Cancer’s Impact on Women’s Fertility and Building a Family after Treatment

By Esther Napolitano

on Friday, October 4, 2013

Summary

Memorial Sloan Kettering experts discuss the impact that cancer and its treatment can have on female fertility, and options for building a family after treatment ends.

Memorial Sloan Kettering experts discuss the impact that cancer and its treatment can have on female fertility, and options for building a family after treatment ends.
Women who confront a cancer diagnosis before beginning or completing their families may have many questions about how cancer treatment will affect their ability to have children in the future. The good news is that investigators at Memorial Sloan Kettering are devoting an increasing amount of attention to this topic, and there are steps that patients may be able to take to preserve fertility, enabling them to parent a child in the future.

Memorial Sloan Kettering and CancerConnect, an online cancer community, recently partnered to air a live web chat that offered expert information about how some cancer therapies can affect a woman’s reproductive system, what options exist to help preserve fertility before treatment begins, and what alternatives can be considered for building a family after treatment ends.

Understanding How Treatment Affects Fertility

Many women diagnosed with cancer during their childbearing years will be able to have children naturally after treatment, but some are at risk for losing their ability to conceive a child or carry a pregnancy.

For example, surgical procedures may require the removal of reproductive organs or alter their structure and function. Chemotherapy can destroy eggs, as can radiation therapy delivered to the pelvic area. Surgery or radiation therapy involving the brain may disrupt hormone function, interfering with egg maturation during a woman’s menstrual cycle.

“Cancer and cancer treatments vary in their likelihood of causing infertility, depending on individual factors such as the type of disease, patient’s age, treatment type and dosages, and fertility before treatment,” says clinical nurse specialist Joanne Frankel Kelvin, who leads Memorial Sloan Kettering’s Cancer and Fertility Program and participated in the webinar.

Back to top

Exploring Your Options before Treatment Begins

Although clinicians cannot always prevent fertility problems in patients who want to have children after cancer treatment, they can provide information about the risk of infertility and the availability of options to preserve fertility, such as egg and embryo freezing. In addition, they can refer interested patients to reproductive specialists to learn more.

“Clinicians have to become more diligent about informing patients of these options, but patients must become educated and know what questions to ask,” says Ms. Kelvin. She recommends that newly diagnosed patients who want to have children in the future ask their oncologist if they are at risk for infertility from treatment and request a referral to a reproductive endocrinologist if this has not been offered. “Decisions about fertility preservation must be made before treatment begins, so this discussion should happen as early as possible while treatment is being planned.”

Back to top

Fertility-Sparing Surgery for Early-Stage Gynecologic Cancer

Fertility-preserving techniques are available for some women who are newly diagnosed with early-stage gynecologic cancers.

For example, since 2001, Memorial Sloan Kettering has offered a surgical procedure called radical trachelectomy for women of childbearing age with early-stage cervical cancer. Due to refinements made by Memorial Sloan Kettering surgeons, radical trachelectomy can be an effective way to remove early-stage cervical cancer without compromising the patient’s outcome or her ability to become pregnant and carry a child after treatment.

During the webinar, Nadeem R. Abu-Rustum, who is Director of Minimally Invasive Surgery for the Gynecology Service and specializes in this technique, explained that in many cases, radical trachelectomy can be done instead of a hysterectomy — the standard treatment, which involves the removal of a woman’s uterus and renders her unable to carry a pregnancy.

Memorial Sloan Kettering surgeons have performed 130 radical trachelectomies to date, making it the largest program of its kind in the United States. The majority of women attempting conception after the procedure are successful, and most babies are delivered full term via cesarean section.

Back to top

Preserving Ovarian Function after Colorectal Cancer

Colorectal surgeon Larissa K. F. Temple presented information on how chemotherapy and radiation treatment can impact fertility in women with colon or rectal cancer, as well as standard and investigational treatment options available to preserve fertility among newly diagnosed women.

She highlighted one surgical procedure, called ovarian transposition, which can help protect a woman’s ovaries from being damaged during radiation therapy for rectal cancer by permanently moving them outside the field of treatment.

“This minimally invasive procedure reduces the exposure of the ovaries to radiation with the goal of keeping the ovaries working properly and increasing the chances that a woman can conceive a child after cancer treatment, will not go into early menopause, or both,” explains Dr. Temple.

Even when the ovaries are moved, they may still be exposed to some radiation. Adding chemotherapy to a patient’s treatment plan may increase the likelihood of eggs being destroyed.

“In order to improve the chances of having a biological child, patients may also want to consider egg or embryo freezing before treatment,” suggests Dr. Temple.

Back to top

Family Building Options after Cancer Treatment

Not all women will be able — or want — to freeze eggs or embryos before beginning cancer treatment. However, if a woman is no longer fertile after treatment, there are still ways to become a parent.

