Fertility-sparing options for patients with gynecologic cancer

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix

This page was reviewed on April 21, 2022.

Treatment for gynecologic cancer may affect a woman’s ability to have children. Our cancer experts at City of Hope will address your questions and concerns before starting a treatment plan. Treatment recommendations are based on a number of factors, including the type of cancer you have and whether it’s spread, as well as your individual goals and preferences. If you plan to have children, you can be evaluated for fertility-sparing treatment options and counseled about their potential impact on your oncologic care.

At City of Hope, a gynecologic oncologist is an important member of your care team. This specialist is a fellowship-trained doctor who treats cancers of the female reproductive system. Research suggests women with a gynecologic cancer who are treated by a gynecologic oncologist have better outcomes than those who aren’t.

Gynecologic cancers include:

Cancer Treatment Centers of America® (CTCA) is now City of Hope®, joining forces to expand patient access to personalized, comprehensive cancer care.

Which types of gynecologic cancers are most likely to affect fertility?

Although women of all ages are at risk for gynecologic cancer, certain diseases are more likely to impact women at specific times of their lives.

Cervical cancer, for example, is more common in younger women than other types of gynecologic cancer. Although the average age of a woman diagnosed with the disease is 50, about 43 percent of patients are diagnosed before age 45.

Uterine cancer, sometimes called endometrial cancer, is the most common gynecologic cancer in the United States. While the disease is uncommon in women under 45, the incidence rate is increasing, including among premenopausal women.

Uterine cancer in younger women tends to be diagnosed in its early stages, with the cancer confined to the endometrium. In some cases, women may be able to avoid surgery and opt instead for high-dose hormone therapy to suppress the cancer’s growth.

For ovarian cancer, the average age of diagnosis is 60, yet about 12 percent of patients are diagnosed before age 45. Also, borderline ovarian tumors (tumors that aren’t invasive but also not completely benign) aren’t uncommon in women in their 30s. These tumors are typically treated with surgery or hormone therapy. A patient may be a candidate for a procedure that removes just one ovary and fallopian tube to preserve fertility.

Who is eligible for fertility-sparing options?

Fertility-sparing procedures are typically performed early in treatment and, in general, on women with early-stage cancers. But preservation may not be an option even in some of these cases. For example, if ovarian cancer has spread outside the ovaries, the doctor may not be able to recommend preserving the ovaries or the uterus.

It is important for your care team to know if you plan to have children.

How surgery may affect fertility

Surgeries that may affect fertility include:

  • Cone biopsy/conization: This procedure removes a cone-shaped piece of tissue containing the abnormal cells. It’s a way for your doctor to take a tissue sample or treat some early-stage cervical cancers. This can weaken the cervix and increase a woman’s chance to have a miscarriage or preterm delivery.
  • Hysterectomy: This surgery removes the uterus and prevents a woman’s ability to carry her own child.
  • Oophorectomy: This surgery removes the ovaries and may be performed at the same time as a hysterectomy. If possible, and if you have a low risk of recurrence (the cancer coming back), your doctor may be able to save one ovary to preserve your eggs.
  • Trachelectomy: This surgery removes the cervix, the upper part of your vagina and nearby tissue. In this procedure, your doctor may put a large stitch around the opening of the uterus to help it stay closed during pregnancy and reduce the risk of miscarriage or preterm delivery.

How radiation therapy may affect fertility

Radiation therapy uses targeted energy, including X-rays and radioactive substances, to destroy cancer cells. Radiation directed at a woman’s reproductive organs may affect her fertility.

If your treatment plan includes radiation therapy, your doctor may recommend freezing your eggs and embryo, called cryopreservation, before therapy begins. This option is designed to preserve fertility in case the eggs or uterus are damaged during treatment. Whether the radiation treatment will cause infertility may depend on how much radiation the ovaries or uterus receive.

In some cases, your doctor may be able to move the ovaries out of the way of the radiation’s path to preserve fertility as part of a technique called ovarian transposition, or oophoropexy.

Radiation to the uterus may cause scarring, which may make it difficult for the organ to grow and expand as needed during pregnancy. Women who experience scarring to the uterus from radiation are at higher risk for premature delivery, miscarriage and low-birth-weight babies.

How chemotherapy may affect fertility

Chemotherapy drugs target cells that divide quickly, affecting not just fast-growing cancer cells but normal cells that are integral to certain bodily functions. For example, hormones like estrogen, which are made by the ovaries, are key to the process that releases eggs each month and prepares the uterus for a possible pregnancy. Because these cells divide quickly, women who receive chemotherapy may experience early menopause.

As with radiation, how much chemotherapy a woman receives affects her fertility risk: The higher the dose, the higher the risk. Infertility risk is also higher in women treated with both radiation therapy and chemotherapy.

Certain chemotherapy drugs affect a woman’s fertility risk more than others. Your doctor may be able to choose your medicine based on your desire to have children in the future.

How hormone therapy may affect fertility

Your doctor may recommend hormone therapy to treat your cancer—either alone or in combination with other treatments. Some of these drugs, like tamoxifen, may raise the risk of birth defects if you get pregnant. Others suppress hormones, which may trigger early menopause

How targeted therapy and immunotherapy may affect fertility

Because targeted therapy and immunotherapy are still fairly new, little is known about the drugs’ effects on fertility. Talk with your doctor before starting treatment if fertility preservation is a priority for you.

Supportive care

At City of Hope, fertility preservation is part of our supportive approach to cancer care. We treat patients holistically, attacking the disease with conventional treatments like surgery and chemotherapy, while also supporting the patient’s well-being and quality of life. Fertility is an important part of quality of life for women who want to have children.

In addition to the oncologists on your team, such as a gynecologic oncologist and medical oncologist, your care team may include supportive care providers like behavioral health therapists, who are trained to address intimacy and sexual health concerns, pelvic floor therapists, who recommend exercises and aids to strengthen the pelvic region, and psychiatrists, who may conduct an emotional assessment and discuss medication options if anxiety from cancer or its treatment is causing stress on your relationship

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