A very common concern among young women who survive cancer is whether they will be able to get pregnant and give birth to a healthy child. This is because chemo and fertility are linked. Chemo has been shown to cause irreversible infertility in many cancer survivors. Therefore it is crucial to discuss these options, especially fertility preservation, with young women to maintain their quality of life following the treatment of cancer. Furthermore, it is instrumental in inspiring the patient to hope for a future without cancer. The best time to discuss the likelihood of treatment-related infertility and measures to prevent this with younger patients is before treatment rather than once the treatment of cancer has started. A comprehensive understanding of the available technologies must be given to the patient through a discussion with her cancer care team and a fertility specialist.
Chemo and Fertility: What Effects Does Chemotherapy have on Fertility?
Patients with any form of cancer detected, and receiving chemotherapy, run the risk of early menopause or premature ovarian failure. Women may have temporary amenorrhea brought on by chemotherapy, with menstruation cycles returning to normal frequency, in some cases, when the medication is stopped.
Before discussing the effects of chemo on fertility, it is important to understand that cancer itself can cause a loss of fertility in young survivors. Cancer can cause damage to the fallopian tubes, uterus, cervix, as well as other reproductive organs. It could also damage ovaries and other hormone-producing organs. As the ovarian reserve may be negatively affected due to the damage to these organs, the loss of viable eggs will cause early menopause.
Chemotherapy is used to treat malignancies that are more advanced than when they are initially found and have a high likelihood of spreading to other parts of the body. Hormone-containing drugs (hormone therapy) can also be used to treat some types of cancer. The kind of chemotherapy drugs, depending on whether or not alkylating agents are used, has a big impact on how quickly menstruation returns to normal.
- About four out of every five women who are on cyclophosphamide, methotrexate, and 5-fluorouracil; a commonly prescribed chemotherapeutic combination, experience ovarian failure or report no resumption in menses. Between 40% and 80% of women receiving this treatment may be rendered infertile.
- Other therapy combinations (such as doxorubicin and cyclophosphamide; doxorubicin, cyclophosphamide, and paclitaxel) led to higher rates of recovery from treatment-induced amenorrhea.
- Another form of treatment – anthracycline chemotherapy – uses doxorubicin, daunorubicin (Cerubidine), epirubicin (Ellence), and idarubicin (Idamycin). These drugs have the potential to weaken the heart and harm cardiac cells. During pregnancy and childbirth, the heart works a lot harder than usual and this weakening could pose a threat to the safety of both the mother and the child.
- Anthracycline chemotherapy may occasionally be used with radiation therapy to the chest or upper abdomen. The likelihood of cardiac issues is increased even more by this combination.
- A small number of cancer tumors are “hormonally insensitive,” leaving chemotherapy as the main treatment choice.
The above points clearly lead one to understand the varied effects of chemo drugs on a woman’s fertility and the risks it poses to a woman’s ability to achieve pregnancy after she has successfully completed cancer treatment, as well as the risks to the developing child if she gets pregnant during treatment or immediately after it.
How Long Should You Wait to Get Pregnant After Beating Cancer?
Pregnancy following cancer therapy is normally risk-free for both the mother and the fetus. The likelihood of a cancer recurrence does not appear to increase during pregnancy. Nevertheless, it is generally advisable to wait for a while (in some cases up to two years) before trying to get pregnant. This gap is necessary for the body to remove all traces of the chemo drugs, as well as give the body time to achieve its internal homeostasis. The time gap is also vital for the body to remove any defective eggs that may have developed during the therapy.
Another reason many health professionals advise waiting for two or more years is to see whether there is a possibility of recurrence of cancer. In case of a relapse, cancer therapy becomes riskier and a lot more difficult if the woman is pregnant.
The gap between successful completion of treatment and trying to achieve pregnancy depends on the following factors:
- The patient’s initial fertility – The effect of cancer treatment, chemotherapy, and drugs on fertility also depends on whether the patient met the standard definition of fertility before starting the treatment. If they happen to have issues with fertility before treatment as well, then there are chances of exacerbation post-treatment.
- The type of cancer – The organs primarily affected with malignant tumors and cancerous growth.
- The dose of chemotherapy (and other therapies) administered.
- The stage of cancer – If cancer has become invasive due to late detection it could cause complications by manifesting in organs that are important to ensure the fertility of an individual. The location of malignancy also determines if an individual is able to retain her fertility or not.
- Type of treatment – The duration of treatment affects the amount of damage caused to the reproductive organs, which directly affects fertility. Long-term chemo treatments (along with radiotherapy, in some cases) can cause significant damage to the reproductive organs.
