Fertility Preservation Before Cancer Treatment

If you or a loved one has been diagnosed with cancer, plans for starting a family may be put on the back burner. However, cancer treatments such as surgery, chemotherapy, and radiation can be toxic to the ovaries and testicles and affect your ability to have children in the future. It is important to speak with your oncologist about how cancer treatments may affect your fertility. fertility couple with doctor cancer

Cancer treatments can affect fertility

Surgery:

If part of your reproductive system (such as the testicles, prostate, ovaries, uterus, cervix, nerves or lymph nodes in the abdomen /pelvis, brain) is directly affected by cancer and must be altered by surgery, your fertility can be impaired or diminished.

Chemotherapy:

Chemotherapy treatments and other medications can damage sperm and eggs and prevent you from having children in the future. Risk of infertility from chemotherapy and medication depends on:

  • Type of drug
  • Location of cancer
  • Dose

Learn more about which chemotherapy drugs have a higher risk of affecting your fertility by discussing this chart with your doctor.

Radiation Therapy:

Radiation therapy can damage the reproductive system. Radiation to the brain can damage areas that control hormone production, affecting fertility. Depending on the dose, radiation aimed near the pelvic region can cause temporary or permanent infertility by affecting the testicles or ovaries.

  • Fertility Preservation for Women

    Infertility in women occurs when the body can no longer produce mature eggs or if there’s an inability to establish or maintain a pregnancy. Women are born with a certain number of eggs in their ovaries and do not produce more throughout life. Cancer treatments can damage or destroy these eggs, causing infertility and premature ovarian failure (also called early menopause).

    Options for preserving female fertility before cancer treatments

    Egg or Embryo Freezing

    These options take 2-6 weeks to complete. If you decide to proceed with egg or embryo freezing after a referral to a fertility specialist, there are several steps in the process:

    • Ovarian stimulation- you will receive or give yourself hormone injections each day for ~ 10 days. These hormones will stimulate multiple eggs in your ovaries to mature. During this period of stimulation, you visit the reproductive endocrinologist frequently for blood tests and ultrasounds. These tests show how your ovaries are responding to the hormones, and allow your doctor to adjust dosage if necessary. Once the eggs are fully mature, an egg retrieval is scheduled.
    • Egg retrieval- This is an outpatient procedure done with anesthesia. No incision (surgical cut) is needed. Once you are asleep, an ultrasound probe is placed in your vagina so your reproductive endocrinologist can see your ovaries. A very thin needle is passed through the wall of your vagina up to your ovary. Each of the large follicles are punctured with this needle to extract the mature eggs. The procedure takes only 10 to 20 minutes. The eggs are brought to a laboratory to be examined and processed.
    • Fertilization- if you are freezing embryos, the mature eggs that were extracted must be fertilized with sperm before they are frozen. At the laboratory, your partner’s or donor sperm is used to fertilize the eggs. This is known as In Vitro fertilization, or IVF.
    • Freezing (cryopreservation)- Your unfertilized eggs or embryos are frozen at a laboratory. It is suggested that multiple samples are frozen, since it is possible for specimens to be damaged during the freezing process. However, once frozen, you can keep your unfertilized eggs or embryos frozen for as long as necessary, with no known negative effects.

    Ovarian Tissue Freezing

    If waiting 2 to six weeks before starting your cancer treatment is not an option, or if you are unable to undergo hormone therapy to mature eggs, ovarian tissue freezing may be an appropriate option. In this procedure, ovarian tissue is surgically removed and frozen. After cancer treatment, the tissue is either surgically implanted back into your body, in the hopes an egg will mature naturally and result in a pregnancy, or eggs are extracted from the tissue and fertilized with IVF.

    Ovarian Shielding and Ovarian Transposition

    Both techniques are used to shield the reproductive organs from harmful radiation during cancer treatment, and decrease the risk of damage. If you are receiving radiation to the abdomen, ask your radiation oncologist about options for protecting your ovaries. 

    Parenthood after cancer

    Speak to your oncologist before trying to start a family after cancer treatment, to make sure the damage from treatment has had time to heal. If natural conception or sustained pregnancy is no longer possible due to your cancer treatment, there are other options for having children, including:

    • IVF with previously frozen eggs or embryos
    • IVF with donor eggs or embryos
    • Gestational surrogacy
    • Adoption

    Any woman who completes cancer treatment but is not ready for children should use a form of birth control. Talk to your doctor about safe options.

  • Fertility Preservation for Men

    Fertility potential decreases when their reproductive organ has been exposed to chemotherapy, radiation or has been altered by surgery due to treatment of the cancer.

    Options for preserving male fertility before cancer treatments

    Sperm Banking

    Sperm banking is the most recommended option for men to preserve fertility before cancer treatment. Sperm samples are frozen and stored for future use, called cryopreservation. Since some sperm can be damaged by the freezing process, it is recommended that men give several sperm samples. Samples can be given daily or every other day, and stored indefinitely. Men who have difficulty providing a sample due to a medical condition or religious or cultural constraints will be provided with alternate options for delivering a sperm sample.

    Testicular tissue freezing

    If no sperm are present on a semen analysis, a procedure can be done to surgically remove small pieces of testicular tissue, which are then examined for sperm. If sperm is present, the tissue is frozen and used in the future to obtain sperm for fertilization.

    Radiation Shielding (or gonadal shielding)

    If receiving radiation to the lower abdomen or pelvis, it is important to talk with your radiation oncologist about radiation shielding. Lead-lined shields can be placed over one or both testicles to protect them and reduce the risk of infertility.

    Parenthood after cancer

    After discussing with your oncologist, it is usually recommended that men wait 18 months to 2 years to naturally conceive to make sure any DNA damaged by treatment has had time to clear the body. If natural reproduction is no longer possible due to your cancer treatment, there are other options for having children, including:

    • Assisted reproduction with previously saved sperm (through sperm extraction and IVF with your partner’s egg)
    • Donor Sperm
    • Adoption

    Any man who completes cancer treatment but is not ready for children should use a form of birth control. Talk to your doctor about safe options.

 

Appointments

Talk to your oncologist or surgeon about how your fertility or ability to maintain a pregnancy may be affected by cancer treatments. If necessary, men and women can both be referred to The Henry Ford Center for Reproductive Medicine, where cancer fertility specialists Dr. Nicole Budrys and Dr. Ali Dabaja can discuss fertility risks in depth, and guide you through the options available to preserve fertility.

  • Cancer patients are guaranteed an appointment at the clinic or an inpatient consult within 48 hours of contact.
  • A fertility specialist will meet with you to gain a clear understanding of your condition assess your fertility potential, and what the chances are of infertility after cancer treatment

If getting to either of those locations is an obstacle, Telemedicine clinic-to-clinic visits are available and usually covered by insurance. Call (248) 637-4050 to request an appointment.

 

Colleen’s Corner: Local and National Resources

 

Online Resources

Learn more about fertility preservation and the options or resources available.