Cancer Treatment Centers of America

We're available 24/7
(800) 615-3055

Chat online with us

Chat now

Other ways to contact us

Video
chat
Have us
call you
(800) 615-3055

Have questions? Call (800) 615-3055 to speak to a cancer information specialist.
Or we can call you.

Fertility preservation

Author: Bridget McCrea

With roughly one in 10 cancer cases occurring in adults of reproductive age,1 fertility preservation is a topic that more patients are discussing with their health care providers before, during and after treatment. In fact, Ashley Koenings, Senior Navigator for Fertility Services at Livestrong in Austin, Texas, says participation in the organization’s fertility preservation program, which offers information, support, discounted rates on preservation and access to free medications, involved 900 individuals in 2013. That is a dramatic increase over just 12 individuals in 2004, the year the program was rolled out.

Despite those rising program participation numbers, Koenings says that early intervention is not always emphasized when patients are managing myriad other issues associated with cancer diagnosis and treatment. “The issue can be time sensitive - depending on when treatment starts and on a woman’s menstrual cycle,” says Koenings, whose team helps health care professionals understand that fertility preservation must be discussed at the time of cancer diagnosis. “There’s been an increased awareness of the need for early intervention, but there’s still a lot of work to be done in this area,” Koenings says.

Affecting men and women alike

According to the National Cancer Institute (NCI), the estimated number of cancer survivors of reproductive age in the United States is about 500,000.2 Although cancer treatments have evolved to cause fewer harmful side effects in these patients, radiation therapy and many chemotherapy agents can still damage fertility. NCI reports that the most frequent causes of impaired fertility in male cancer survivors are chemotherapy and radiation-induced damage to sperm. The fertility of female survivors may be impaired by any treatment that damages immature eggs, affects the body’s hormonal balance or injures the reproductive organs.

In 2006 the American Society of Clinical Oncology published guidelines recommending that oncologists discuss with all patients of reproductive age the possibility of treatment-related infertility, as well as options for preserving fertility, and provide them with referrals to reproductive specialists. Recent surveys, however, have found that fewer than half the oncologists in the United States are following these guidelines and that even oncologists who regularly discuss the risk of infertility with patients rarely refer them to reproductive specialists.2 The fact that treatment can affect fertility in both men and women is an important point, says Koenings, because fertility preservation options exist for both genders - particularly when the issue is addressed in advance of any cancer treatment. Men, for example, can use sperm banking, testicular sperm extraction or radiation shielding (for one or both testicles) during treatment. Testicular tissue preservation is another option that men can explore, says Koenings, though it is still considered experimental at this time.

For women, options such as embryo and egg freezing (in advance of any treatment) have become more mainstream in recent years. Ovarian shielding to protect the ovaries during treatment, ovarian tissue freezing and ovarian suppression (both of which are still experimental at this stage) are other alternatives. Fertility-sparing surgery, wherein doctors remove the cancer with an effort to preserve as much reproductive function as possible, is also an option in some cases.

Chris Stephenson, DO, Medical Director of the Survivorship and Quality of Life Programs and an internist at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois, says making the decision among those options can be diffcult for patients who are also facing other difficult choices. “When patients are diagnosed with oncologic issues, they’re often so worried about the cancer that fertility becomes an afterthought,” he says. “Reversing this trend is an ongoing challenge for doctors who want to get patients thinking about fertility before treatment.” As with any known side effect associated with a treatment, Dr. Stephenson says, timely education is key: “We want to stay a step ahead of it and make patients aware of the potential for fertility issues in the future.”

Treatment and fertility

Nicole Longo, DO, an internist at CTCA® in Philadelphia, Pennsylvania, and leader of the Oncofertility Preservation Program at CTCA, says chemotherapy, radiation and surgery—all can potentially have a negative impact on an individual’s ability to reproduce, depending on the type of treatment and the dosage.

Intravenous chemotherapy, for example, runs through the patient’s entire system and can affect how critical reproductive organs like ovaries work. “Chemo can create a menopause environment to the point where you are no longer maturing eggs or where the structure of the egg becomes mutated,” Dr. Longo explains. Men can experience similar side effects of chemotherapy, she adds, which can affect sperm production or result in other reproductive issues.

Radiation can also have harmful effects on an individual’s reproductive capabilities, with the actual location of the radiation treatment determining the extent of that impact. “If you’re receiving radiation in the pelvic region, it can affect your ability to have a family down the road,” Dr. Longo says. “If, on the other hand, the radiation is applied to the chest or lower extremities, then it may not be as much of a concern.”

Finally, the impacts of surgery on reproduction are fairly self-explanatory: If organs necessary for reproduction and childbearing (such as the ovaries or uterus) are removed, a woman’s fertility will clearly be affected. For men, removal of the testicles can create a similar challenge and hamper an individual’s ability to reproduce.

Koenings says that all patients who are concerned about fertility should look carefully at the risks associated with their treatment protocol (the specific types of chemotherapy and/or radiation treatment they will undergo, for example). “Know the risks associated with the [treatment and specific] dosage,” Koenings says, “and factor that information into your fertility preservation approach.”

Considering the options

Dr. Longo says the three most common fertility preservation options available to patients are egg preservation, sperm preservation and embryo preservation. These techniques allow patients to take a proactive step toward preserving their fertility before treatment, allowing them to make decisions about family planning at a later date.

These techniques are especially helpful, Dr. Longo says, for patients who are single when they are diagnosed. “When egg cryopreservation was removed from experimental status, it became a great resource for single patients,” she says. “It’s an option that is open to someone who is unsure of who they would like to share that journey with—or even those who are not 100 percent sure [at the time of diagnosis] that they want to be a parent.”

Dr. Longo says that she is seeing more patients take an interest in fertility preservation. “This is a good thing because it’s a subject that needs to be discussed and brought out into the open,” she says, adding that doctors should broach the topic and have the conversation with their patients early in the treatment process. “A cancer diagnosis can be daunting in and of itself, but as doctors we want to be able to get patients thinking about this before treatment so that they can explore options to potentially have families in the future if they so wish.”

Preserving future options

Dr. Stephenson says the growing number of young adults affected by cancer, combined with the trend toward later-age pregnancies, means the need for good conversations and a proactive strategy around fertility preservation has become even more important.

“These two trends are making people think more about preserving their family lines,” Dr. Stephenson says. In his conversations with patients about their fertility preservation options, he makes a point to provide empowering information: “Our goal is to raise awareness of the fact that there are some medications used in oncology that, even if used just one time, can impact generations. It’s important that patients realize this and know what their options are if they want to have families in the future.”

Patients who are in the position to start talking about fertility preservation should begin a conversation with their oncologist. “That’s the best place to start,” says Dr. Longo, who cautions patients not to be afraid to open those communication lines—even if the time-to-treatment deadline appears to be tight. “Your doctor should help you navigate the process and explore your options of what may be appropriate before commencing any treatment for cancer. When that happens, the odds that you’ll be able to bear children from your own genetic line at some point in the future may improve significantly.”

References

1. Adams, E., Hill, E., & Watson, E. (2013). Fertility preservation in cancer survivors: a national survey of oncologists’ current knowledge, practice and attitudes. British Journal of Cancer, 108(8), 1602–1615. doi: 10.1038/bjc.2013.139.

2. Mayfield, E. Preserving Fertility While Battling Cancer. National Cancer Institute. Retrieved January 27, 2014, from http://www.cancer.gov/ncicancerbulletin/011111/ page5.

Your browser (Internet Explorer 7) is out of date. Learn how to update your browser.