It’s important to talk to your doctors about your cancer care treatment and how it may affect your fertility before going forward with any procedures. Don’t assume your doctors will ask you about fertility and pregnancy concerns; it’s better to be upfront and voice your concerns right away.
Getting enough resources, information, and support will help you deal with any doubts. So what can cause fertility problems?
What Causes Infertility?
When trying to conceive a baby, many things have to take place for it to happen. Any changes that go on in a female’s ovaries or hormones can cause difficulties with conception. Changes or malfunctions in the body can affect a woman’s fertility and ability to carry a child through a full pregnancy.
Females may be infertile if:
- A fertilized egg can’t grow inside the uterus
- Hormones are disrupted
- Ovaries don’t contain healthy eggs
- A tumor might press on the ovaries or uterus and cause problems
- Damage to any parts of the reproductive system that might prevent eggs from being released, fertilized, and implanted
- Something happens that prevents the fetus from being carried full term
In most cases, cancer treatments and surgery are more likely to interfere with the reproductive system than cancer itself. Different surgeries and treatments can cause various health issues.
Infertility varies depending on:
- Type and extent of surgery
- The dosage of treatment
- Type of treatment (radiation, chemotherapy, targeted therapy, hormone therapy, immunotherapy, stem cell transplant)
- A patient’s age and stage of development (before or after menopause or before or after puberty)
Surgery
Surgery may be needed to remove a tumor near or in the reproductive system—for example fallopian tubes, ovaries, cervix, or uterus. Surgery may also be required for a tumor that’s near your abdomen or pelvic organs such as rectum, colon, or anus. Lastly, surgeries near the nervous system, brain, or spinal cord can also affect a woman’s fertility.
Removing Reproductive Organs
A surgery called a hysterectomy removes a woman’s uterus. Since an unborn child is carried in the uterus, a woman cannot conceive after she has had a hysterectomy. If a female suffers from uterine or cervical cancer, surgery is done to remove the uterus and prevent a woman from becoming pregnant.
An oophorectomy removes a woman’s ovaries and might be done the same time as a hysterectomy. Ovaries hold a woman’s eggs, and she is unable to get pregnant without them. An oophorectomy is performed on women with ovarian cancer and other cancers that affect the reproductive system. It is low risk for cancer to come back, so a doctor may try to preserve one ovary and its eggs, allowing a woman to become pregnant. By keeping at least one ovary, you are preserving all hormones that prevent menopause symptoms. Some women may be at risk for uterine, ovarian, and breast cancers and have to have an oophorectomy to prevent these cancers from happening.
A trachelectomy is a surgery that removes a woman’s cervix. This surgery leaves the uterus, so a woman may still be able to get pregnant. This surgery can be done laparoscopically through the vagina or an incision made on the abdomen.
Other types of cancer surgeries done for tumors in the abdomen or pelvis may cause scarring around or in reproductive organs; these are called adhesions. Adhesions may block the ovaries, uterus, or fallopian tubes preventing a woman’s eggs from traveling to meet the sperm. This doesn’t allow eggs to become fertilized and implanted in the uterus.
Cancer surgeries will give you more information on cancer treatment.
Radiation
Radiation therapy treatments use high energy rays to kill off cancer cells. If radiation is aimed around a woman’s reproductive system, it may affect fertility. Radiation that is often aimed around the ovaries may affect how they work. Even radiation that isn’t precisely aimed at the ovaries may still cause damage because the rays are absorbed. Radiation that is inside of the vagina causes the ovaries to absorb large amounts of radiation.
High doses of radiation may damage some or all of the eggs in the ovaries; it may also cause early menopause. The majority of women receiving radiation to their pelvic region become infertile. There is a chance to save your eggs in a minor surgery to move your ovaries further away from the target site; before you begin radiation.
If you are receiving radiation to your uterus, it may cause scarring. Scarring in your uterus decreases its flexibility and the amount of blood it receives. For these reasons, your uterus may not be able to stretch to its full size during pregnancy. Radiation to your uterus also increases your risk of miscarriage and premature birth—women who had radiation before puberty experience these complications the most.
Chemotherapy
Chemotherapy kills all the cells in the body that are quickly dividing. Hormones like estrogen are needed to release eggs every month to prepare for a possible pregnancy. This hormone is created in the oocytes. Oocytes divide quickly and are frequently affected by chemotherapy. With chemotherapy, a woman may enter early menopause.
A woman’s fertility often depends on their stage of life, type of treatment, and dosage amounts. With all this being considered, it may be hard to determine if a woman will still be fertile after chemotherapy.
Here are chemotherapy medications that cause a high risk of infertility:
- Cisplatin
- Busulfan
- Carmustine
- Carboplatin
- Chlorambucil
- Cytosine arabinoside
- Cyclophosphamide
- Lomustine
- Doxorubicin
- Ifosfamide
- Melphalan
- Mitomycin-C
- Procarbazine
- Nitrogen mustard
- Thiotepa
- Vinblastine
- Vincristine
- Temozolomide
The higher the dose the more likely the medication is to cause infertility. If you are treated with both radiation and chemotherapy the risk of infertility increases.
These chemotherapy medications pose a lower risk of infertility:
- 6-MP
- 5-FU
- Cytarabine
- Bleomycin
- Daunorubicin
- Dactinomycin
- VP-16
- Fludarabine
- Epirubicin
- Gemcitabine
- Methotrexate
- Idarubicin
You should talk to your doctor about the medications you receive and the fertility risks they pose.
Hormone Therapy
Hormone therapy is typically used to treat breast cancer and can affect your fertility. Some medications may not cause infertility but may cause congenital disabilities. Other hormone therapy methods might suppress or block hormones that may cause infertility because a woman may enter menopause early. Depending on the length and type of treatment, this may either be temporary or permanent.
NVSCC
If you have any questions about your cancer care treatments, the experienced oncologists at Nevada Surgery and Cancer Care can help relieve your stress. Our oncologists and surgeons have extensive expertise in cancer care. Call us to schedule an appointment today.