Some cancer treatments can damage the reproductive system and lead to fertility problems. As a result, women may have difficulty getting pregnant or carrying a pregnancy to term and men may have difficulty getting their partner pregnant. Fertility specialists at Procrea Fertility have identified the following points to help inform patients on available concerns and solutions.
Consequences of chemotherapy and radiotherapy on fertility.
Consequences for women:
Regarding chemotherapy, different factors can affect the woman’s menstrual cycle (i.e., type, duration, drug combinations), leading to ovarian insufficiency and fertility issues. The absence of ovulation can lead to early menopause, although the side effects may vary from one woman to another.
The time at which these side effects will affect ovarian function is variable throughout the chemotherapy treatment. The higher the cumulative doses of medication, the greater the impact on fertility.
With respect to radiotherapy, which plays a significant role in treating gynecological tumours, the repercussions it can have on fertility depend on age, the site(s) that received radiation, the dosage, and the dose per fraction.
- Ovarian irradiation can produce premature ovarian insufficiency and consequently a reduction in the fertility period.
- Abdominal-pelvic radiotherapy and total body irradiation also have this effect on the ovaries and fertility.
- Following uterine irradiation, pregnancies are considered at risk and must receive specific care.
- Brachytherapy in vulvar or vaginal tissues can also cause fertility issues.
- Cranial or craniospinal irradiation, can cause amenorrhea (the absence of menstruation) and anovulation.
Recovery processes that follow any of these treatments vary from one woman to another. However, because the number of viable eggs (ova) decreases with age, ovarian function in women in their mid thirties to early forties is less likely to be fully restored.
Consequences for men:
Male germ cells are very sensitive to certain classes of chemotherapeutic agents, so there is a risk of altered spermatogenesis depending on the treatment.
Radiotherapy, can cause a transient cessation of spermatogenesis, and ionizing rays reaching the testicles may be responsible for permanent azoospermia.
How can fertility be preserved following these treatments?
- Available options for women:
Oocyte vitrification: conservation of mature oocytes
This method preserves female gametes (oocytes) and solves issues concerning embryo conservation. For those who might want to conceive in the future, egg freezing requires approximately two weeks of ovarian stimulation with injections, and a ten-minute procedure to retrieve the eggs from the ovaries through the vaginal wall using local anesthesia and sedation. The eggs can then be frozen for long periods of time. This option helps preserve the autonomy of the patient who wishes to preserve her own gametes.
In vitro fertilization (IVF) and embryo cryopreservation
In vitro fertilization (IVF) and freezing the embryos are also viable options. These embryos can be transferred upon completion of treatments if the patient wishes to conceive.
Freezing embryos until the patient wishes to conceive requires the same steps as oocyte vitrification, but once the embryos are removed, they are fertilized by the partner or donor sperm to create embryos that will be frozen and kept in long-term storage.
Ovarian tissue preservation
This method is used in patients who have a good ovarian reserve and must receive highly gonadotoxic treatment. Partial or entire ovary removal for future use is still considered an experimental procedure and requires laparoscopy (minimally invasive surgery) under general anesthesia. Once the patient wishes to conceive, the ovarian tissue is transplanted on or near the ovary and pregnancy can be attempted naturally or through medically assisted reproduction techniques.
- Available options for men:
Men have the option of conserving sperm in a bank in case they cannot produce viable spermatazoa during or after treatment. In fact, for some spouses, knowing that sperm can be stored greatly reduces the stress that can be caused by the fear of not being able to reproduce as a result of treatment. In order to improve sperm viability, plan to produce three semen samples (on average) and practice sexual abstinence for two to five days prior to producing each sample.
At Procrea Fertility, the cryopreservation centre offers men the opportunity to bank their sperm for short to long-term periods.
Today, despite receiving a cancer diagnosis, it’s possible to take steps to protect your reproductive potential and improve the probability of making your dreams of starting a family come true. Thanks to these various medical procedures, pregnancy is no longer ruled out and becomes possible for our patients. For more information and guidance, ask your doctor for a consultation with a fertility specialist. You can also consult our page Fertility preservation for medical reasons.