Cancer; Men's Health; Women's Health
Fertility options for cancer survivors
April 10, 2019
After successfully fighting cancer as a teen or young adult, life goes on, and having a child is an important milestone that many cancer survivors want. However, cancer treatments such as radiation and medical therapies can affect fertility, or the ability to conceive, in men and women.
For women, the risk of fertility issues due to cancer treatment can vary depending upon a patient’s age. About 20 percent of female patients between the ages of 15 and 30 develop premature ovarian insufficiency because of their cancer treatment, and that number increases to more than 42 percent for female patients over age 30. In men, sperm production is very sensitive to chemotherapy because the drugs that target fast-growing cancer cells also can target sperm-producing cells. In addition, radiation therapy to the pelvis can destroy sperm-producing cells, and radiation to the brain can affect testosterone levels just as it does estrogen levels in women.
Years ago, patients were left with very few options to become parents after cancer. But today, our cancer and fertility experts collaborate before treatment even begins to offer advanced options for patients to successfully treat their cancer while preserving their fertility.
“It’s hard to add yet another thing to consider when you’ve been diagnosed with cancer, but preserving your options for having a baby can’t wait until you’re done with treatment.”
How might cancer treatment affect fertility?
Radiation therapy and chemotherapy play key roles in treating several kinds of cancer, including breast cancer, leukemia, and many others. Unfortunately, these effective treatments can cause premature ovarian insufficiency in women, or a loss of normal ovarian function before age 40.
Radiation therapy can damage the tiny vessels that supply blood to the ovaries, which can reduce or eliminate ovarian function. Radiation to the brain can affect the pituitary gland, which controls the secretion of estrogen, and make it harder to become pregnant. Alkylating agents, some of the most common chemotherapy drugs, treat cancer by damaging the DNA of fast-growing cancer cells but also can damage ovarian cells in the process.
We work closely with referring oncologists to lower our patients’ risk of complications to their future fertility whenever possible. In some cases, your oncologist might be able to:
- Reduce your radiation dosage to
minimize reproductive side effects
- Shield your reproductive organs
from unnecessary radiation exposure
- Substitute less-toxic chemotherapy
medications, such as an ABVD regimen for Hodgkin’s lymphoma (Adriamycin®
[doxorubicin], bleomycin, vinblastine, and dacarbazine), which doesn’t include
classic alkylating agents like cyclophosphamide
- Recommend alternative treatments to help preserve your fertility
Related reading: Britni's story: Destroying cancer, preserving fertility
The best chance for women and men to conceive a child after cancer treatment is for us to preserve their options before treatment begins. We advise patients to wait at least six months to a year after completing cancer treatment before trying to start a pregnancy in order to reduce the risk of birth defects. Some cancer medications require patients to wait even longer before trying to conceive.
Fertility preservation for women and girls
Egg and embryo freezing, also known as cryopreservation, are popular options for preserving fertility before cancer treatment at our Fertility and Advanced Reproductive Medicine Clinic. Patients who choose embryo freezing can have their embryos (fertilized eggs) implanted safely through frozen embryo transfer after they complete their cancer treatment. Women who choose egg freezing will need to have their eggs fertilized with sperm from a partner or donor in our laboratory (in vitro fertilization, or IVF) before the embryos can be implanted. For women who have been surgically treated for endometrial or cervical cancer or who have other complications that would prevent them from carrying a pregnancy to term, gestational surrogacy might be an option, where the patient’s embryo is transferred to another woman who will carry the pregnancy for her.
Embryo and egg freezing require 12 to 14 days for us to stimulate the follicles in the patient’s ovaries to produce multiple eggs. This process is called controlled ovarian stimulation, and it requires the patient’s cancer to be stable enough to delay treatment a couple of weeks. Gathering multiple eggs or embryos gives a patient the best chance of successful pregnancy later, especially for women older than 40. We can test the frozen embryos for their genetic risk for certain cancers if detected in the patient, such as the BRCA gene for breast cancer, but this can limit the number of embryos available for implantation.
Another potential fertility preservation method is injection with a medicine called gonadotropin-releasing hormone (GnRH) agonist. This drug suppresses the normal function of the ovaries and can put the patient into a false menopausal state, potentially sparing the egg-producing tissue from damage during chemotherapy. A series of studies found that receiving a GnRH agonist before chemotherapy for breast cancer increased women’s chances of becoming pregnant after treatment. However, other studies have been inconclusive. This option is only partially protective, and some patients might not benefit.
Girls who have been diagnosed with cancer but who have not yet entered puberty will not benefit from traditional egg- and embryo-preserving methods, but a treatment called ovarian tissue freezing might be an option. During this procedure, strips of tissue from the ovaries are removed and frozen. This tissue contains many viable eggs that can be spared from damage during the freezing and thawing process. Once the patient has completed treatment and reaches the age at which she wants to start a family, she can have her frozen ovary tissue transplanted back to attempt to conceive naturally or through IVF. Small studies of this treatment are very encouraging, but more research is needed.
Fertility treatments for men and boys with cancer
Sperm banking, or freezing sperm, is a well-established preservation method for men of reproductive age before they begin cancer treatment. We offer sperm banking in our Fertility and Advanced Reproductive Medicine Clinic.
Our male infertility expert can help to obtain sperm that could not be collected naturally. For boys and young men in their early teens or who cannot collect, however, harvesting sperm can be an issue. One approach we can use is called electroejaculation, in which we put the patient under general anesthesia and use a safe electrical probe to help produce semen for collection. In some cases, our male infertility expert also can perform surgery to retrieve sperm directly from the testicles for freezing.
Help for patients in need
Although sperm preservation is a fairly affordable procedure, egg and embryo freezing are much more expensive. Egg freezing can cost over $6,000 to $7,000, and embryo freezing can cost over $10,000. Unfortunately, most insurance plans do not cover these procedures, so we work with partner organizations to reduce the costs whenever possible.
For example, after completing cancer treatments at UT Southwestern, our patients can receive a 25 percent discount if their fertility procedures aren’t covered by insurance. We work with the Livestrong Foundation and DESIGNRx first steps programs, which provide financial assistance for fertility treatment medications to cancer patients. In addition, Walgreens’ Heartbeat program provides free fertility treatment medications to women who have been diagnosed with cancer. With these discounts, patients can get more than 90 percent of their medications for free and save several thousand dollars over the course of their fertility treatment.
Lower the risk of fertility complications
Talk with your oncologist ahead of time about how treatment could potentially affect your future fertility. I’ve spoken with many patients who came to me for help after treatment, but because their doctors didn’t discuss fertility beforehand, there wasn’t much we could do. It’s hard to add yet another thing to consider when you’ve been diagnosed with cancer, but preserving your options for having a baby can’t wait until you’re done with treatment.
'I have to live for my son'
After five years of fertility treatments, Meredith Greenstreet got the gift she and her husband had been longing for. Their beautiful baby boy, Benjamin, was born. Ten month's after his birth came another medical hurdle: Meredith learned she had an aggressive form of lymphoma. See how Meredith and her UT Southwestern doctor approached her treatment, and her desire to have another child.