3 April 2020

How Cancer Treatments Can Affect Fertility in Women

Doctor
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London

 

In our era of ever-improving treatments for cancer and improved survival rates, there are fortunately more and more people able to look forward to a cancer-clear future after treatment. So many are now able to think about how the treatment itself may affect their future prospects and their chances of having a family.

There are many different types of cancer treatment. The most well-known are radiotherapy and chemotherapy, both of which carry the possibility of damaging fertility. Other less well-known types of treatment can also carry this hazard. Is it possible to protect yourself from this unwanted side effect? In many cases, it is. Let’s look at some of the options.

 

Which cancer treatments can affect fertility?

Many types of cancer treatment can have an effect, either temporarily or permanently, on a woman’s fertility. This is because the ovaries contain a finite number of follicles which gradually reduce over a woman’s life. The most common cancer treatments accelerate the reduction of these follicle numbers and can also prevent them from maturing. As a result,  the ovaries are unable to regenerate, this can lead to premature ovarian failure (also known as early menopause).

 

The impact of different cancer treatments

  • Chemotherapy not only can affect the ovaries causing a cessation of egg production as well as oestrogen production but also it can reduce the quality of the remaining eggs. In some patients, menstrual periods and fertility are restored naturally after treatment, but for others the impact is permanent.

 

How can your fertility be protected before cancer treatment?

A diagnosis of cancer is obviously a major life event, and you may not feel up to thinking about any other issues for the time being. The support of a close friend or family member can be a great help. You should also accept any counselling or psychological support that’s available to help you and consider the options for fertility protection.

  • Embryo freezing, or embryo cryopreservation, is a well-established technique for the preservation of fertility. It follows the IVF pattern of ovarian stimulation, egg retrieval and fertilisation in the laboratory. The resulting embryos are then frozen and stored. At the right time, they can be thawed and transferred to the patient’s uterus.
  • Egg freezing, also known as vitrification of oocytes, is a similar process where after the eggs have been collected, these are vitrified and stored for future use (instead of being fertilised in the laboratory). When needed, these can be thawed and fertilised and the resulting embryos can be used.
  • Ovarian shielding is, as it sounds, a procedure in which the ovaries are shielded by a protective cover placed externally over the vulnerable areas such as parts of the reproductive system. This protects them from scatter radiation during sessions of radiotherapy.
  • In vitro maturation of oocytes is a technique which can be particularly important for patients whose urgent cancer treatment leaves inadequate time for ovarian stimulation, or where the hormonal medication used in ovarian stimulation is contraindicated because of the type of cancer involved or the age of the patient. In this technique, immature oocytes are retrieved from small follicles without stimulation or with only minimal stimulation. These are then matured in a suitable culture in the laboratory and can be stored for future use in an IVF cycle.
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In vitro maturation of oocytes and the use of GnRH agonists are still considered investigational by several authorities, but there are many fertility preservation options. The one which is appropriate for an individual patient depends on the nature of the cancer and on a number of other factors such as their age, general health and underlying fertility status. Only a medical practitioner with an understanding of the implications of the treatment, and expertise in fertility protection measures, can recommend the right choice for each particular case.

 

Contacting IVI              

At IVI we have worked over many years towards the goal of offering cancer patients a way to preserve their fertility for the future so that when they are well again, they can look forward to the option of having a baby. Our counselling service is also an integral part of every fertility treatment.

If any of these issues are affecting you, your partner or a close family member, it’s easy to contact us. Just complete our online contact form and we’ll be in touch.

 

 

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