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Management of Fertility Issues Related to Cancer Treatment

The treatment of cancer may pose temporary or permanent fertility problems in both men and women. The effects may be immediate or show up much later in life. Various factors, such as the type of cancer, treatment, and age, determine your chances of infertility following treatment. Any cancer therapy would involve one or more of the three general techniques – chemotherapy or the use of high-end medication, radiotherapy, which is the use of high-energy radiation and surgery to destroy and remove cancer cells. The higher the dose of chemo and radiation therapy, and the older you are, the greater its effect on fertility.

Cancer therapy can damage the endocrine glands (glands that release hormones essential for puberty and fertility). Radiotherapy and chemotherapy may damage the quantity and quality of sperm in men, and decrease the number of mature healthy eggs produced in women. Cancers of the reproductive organs such as the testicles, ovaries, uterus, fallopian tubes and cervix may require surgical removal, thus affecting the ability to reproduce. Cancer treatment can also increase the risk of early menopause in women, making them infertile at a much younger age.

Since avoiding cancer treatment is not an option, there are methods to preserve your fertility. Fertility-preserving procedures are most commonly performed before cancer treatment. It is important that you talk to your doctor about these methods and plan early to preserve your fertility.

Fertility-preserving options in men

The options for men may include:

  • Physically protecting the testes from radiation therapy.
  • Testicular sperm extraction and epididymal sperm aspiration involve removing a small amount of tissue from the testicles or epididymis. The mature sperm are frozen and stored for later use through assisted reproduction (a technique of artificially fertilizing a preserved sperm with a woman’s egg outside the body, and transferring the embryo into the uterus for development).
  • In boys who have not entered puberty, a small portion of the testicular tissue, containing stem cells that will eventually become sperm, is extracted, frozen and stored.
  • Sperm banking involves preserving (freezing) semen for assisted reproductive procedures.

Fertility-preserving options in women

The options for women may include:

  • Embryo freezing- involves the collection of mature eggs and fertilization with sperm in the laboratory. The resulting fertilized embryos are frozen and preserved until the woman is ready to become pregnant.
  • Oocyte freezing - involves the collection of mature eggs and freezing them (without fertilization with sperm).
  • In the case of early-stage cervical cancer and ovarian cancer, fertility-preserving surgery is performed to remove the cervix and affected ovary, respectively, keeping the uterus intact. This will help the woman to get pregnant and deliver the baby by cesarean section.
  • Oophoropexy - involves surgically moving the ovaries away from the path of radiation and bringing them back to their original position after treatment, with an intention of protecting the ovaries from radiation therapy.
  • In girls who have not yet entered puberty, ovarian tissue preservation is performed, which involves the surgical removal of ovarian tissue and preserving it by freezing. The tissue may be transplanted back into the girl after the cancer treatment.

Fertility-preserving procedures may vary for each individual and each condition. You can discuss it with your doctor in detail before you decide.

Allen OB/GYN

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