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Ask The Expert/FAQsMain | About Us | Ask The Expert | News | Events
Q. How can cancer affect my fertility? A. A woman is born with all of her eggs; she cannot produce more. Over time and with each menstruation, the supply of eggs decreases until the ovarian reserve is empty and results in menopause. Cancer itself can reduce fertility. However, this is only true for cancers that affect the reproductive organs, such as cancer of the uterus. Other cancers may not directly cause infertility. In most cases, infertility is actually caused by the treatment for the cancer, such as chemotherapy or radiation, rather than the cancer itself.1 Chemotherapy is designed to kill rapidly dividing cells throughout the body. Cancer cells divide rapidly, but so do the cells surrounding the ripening eggs in women’s ovaries. Thus, infertility is a potential side effect of chemotherapy. Likewise, radiation therapy also kills rapidly dividing cells, but only in or around its target area. If the radiation field includes the brain, it may affect fertility by damaging areas that control hormone production. Radiation therapy aimed close to or at the pelvic area can also cause infertility by directly damaging the ovaries. Surgery to remove part or all of the reproductive system can lead to infertility as well. 2 Female fertility can be affected in two ways. First, you may not regain your menstrual cycle after cancer treatment. If your period is going to return, it usually takes six months to one year. Secondly and more commonly, even if you regain your menstrual cycle, you may be at risk for premature ovarian insufficiency. Premature ovarian insufficiency means that your body enters menopause prematurely. (The average age of menopause is around 51).2 Q. If I have been diagnosed with cancer, how soon will I have to undergo fertility preservation? A. One of the assumptions people have is that when a woman is diagnosed with cancer it is essential that her treatment begin immediately after her diagnosis. For common types of cancers observed in young women, some oncologists may be comfortable with delaying treatment two to three weeks to allow time for emergency in vitro fertilization and egg harvests to be performed. Q. How long can eggs, embryos and ovarian tissue be frozen? A. Eggs, embryos and ovarian tissue can be frozen indefinitely. Damage occurs at the time of freezing and thawing, so once frozen they can be frozen for many years. There are case reports of patients who have had embryos frozen for more than 10 years and have still gone on to achieve pregnancy. Q. If I freeze eggs, embryos or ovarian tissue prior to cancer treatments, and don’t use them, or I have some left over after completing my family, what do I do with them? A. This is a very personal decision. Generally, prior to freezing any of these tissues your fertility specialist will ask you to decide what you would like done in the event of your death, divorce or other unforeseen circumstances. For example, in the event of death, if you would like to leave them to your husband or another family member, you would need to create an advance medical directive outlining your wishes. Q. What are some other fertility preservation options for individuals who are unmarried or without a partner? A. Women may consider going through emergency in vitro fertilization using donor sperm to create embryos that will be frozen and stored for use at a later date. You can find donor sperm at sperm banks. Although still considered somewhat experimental, it is also possible to undergo egg retrieval, and freeze the eggs rather than create embryos. Another option is to have ovarian tissue removed and frozen, a process called ovarian tissue cryopreservation.1 Q. What can my oncologist do to protect my fertility during treatment? A. There are ways your oncologist can protect your fertility during surgery or during cancer treatment. They are:
Although your doctor can take certain measures to protect your fertility, it is important to take charge of your own fertility. Patients are the best advocates for their own health. Make sure to discuss how your cancer and your treatment will affect your fertility. Below is a list of questions that may be helpful to ask your oncologist:
