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Having a family after cancer

May 26, 2016 | by CTCA

Fertility
If you’ve been diagnosed with cancer and dream of having a family, there may be options thanks to advances in fertility preservation techniques.

Certain cancer treatments may impact your fertility, either through removal of reproductive organs such as ovaries or testicles, or by receiving chemotherapy or radiation that affect hormones or damage egg or sperm quality. If you’re about to undergo treatment and want to preserve your fertility, it’s crucial to talk to your oncologist as soon as possible about your options. The earlier you voice concerns about your fertility, the more options you have. Many patients are so focused on the cancer itself that taking steps to preserve their fertility may not be at the forefront of their concerns. But with improving therapies, many cancer patients have the potential to live longer with expectations to resume their normal lives when treatment is over—which may often include creating or increasing their family.

Jump-start a conversation with your doctor by asking about these topics:

Egg and embryo cryopreservation. In these procedures, a woman is given injections of drugs at the beginning of her menstrual cycle to stimulate the ovaries to produce multiple eggs, which can be harvested and frozen for later use. Unfertilized eggs can be frozen alone, or combined with sperm to create frozen embryos. This process usually delays treatment by two to four weeks, but can be orchestrated around other planned treatments (including surgery) or through resetting the menstrual cycle with medication, in order to reduce the risk of treatment delays. Studies now show that pregnancy outcomes from frozen eggs are comparable to fresh, thanks to a newer freezing technology called vitrification, which reduces damaging ice crystals from forming within the egg.

Sperm cryopreservation. This procedure for men is quite simple: The patient provides a semen sample, which is then frozen and stored for later use in IVF (in-vitro fertilization).

Ovarian transposition (oophoropexy). Women who plan to undergo radiation treatments to their pelvic area may opt to have this procedure, which relocates the ovaries away from radiation target sites, moving them closer to the ribs to reduce exposure to damaging rays. In addition to attempts at protecting the integrity of the eggs' genetic material, transposition also aims to reduce the incidence of ovarian failure (premature menopause).

Radical trachelectomy. Women with early-stage cervical cancer may be candidates for this surgery, which involves removing the cervix and wrapping a small band around the bottom of the uterus to take its place. This treatment is designed to help improve a woman’s chances of getting pregnant and carrying a baby to term, though it does carry a higher risk of miscarriage and premature birth. It also requires a C-section delivery.

Ovarian and testicular tissue cryopreservation. This procedure, while still experimental, involves surgically removing, then freezing and, ideally, re-implanting tissue after cancer treatments are completed. 

If these options are not available, donor cells, including eggs, embryos and sperm, may be considered. If a woman’s uterus is healthy enough to conceive and hormonal reserves are strong enough to carry a baby to term, surrogacy may be another option. Women may also consider fostering or adoption. If you think you still may want children, initiate a conversation with your doctor as early as possible, and raise any fertility concerns. Many cancer centers like Cancer Treatment Centers of America® (CTCA) have oncofertility services with experienced physicians who can offer advice about the fertility preservation method that suits your needs.