Fertility after cancer treatment

Fertility may not be the first thing you think of after a blood cancer diagnosis, but it’s an important point you should consider. Here, we discuss fertility after cancer treatment

When you are faced with a diagnosis of cancer, it may be difficult to focus on the future and think about having a baby. If you are about to start cancer treatment, it is important to take time to consider how you will try to preserve your fertility. This is a discussion you need to have with your Doctor or Specialist Nurse, and they will advise you about the best options available and refer you to a fertility specialist.

The term ‘fertility’ is used to describe the ability to conceive a child naturally. Some cancer treatments affect fertility in males and females. Chemotherapy and radiation can cause side effects as well as long-term and late effects, which can appear months or years after treatment. One possible late effect is infertility, the inability to conceive a child naturally. When first diagnosed with a blood cancer, your primary concern will be your upcoming treatment and long-term survival; you may not be thinking about whether you can one day become a parent. However, information about the potential effects of your treatment can help you take steps to maximize your ability to have a child in the future.

Advances in assisted reproduction techniques that involve cryopreservation of gametes (sperm, oocytes and ovarian tissue) offer greater opportunities to treat infertility in patients with cancer.

Please ask your Doctor or Specialist Nurse for further information. It is important to talk with members of your haematology team before treatment begins about the effects of your treatment.

How does chemotherapy/radiation and surgery lead to infertility for men and women?

The risk of infertility from cancer treatment is based on several factors, including the patient’s age and the type and dosage of treatment received.

Cancer treatments like chemotherapy and radiotherapy are designed to kill rapidly dividing cells throughout the body while leaving other cells intact.

Cancer cells divide rapidly, but so do the normal cells surrounding the maturing eggs in women. This can lead to premature ovarian failure, which can be temporary or permanent. Infertility for women also depends on your age; younger patients may have a chance of regaining fertility.

In men, infertility occurs primarily through damage to the lining of the testicles which produce sperm. Sperm collection pre-treatment is recommended.

How do you preserve fertility when you have cancer?

Preserving fertility may not always be possible when you have been told you have cancer. This will depend on how you are feeling when diagnosed and if treatment needs to start straightaway. The doctors and nurses will do their best for you and arrange interventions that will enable you to store sperm if you are a man, or egg collection if you are female. The treatment of your cancer will be their main priority, and if the collection of sperm or eggs will delay the treatment of your cancer, the collection of sperm/eggs may be abandoned. This will be done with your best interest in mind.

Cancer treatments that affect fertility

Chemotherapy especially drugs known as alkylating agents.

  • Busulfan (Busulfex, Myleran)
  • Carmsutine (BiCNU)
  • Chlorambucil (Leukeran)
  • Cyclophosphamide (Neosar)
  • Cytarabine
  • Vincristine
  • Vinblastine
  • Bleomycin
  • Doxorubicin (Adriamyci)
  • Lomustine (CeeNU)
  • Melphalan (Alkeran)
  • Procarbazine (Matulane)

Please check your chemotherapy plan with your Nurse.

Radiation

  • TBI – Total Body Irradiation
  • Radiation to the abdomen/lower pelvic area or
  • Pituitary gland in the brain.

Surgery

  • Removal of the reproductive organs

Options for female patients

Ideally, most fertility preserving procedures need to be done before you start your cancer treatment. The options available depend on several factors:

  • Age
  • Relationship status
  • How physically and sexually mature a woman is

After a consultation with the woman, these options may be available:

  • Embryo freezing
  • Oocyte (unfertilized egg) freezing
  • Protecting the ovaries from radiation
  • Ovarian tissue preservation

Each of these procedures take time and may not be offered if it is going to compromise your overall treatment.

However, it may be beneficial to have the conversation with the fertility specialist about your options. They can then advise about the possible level of infertility in relation to your cancer treatment.

Not all of the above options are appropriate or successful for everyone – please discuss this with your doctor if you are about to start chemotherapy or radiotherapy treatment. You will be referred to a specialist fertility doctor for further counselling and care.

Options for male patients

  • Shielding of the gonads during radiotherapy
  • Sperm banking for men should be offered and completed prior to any chemotherapy/radiotherapy treatment. Each donation should be eight hours apart and 48 hours after sexual activity. Sperm donations are frozen and stored for up to 50 years without damage. There is a storage fee for each year, which is usually covered by your hospital.

Every patient has the right to comprehensive information about fertility services available in their area.

Counselling and informed consent is essential for all patients and there is a legal requirement for fertility centres to follow.

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