It’s Not Only You

Cancer is a reality for many young adults. Approximately 10,000 Canadians aged 20–44 are diagnosed with cancer every year. The good news is that approximately 80% survive. Methods to diagnose and treat cancer are constantly evolving and improving. As a result, many young Canadians are leading full lives after conquering cancer. Among this increasing number of survivors, the ability to have a family of their own is an integral element in the quality of their life.

Thinking Beyond Surviving Cancer

Infertility is defined as an inability to have children. Not all forms of cancer treatment will lead to infertility, although many do. For men, this means being unable to produce an adequate number of sperm, or producing sperm that are irreversibly damaged by cancer treatment and are not able to naturally fertilize a woman’s egg. For women, infertility means being unable to produce eggs, the inability to conceive, or the inability to carry a pregnancy to term.

In some cases, it is difficult to know if your treatment will cause infertility. In other cases, your physician(s) may be able to tell you with certainty if your fertility will be compromised. To allow for as many options as possible after treatment, it is important to consider fertility preservation prior to beginning your cancer treatment. The first step is to inform your physician(s) and oncology professionals of your wish to preserve your fertility. Options are available for both cancer patients beginning treatment and for those who have already started or completed treatment.

Thanks to advances in the field of assisted human reproduction, in many cases cancer patients are able to pursue fertility preservation in a timely manner. Fertility preservation can often be completed prior to the start of cancer treatment.

Cancer Treatments That Can Cause Infertility

Certain cancer treatments are more likely to lead to infertility than others. Chemotherapy, radiation and surgery may all result in infertility, depending on the type, dose, length, frequency, or location of treatment. Talk to your oncologist and/or a fertility specialist to determine the likelihood of infertility associated with your course of treatment.

Chemotherapy risks:

Certain types of chemotherapy can cause permanent damage to eggs and sperm cells.

Radiation risks:

Whole body or abdominal/pelvic radiation can lead to permanent infertility for females and males, due to irreversible damage to the eggs or sperm cells. For women, radiation targeted at the pelvic area may result in irreversible uterine damage, making a woman unable to conceive or carry a pregnancy.

Surgery risks:

Cancers of the reproductive system treated surgically may cause infertility, especially in cases where reproductive organs such as the testes, uterus or ovaries are removed as part of the procedure.

Premature ovarian failure occurs when a woman’s ovaries are damaged due to an unnatural occurrence, such as surgery, radiation or chemotherapy and stop functioning normally. For some women, this lack of egg production is temporary; however, for many cancer survivors it is permanent and results in the loss of their fertility. If this occurs, it is important to manage hormone and bone changes that result with the appropriate therapy.

Your Options

Fortunately, there are many options available to female and male cancer patients who wish to preserve their fertility. This guide contains brief explanations of potential options that patients can discuss with their physician(s) to determine the best course of action to suit their individual needs.

For Women

Embryo Cryopreservation:

The freezing of one or more embryos (the product of an egg fertilized by sperm), until you are ready to attempt pregnancy. This is a well-established method to preserve your fertility. It is an excellent option for women who are in a secure relationship or for those comfortable using donor sperm. This process takes approximately two to six weeks, and usually requires hormone stimulation to mature several eggs at one time. Mature eggs are fertilized in vitro (outside the body) and then frozen.

Egg Cryopreservation:

The freezing of one or more eggs until you are ready to attempt pregnancy. This is still considered an experimental option, but is increasingly popular among young, single women who do not wish to use donor sperm. This process takes approximately two to six weeks, and usually requires hormone stimulation to mature several eggs at one time. Mature eggs are frozen and can be thawed and fertilized at a later date.

In Vitro Maturation:

The difference between this procedure and standard egg or embryo freezing is that egg(s) are matured in vitro (outside of the body); therefore, hormone stimulation is not necessary. This is an experimental treatment that takes approximately one to two weeks. It is an option chosen increasingly among women who have minimal time before treatment starts and/or cannot undergo hormone stimulation.

Ovarian Tissue Cryopreservation:

The removal of either a section of the ovary, or the entire ovary, in order to freeze it for future use. While this is an experimental procedure, it is another possible option for a female who has minimal time before treatment starts and/or cannot undergo hormone stimulation.

Ovarian Transposition:

The surgical repositioning of one or both ovaries away from the radiation field. Success rates are unknown and vary from patient to patient.

Ovarian Shielding:

The shielding of radiation from the ovaries and/or uterus to minimize damage to reproductive organs. Success rates are unknown and vary from patient to patient.

Trachelectomy:

The surgical removal of the cervix, leaving the uterus intact for the future possibility of pregnancy. This is an increasingly common treatment option for those in early stages of cervical cancer.

For Men

Sperm Cryopreservation:

The freezing of sperm for future use. This is the standard way for men to preserve their ability to have children. Sperm can be frozen for many years and thawed in an attempt to conceive using assisted reproductive technologies.

Testicular Shielding:

The shielding of radiation to the testicles or pelvic area to minimize the risk of damage to reproductive organs. Success rates are unknown and vary from patient to patient. Successful shielding is also dependent on the proximity of the radiation field to the testicles.

Testicular Sperm Extraction:

The removal of testicular tissue via biopsy and examining the sample for sperm cells. If cells are found they can be frozen for future use.

Testicular Tissue Cryopreservation:

The removal of a piece of the testicle for freezing. This procedure is experimental with no live births to date, but shows promise for the future.

Please Note: Many fertility related procedures are not publicly funded. Please inquire with individual fertility centres regarding the services available and associated fees.

Fertility Options for Cancer Survivors

Natural Conception:

Some female cancer survivors may become pregnant naturally after cancer treatment. The likelihood of conceiving naturally can be assessed with blood tests and ultrasounds that determine hormone levels and ovarian activity. Male cancer survivors may have their sperm tested (semen analysis) to assess the likelihood of natural conception.

Assisted Reproductive Technologies:

Female cancer survivors who froze their eggs or embryos prior to cancer treatment can thaw and implant these materials to attempt pregnancy. For affected male cancer survivors, the frozen sperm can be used to fertilize an egg through intrauterine insemination (IUI) or in vitro fertilization (IVF).

Donor Eggs/Sperm/Embryos:

If an individual is infertile because of his or her cancer treatment, he or she may choose to use donor egg(s), sperm, or embryo(s).

Gestational Carrier:

A gestational carrier or surrogate mother is a woman who carries a pregnancy for an individual or couple. This is a useful option for women who have had radiation therapy in the pelvic or lower abdominal area, causing the inability to conceive or carry a pregnancy.

Adoption:

Some private agencies may consider medical history as a factor for adoption.

Conclusion

There are many fertility preservation options that can maintain your ability to have a family in the future. Addressing your fertility prior to undergoing cancer treatment can help provide you with as many options as possible to have a family in the future. If you have been recently diagnosed, are undergoing treatment, or have already completed cancer treatment, you can get more information about your fertility preservation options by asking your physician(s) for a referral to a Reproductive Endocrinologist – a physician who specializes in fertility and reproduction.

1. Cancer Care Ontario: Cancer in Young Adults in Canada, Toronto, Canada, 2006.