Cancer; Women's Health

Is there hope for fertility after surviving cancer?

Cancer; Women's Health

Drs. Orhan Bukulmez and Siobhan Kehoe review a cancer patient's results.

A cancer diagnosis can be devastating, but for women who plan to start or grow a family, the threat of infertility can feel like a double blow.

But depending on the type of cancer you have, fertility preservation options may be available. We often see women in the Dallas-Fort Worth area who have been told that there are no options available to them – and they are thrilled when they find out that they do have options.

A 2015 study in Cancer found that women do not receive enough information about fertility preservation before beginning cancer treatments. And while 70 percent of the study’s participants said they knew their cancer treatment could make them infertile, only 6.8 percent of the women used fertility preserving options.

With more people surviving cancer today, we make it a point to focus on quality of life after the disease – and that includes the ability to have children.

Don’t rush – think through fertility options before cancer treatment

When you hear, “You have cancer,” you may feel the need to start treatment immediately. Even if your doctor talks about your fertility options, you may be in shock from your cancer diagnosis and block it out or not hear everything your physician says. That’s why we as doctors must do a thorough job of educating our patients about their choices and reminding them about their options over multiple visits.

For most women, a two- to three-week delay won’t compromise cancer treatment. It’s important to ask about your options – and if you’re told you don’t have any, consider a second opinion.

A couple years ago, we saw a woman who had been diagnosed with uterine cancer. She had been told that hysterectomy was her only treatment option, so she came to us for a second opinion. Her face lit up when we told her there was another option: progestin therapy.

Just recently, our now cancer-free patient introduced us to her new baby, which made us giddy! It reminded us of what is possible when patients are armed with the right information.

So, pause, and talk with your oncologist and a fertility treatment specialist about your options before beginning treatment. The gynecologic oncologist, the fertility specialist and the obstetrician will take into account your wishes and work closely together to provide the best cancer treatment while maintaining your fertility whenever possible.

Fertility preservation options for certain cancers

While, historically, treatment of many gynecologic cancers involved removing the uterus, we now have other ways to treat young women while avoiding hysterectomy.

While treatments for many types of cancer can affect your fertility, three gynecologic cancers can pose the greatest risk: endometrial, cervical, and ovarian. However, there are treatment options for each that may save your fertility.

  • Endometrial cancer: We are seeing more and more cases of endometrial cancer (in the lining of the uterus), which is likely linked to the rising obesity rate. To avoid a hysterectomy, the main fertility preservation option is progestin therapy, which is a hormone-based treatment that can eradicate the tumor. Weight loss in conjunction with progestin therapy often increases the success rate, allowing a woman time to undergo fertility treatments and carry a pregnancy to term. The timing and details of pregnancy planning along with subsequent cancer surveillance and treatment should be individualized for each patient by her physician.
  • Cervical cancer: Thanks to excellent screening methods such as pap smears, advanced cervical cancer cases are rarer than they used to be. An innovative surgical procedure has given us the ability to remove the cervix with the cancer and avoid removing the entire uterus. In this procedure, known as a radical trachelectomy, after we remove the cervix, we reconnect the uterus to the top of the vagina, preserving the uterus and giving the patient the option of carrying her own pregnancy. Data show trachelectomy to be an effective cancer treatment and fertility-preserving option. If you are diagnosed with an early cervical cancer, ask your oncologist if you are a candidate for a trachelectomy.
  • Ovarian cancer: Depending on the stage and cell type of your ovarian cancer, we may be able to remove just one ovary, allowing you to keep the other ovary and uterus. For women who are not candidates for keeping both of their ovaries, oocyte cryopreservation, a procedure that freezes egg specimens, may be an option and you should discuss this with your physician. If you still have your uterus, then these eggs can be used later for a pregnancy that you carry. If we do need to remove both your ovaries and uterus, there is another option. The embryologist can coordinate treatment so that immediately after removing your ovaries, we can try to retrieve the eggs – known as ex vivo egg retrieval. The eggs can then be frozen and used in the future through a surrogate– a woman who carries the pregnancy for you.

Many fertility-sparing methods work best if you have an early-stage cancer. When we find cancer at an early stage, we feel more confident that we won’t have to alter your plans for having a family.

That makes following guidelines for cancer screening very important (we know they can be confusing, change frequently and be debated among various women’s healthcare groups). Seeing your doctor when something doesn’t feel right is also very important.

Fertility after chemotherapy and radiation

If chemotherapy is recommended as a course of treatment for your cancer, it may suppress ovarian function for a while, but it doesn’t always render the ovaries non-functional. Talk to your doctor about how your specific course of chemotherapy may affect your fertility.

Radiation therapy, on the other hand, even in a small dose, can destroy an ovary. If you need radiation therapy in the pelvic area, we may be able to perform ovarian transposition. This procedure involves moving the ovaries out of the pelvis and into the upper abdomen so they’re not exposed to the radiation. After ovarian transposition, you will need to see a fertility specialist in order to get pregnant. But, this procedure allows you to potentially have functioning ovaries after radiation therapy and the possibility of harvesting your eggs later when you want to become pregnant.

Next generation of fertility preservation methods

We’re always looking for new and innovative ideas to keep our patients fertile, even after cancer treatment. There are methods in experimental phases that we have great hope for in the future.

Some researchers are working on taking out a piece of the ovary, freezing it, and then transplanting it back into the patient after the cancer has been eliminated. While there have been 20 to 30 successful births thanks to this method, we haven’t found a solution to make 100 percent sure there isn’t cancer still hiding in that ovarian tissue.

Researchers also are working to perfect in vitro maturation (IVM), in which immature eggs are harvested from an ovary, matured in a lab, and then frozen. This procedure could be helpful when cancer treatment needs to start immediately and does not allow the two or three weeks it takes for mature eggs to be harvested.

There are still obstacles. For instance, fertility preservation is not covered by insurance, but we are trying to do our part by keeping prices low, giving discounts for cancer patients, and seeking grants from pharmaceutical companies.

Still, young women who find themselves facing cancer should know there may be options to preserve their ability to have children – and that we are a resource to consider in working toward this goal.

If you have been diagnosed with cancer, talk with an oncologist and fertility specialist about your options for fertility preservation before beginning treatment. Request an appointment online or call 214-645-8300.

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