Fertility Options for Cancer Patients and Survivors

Whether you want to have kids in the future (or want more kids if you already have them) is a question that often takes a lot of time and discussion with your partner and cancer care team. For someone newly diagnosed with cancer, however, sometimes that decision has to be made much earlier than normal before treatment starts. In addition, for people who have had cancer treatments, there can be challenges with fertility, which means the ability to have children. Some cancer treatments, like chemotherapy and radiation, can affect the reproductive organs and the body's ability to produce eggs or sperm. This can make it harder for people who have been or will be treated for cancer to get pregnant or father children after treatment. However, there are options available to help preserve fertility before starting treatment, such as freezing eggs or sperm, freezing embryos, and trying to protect the ovaries. It's important to talk to your doctors about these options as early as possible, and if that conversation never happened, or you weren't able to store as much as you'd hoped, it's still worth having. Current ASCO guidance recommends that reproductive risks be discussed both at diagnosis and during survivorship, and that fertility preservation can still be offered after treatment ends.

Understanding the Impact of Cancer Treatments on Fertility

Cancer treatments like chemotherapy and radiation can have different effects on fertility for both men and women. Chemotherapy can sometimes damage the eggs in a woman’s ovaries or the sperm in a man’s testicles. Radiation therapy, especially when it's aimed near the reproductive organs, can also cause problems with fertility. That's why it's very important to talk to your doctor about fertility before starting treatment. They can help you understand the risks and options for preserving fertility, like freezing eggs or sperm. By discussing this early on, you can make choices that might help you have kids in the future, even after cancer treatment.

Fertility Preservation Options

Facing cancer can be scary, but there are ways to keep hope for a family alive. Fertility preservation means saving the chance to have kids later on, even after cancer treatment. For women there are options like egg freezing, where eggs are stored for later use, or embryo freezing, where fertilized eggs are preserved. Another option for women is ovarian tissue freezing, where a small piece of ovary is stored. Drugs that temporarily shut down ovarian function (GnRH agonists, such as goserelin) may offer some added protection, and are sometimes used alongside other methods in women with breast cancer. Current ASCO guidance is clear that they should not be used instead of proven methods like egg or embryo freezing. Think of them as an addition, not an alternative. For men, sperm banking is available, where sperm is saved for future use. There's also testicular tissue freezing, where a piece of testicular tissue is preserved. These options give people dealing with cancer a chance to still have a family one day, even after cancer treatments are done.

Navigating Fertility After Cancer

After experiencing cancer, figuring out how to have kids can feel overwhelming. But there's help out there! Doctors can guide you through your options, like freezing eggs or sperm before treatment, so you can still become a parent someday. Depending upon a woman’s age, there can be a return of natural ovarian function after chemotherapy. In general, younger women have a greater chance of natural return of ovarian function and menstruation after chemotherapy. The chances of natural return are reduced as a woman approaches menopause. We’ll go over some of the common options that might be available to you or a loved one as you navigate life after cancer treatments.

For Women

Some options for women include:

• Egg Freezing: Harvesting and freezing a woman's eggs for future use.
• Embryo Freezing: Freezing fertilized eggs (embryos) for later implantation.
• Ovarian Tissue Freezing: Preserving a piece of ovarian tissue for potential future use.
• IVF (In vitro fertilization): Combining eggs and sperm outside the body, then transferring the embryo into the uterus.
• Donor Eggs: Using eggs from a donor for IVF if a woman's own eggs are not viable.
• Surrogacy: Having another woman carry the pregnancy for the intended mother.
• Adoption: Choosing to build a family through adoption if pregnancy is not possible or desired.

For Men

Some options for men include:

• Sperm Banking: Collecting and storing a man's sperm before cancer treatment for future use.
• Testicular Tissue Freezing: Preserving a piece of testicular tissue. This is still experimental and is only offered to boys who haven't yet reached puberty, through a clinical trial. It isn't an option for adult men. For men and adolescents, sperm banking is the established method, and if you're unable to provide a semen sample, a procedure called testicular sperm extraction can retrieve sperm directly.
• IVF (In vitro fertilization) with Intracytoplasmic Sperm Injection (ICSI): Using sperm retrieved from the testicles directly injected into an egg during IVF.
• Donor Sperm: Using sperm from a donor for IVF if a man's own sperm is not viable.
• Surrogacy: Having a surrogate mother carry the pregnancy for the intended father, using either the man's own sperm or donor sperm.
• Adoption: Choosing to build a family through adoption if biological fatherhood is not possible or desired.