- A woman’s age – A woman typically has more eggs in her ovaries when she is younger. This increases the likelihood that she will retain some fertility after cancer, despite the treatment-related loss. Moreover, when it comes to amenorrhea lasting six months or more, women over 40 are 25 times more likely than those treated at age 35, to experience it. Only 11% of women aged 20 to 34, on the other hand, claimed to have stopped menstruating for six months or even longer, following the end of chemotherapy.
- The amount of time that has passed since cancer treatment
- Other personal health factors – Pre-existing or newer health conditions as a result of the treatment.
Will my Menstrual Cycle be Regular After Cancer Treatment?
Menstruating women may conceive following their cancer treatment. But getting one’s menstrual period does not always determine that they are fertile. Also, menstruation does not follow a set path in all cancer survivors.
Some cancer therapies that young female patients need to undergo result in permanent cessation of menstruation. This is known as early menopause. It results in irreversible or permanent infertility.
While receiving therapy, the frequency of menstrual cycles in some women decreases or ceases and then resumes. Some women may still have decreased fertility after cancer, despite getting their periods after the treatment.
Likewise, it is possible for a woman to experience early menopause or decreased fertility even if she menstruates throughout the chemotherapy and treatment, and is still fertile thereafter.
In general, starting to get one’s menses regularly again takes longer for older women and those who had heavier doses of radiation treatment or chemotherapy. Furthermore, studies show that the menstrual cycles of such women are less likely to resume after therapy.
How Can I Ensure that I Will Get Pregnant After I Complete Cancer Treatment?
Since there is a high risk that you will lose your fertility post cancer treatment, there are a few options that will help you to preserve your fertility before treatment starts. Through these fertility preservation options, you can ensure that you have a high chance of getting pregnant post successful completion of your cancer treatment.
It is the most successful method among all fertility-preserving procedures. The woman is first administered fertility drugs to stimulate ovulation. Mature eggs are then retrieved using a minor outpatient procedure. The egg(s) is fertilized with a sperm sample (either from the husband or from a donor) in-vitro (a method called in vitro fertilization or IVF), and the resulting embryo can be stored until after treatment.
Oocyte Cryopreservation (Egg Freezing)
In this method, only the eggs that have been retrieved from the woman’s ovaries are frozen without fertilization. Once the time is right, they are thawed, fertilized with a sperm sample, and the resultant embryo is implanted into the woman’s uterus in an effort to achieve pregnancy.
This entails taking certain drugs (starting a couple of weeks before cancer treatment starts up until sometime after the completion of treatment) so that the eggs do not mature and aren’t damaged during chemotherapy and other cancer treatments.
Ovarian Tissue Preservation
In this method, a small part of the ovarian tissue is surgically removed and stored by freezing. After completion of cancer treatment, this tissue is implanted back into the woman’s body in an effort for it to start producing mature eggs that can be fertilized through natural means.
This is a great way of preserving ovaries and other organs if cancer is detected in one of them. An example of surgical removal of an organ with cancerous growth is the removal of the cervix (in the case of cervical cancer) without harming the uterus so that the woman can still deliver a child through a C-section.
How Dreams Can Help You Get Back on Your Fertility Journey Post Cancer
The American Society of Clinical Oncology (ASCO) advises that all cancer patients talk to their doctors as soon as possible before starting cancer treatment about the increased risk of infertility and their choices for fertility preservation.
Even though it may feel daunting to consider one’s fertility prospects while also battling cancer, most individuals benefit greatly by discussing it with their doctor. After survival, quality of life is of utmost importance, and hence any distressing factor, such as doubts about infertility should be immediately addressed and resolved.
At Dreams Fertility, we have worked closely with hundreds of women who were diagnosed with cancer. Our fertility specialists enter the discussion with their oncologists early and chart out effective strategies to preserve fertility before treatment starts. Once the woman has beaten cancer, we design customized strategies for fertility treatment to ensure that they can leverage their preserved fertility to realize their dreams of parenting.
To know more about how we can help you preserve your fertility, schedule a consult with a Dreams Fertility physician today.
Dr. Luis Murrain joined Dreams Fertility in 2021, providing specialty services in Fertility and Reproductive Genetics. With a shared vision that everyone deserves to have the family of their dreams, we are dedicated to helping all of our patients. We believe that families come in all shapes and sizes, and all of them are beautiful. We are proud to have a long history of providing services to all, including gay, lesbian, and transgender individuals and couples on their road to parenthood.