Q. Can hormone injections for emergency in vitro fertilization make breast cancer worse? A.Women being treated for breast cancer are often concerned that the hormonal change induced as part of the egg-harvesting process might make their cancer worse or more difficult to cure. To date, there is no evidence to support this, but some doctors still have a concern because of the known association between estrogen and the development of breast cancer. However, experts in the field of oncofertility have concluded that if such a risk does exist, it is very minimal and they still recommend that patients with breast cancer undergo such fertility preservation methods as embryo or egg freezing.2 Q. Will my fertility ever return? If so, how long does it take to regain fertility? A. If your menstrual cycle is going to return, it usually takes six months to one year. Occasionally it can take longer than that. If your cycle has not returned or is very irregular more than a year after treatment, you may want to consider fertility testing.2 Q. After cancer, how long should I wait to try to conceive? A. Most patients are told to wait two years. The suggested timeframe is provided for several reasons. First, most cancers come back in the first two years. Second, eggs exposed to chemotherapy and/or radiation may suffer genetic damage. This damage is believed to repair itself within six months. Each person’s situation is different. It is important to consult with your medical team to determine your individual circumstances before trying to conceive.2 Q. If I regain my menstrual cycle after treatment, does that mean that I'm fertile? A. Regaining your menstrual cycle after cancer treatment is a good sign and may be an indication of fertility. However, it does not necessarily mean that you are still fertile. Many women resume menstruation after cancer and are fertile. Others resume menstruation and are infertile. It is important to remember that while producing and releasing normal eggs is an essential component of fertility potential, other abnormal conditions, such as hormone imbalances, can lead to infertility. Also, although you may regain your menstrual cycle after treatment, you may enter menopause prematurely (before the age of 51), shortening the time span in which you are able to conceive naturally.1 Q. How can I get a measure of my current fertility? A. Traditionally, blood tests to measure thyroid-stimulating hormone levels have been very helpful in looking at how well an adult woman’s ovaries are working and thus measuring her fertility. However, many new drugs are being used to treat cancer in young adults. As a result, the long-term effects of these drugs, including their effects on fertility, have not been measured and quantified. Therefore, we don’t have a clear-cut answer on how to measure the fertility of a woman who has had cancer and/or undergone cancer treatment. Research is being conducted in an attempt to determine how ultrasounds and blood tests are affected by cancer treatment. This information will help doctors develop techniques to accurately measure a woman’s fertility after cancer treatment.3 Q. Can pregnancy after cancer cause recurrence of the cancer? A. Research in this area is limited, but reassuring. Current available research suggests that pregnancy after cancer does not cause or increase the risk of recurrence, even after breast cancer.4 Q. Do cancer survivors have a higher rate of miscarriage? A. Miscarriage is only a concern for a small percentage of patients who had radiation to their pelvic area. Miscarriage, pre-term delivery and low birth-weight infants are more common in women who received radiation to their uterus. A specialist can evaluate whether there is damage to your uterus. To date, research does not suggest a higher rate of miscarriage rate after exposure to chemotherapy or radiation to other parts of the body.4 Q. Is it harder for cancer survivors to adopt children due to their medical history? A. There is no published research on this subject. Anecdotally, most adoption agencies state that they do not rule out cancer survivors as parents. However, adoption agencies often require medical examinations and/or a complete medical history. Adoption methods vary greatly from public to private and domestic to international. It is important to research and understand the health restrictions of the agencies you’re considering.4 Q. Do children born to cancer survivors who underwent chemotherapy and/or radiation have higher rates of birth defects? A. Rates of birth defects in the general population are 2-3 percent. Studies reported to date strongly suggest that children born to cancer survivors are no more likely than others in the general population to have birth defects.4 Q. Do children born to cancer survivors have higher risks of getting cancer themselves? A. Overall, the vast majority of cases of cancer diagnosed before age 30 appear to be spontaneous and unrelated to either carcinogens in the environment or family history. As a result, no unusual cancer risk has been identified in the offspring of cancer survivors except in families identified with true, rare genetic cancer syndromes, for example, inherited retinoblastoma or family history of the BRCA gene. For individuals with genetic cancer syndromes, preimplantation genetic diagnosis (PGD) may be a helpful tool. Preimplantation genetic diagnosis (PGD) is a technique used during invitro fertilization to test embryos for genetic disorders. With PGD, it is now possible to help decrease the risk of passing on a cancer-predisposing gene to your offspring.4 Endnotes |
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