If You're on Hormone Therapy

If you have hormone receptor-positive breast cancer, you may be facing five to ten years of endocrine therapy, years that can overlap with the window in which you hoped to have children. This used to be an unanswerable question. The POSITIVE trial followed more than 500 women aged 42 and under who paused endocrine therapy after 18 to 30 months to try for a pregnancy, and found no increase in breast cancer recurrence compared with women who stayed on treatment, both in the initial analysis and in longer follow-up. Most of the women who became pregnant had a live birth. Researchers are still following these women, because recurrence risk in hormone receptor-positive breast cancer continues for many years, so this is a conversation to have with your oncologist rather than a decision to make alone. But it is now a conversation with real evidence behind it.

Talking with Your Health Care Team

One thing we hear over and over from our community is how helpful (and essential!) it is to keep open lines of communication with your care team. Make sure you discuss your fertility questions, concerns or goals as early after your (or your loved one’s) diagnosis as possible so you can keep as many options open as possible. It’s overwhelming to make huge life decisions when you’re already dealing with cancer, but use your care team as partners in the process to support you and make sure they understand your goals and preferences. 

Questions to Ask Your Health Care Team: 

Here are some questions you might consider asking your care team about fertility options:

• What are some options available to preserve fertility?
• How soon will treatment be started? Is there time to consult a fertility specialist? Can the oncology care team refer to a fertility specialist?
• How successful has the medical team at this facility been with preserving fertility in patients with my type of cancer?
• What are the costs associated with fertility preservation? Will insurance cover this?
• Some states have laws that ensure that insurance covers these procedures. Are there any applicable laws?

When it comes to the insurance coverage question, our friends at Triage Cancer have some great resources to determine your state’s laws about fertility preservation coverage.

Conclusion

Understanding how cancer and its treatments can affect fertility is crucial for those facing a diagnosis. Making decisions about future family planning can feel overwhelming, especially when cancer treatment needs to begin quickly. Chemotherapy and radiation, common cancer treatments, can impact the ability to have children later on. However, options like egg or sperm freezing offer hope for parenthood after treatment. It's vital to have open discussions with your healthcare team early on to explore these options. By understanding the impact of cancer treatments on fertility and discussing available choices, individuals can make informed decisions about their future family. Remember, you're not alone!

FAQs

Q: Can a cancer survivor be fertile?

Ans - Yes, some cancer survivors can still have children, but it depends on many factors like the type of cancer, patient's age and the treatment received. It's important to talk to a doctor about fertility options after cancer treatment.

Q: How can a female with cancer preserve fertility?

Ans - Females with cancer can preserve their fertility through methods like embryo or egg freezing before starting treatment. This can give them a chance to have children in the future.

Q: Can you do IVF after cancer?

Ans - In some cases, IVF (in vitro fertilization) can be done after cancer treatment to help someone become pregnant if natural conception is difficult. It’s important to have conversations about fertility with your care team as early in your treatment process as possible.

Q: What are the chances of getting pregnant after chemotherapy?

Ans - The chances of getting pregnant after chemotherapy can vary for each person. Some may find it more challenging while others may still be able to conceive.

Q: Fertility impact after chemotherapy for men?

Ans - Male fertility can be affected by chemotherapy, but it's possible for some men to still father children after treatment. Consulting with a doctor is important to understand individual fertility options.

Q: Does chemotherapy cause infertility in males?

Ans - Chemotherapy can impact male fertility, but it doesn't always mean infertility. Some men may still be able to get a woman pregnant after treatment.

Q: Are cancer survivors high risk pregnancy?

Ans - While cancer survivors can have successful pregnancies, they may face some risks during pregnancy due to their medical history. It's essential for them to receive specialized prenatal care.

Q: What happens if a woman with cancer gets pregnant?

Ans - If a woman with cancer becomes pregnant, it's crucial for her to work closely with both her oncologist and obstetrician to manage her health and the pregnancy safely.

Q: Does chemo affect egg quality?

Ans - Chemotherapy can affect egg quality, which may impact fertility. Discussing options for preserving fertility before treatment is important for women facing cancer.

Q: How fertile are you after chemo?

Ans - Fertility after chemotherapy varies for each person. Some may experience temporary or permanent infertility, while others may still have the ability to conceive naturally or with medical assistance.

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