs are affected when radiation is used to treat cancers of the reproductive organs themselves or cancers in other organs in the pelvis.

What are the first steps women can take to protect fertility if they are facing cancer therapy?

Reproductive endocrinologists are working with oncologists to spread the word about options for women and are taking a team approach to fertility preservation. If their doctors don't bring up the subject, women and their partners or advocates should do so before treatment starts. Raising the subject can be challenging because pursuing fertility preservation can delay the start of treatment. It's important to keep in mind that some kinds of cancer treatment may not be a threat to fertility or may pose less of a threat than other kinds. In addition, the stage of cancer at the time of diagnosis may increase or limit options for fertility preservation.

What are the options for women who want to consider fertility preservation?

The best option is to undergo an emergency cycle of egg retrieval or in vitro fertilization or both, and have eggs or embryos frozen for future use. Embryos or eggs or both can be stored during cancer treatment and used once a woman is in remission and no longer undergoing treatment that could damage a fetus. Sometimes, in women undergoing radiation therapy, ovaries can be moved out of the pelvis to reduce the risk of damage. Although experimental, another approach is to remove an ovary, freeze it, and then transplant it back to the patient once treatment is completed.

Are women who undergo cancer treatment able to carry their own babies or do they need to use surrogates?

Most women who undergo cancer treatments can carry their own babies, but the prospects for success depend on the kind of cancer they have, the treatments they have and their overall health. Women need to work closely with their oncologist to determine what would be appropriate in their situation.

What are the emotional consequences of cancer-related infertility?

Cancer mostly affects older people, and for those who are young and of childbearing age, a diagnosis of cancer can be especially difficult, particularly if they have not yet started a family. Physicians who care for such women have learned that those given the opportunity to learn about fertility preservation feel a renewed sense of hope at a time when their world has been turned upside down. Fertility preservation provides young women a chance to look forward to their future and to plan for something beyond cancer treatment.

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