“Discussion of other routes to parenthood is an important topic for many cancer survivors,” says Ms. Kelvin. These options include using donor eggs, surrogacy, and adoption.

During her presentation, Ms. Kelvin also touched on the complex legal issues and considerable financial implications that these choices may have. “Our goal is for you to feel you have the information you need to make the best decision you can for yourself, and regardless of the outcome, we want to be sure you have no regrets,” she said.

Back to top
 

Comments

Great article thanks.
Could you also share information about future fertility issues
When you received chemotherapy during your childhood? Thanks

Sylvie, thank you for your comment. We sent your question to Joanne Kelvin and she responded:

There have been a number of studies looking at fertility in survivors of childhood cancer. From these we have learned that there are specific factors that increase the risk of infertility in women. These include older age at the time of treatment, higher cumulative dose of alkylating agents (a type of chemotherapy that damages eggs in the ovaries), and exposure of the ovaries and uterus to high doses of radiation therapy.

We recommend that female survivors of childhood cancer be monitored during follow up visits to evaluate their ovarian function by checking their menstrual pattern and their blood levels of hormones such as FSH (follicle stimulating hormone). Women can also be referred to reproductive endocrinologists for more extensive evaluations. However, many survivors of childhood cancer are able to get pregnant and build their families without difficulty. Women at risk of become infertile at a young age because of their cancer treatment may want to consider starting their families early or having some of their eggs removed and frozen to be used in the future if needed.

Thank you very much! We will follow your advice. This hospital is wonderful... Thank you for saving our Lisa...

My daughter just was notified that her pap test showed squamous cells. She is 2months pregnant with her first baby. Which specialty Dr should she follow-up with. She wants this baby but her health first. SHe is 34. You advice would be appreciated. What questions should she be asking? Thank you

Lynne, to make an appointment with a Memorial Sloan Kettering doctor, your daughter can call our Physician Referral Service at 800-525-2225. Our Physician Referral experts will be able to answer her questions and help determine the best doctor for her diagnosis. You can go to http://www.mskcc.org/cancer-care/appointment to learn more about what information she will need when she calls. Thank you for your comment.

Great article! Thanks for the info!
I just want to send a comment to all MSKCC cancer doctors - Maintaining pregnancy and safe delivery are a whole different story from getting pregnant. I was TTC when my rectal cancer was diagnosed, had LAR with no RT or chemo, and was told by my surgeon, onc, and GI there was no effect on pregnancy. I went ahead spending over $30K on fertility treatment. My first pregnancy ended in missed miscarriage at 8wks (never miscarried before with two live births vaginally delivered at full term prior to cancer). Before my RE agrees to start next FET cycle, I got referrals to MFMs and pelvic disorder specialists. I was informed of the possibility that I may need surrogacy. I just wish my story could remind these cancer-focused doctor that discussions like this should involve consultations to the OB communities as well, esp. REIs and MFMs should be consulted before you offer your patients any advice. Had I been fully informed with the pregnancy risks after colorectal cancer surgery, we probably wouldn't have poured that much money into IVF.
http://www.ncbi.nlm.nih.gov/m/pubmed/23371020/

Dear Annie, we are sorry to hear about your miscarriage and all you've had to endure. We work closely with REI and MFM and would not offer a fertility sparing approach if they felt pregnancy was not realistic. Thank you for sharing your experience.

Not sure if the thread is still opening. Should I get egg freeze before hysterectomy or it is Ok to do after the surgery, because I am not sure if I am OK to do long waiting~

Miulee, we are not able to answer personal medical questions on our blog. This is something that you should discuss with your healthcare team. Thank you for your comment.

Im 33 years of age, had colon cancer at 29, didnt frezze my eggs and now i want a child more than anything....don't have any biological kids.

Dear Nashira, we are sorry to hear about your diagnosis. Unfortunately, not everyone has the opportunity to take steps to preserve their fertility prior to cancer treatment. But there are alternative ways to building a family and becoming a parent after treatment ends. Please visit our Fertility page on our website to learn more: http://www.mskcc.org/cancer-care/survivorship/fertility

We hope this information is helpful and appreciate you reaching out to us.

Thank you for this article. Can you please explain first of all whether colorectal cancer treatment (i'm specifically interested in chemo) increases the risk of pregnancy complications, or the likelihood of giving birth to an unhealthy child?

Also, does getting pregnant increase the risk of a cancer recurrence? I'm particularly interested in later-stage disease that has been in remission for some time. Isn't pregnancy immuno-suppressing? That seems like it would increase the risk of recurrence.

We forwarded your inquiry to MSK fertility expert Joanne Kelvin (who is quoted in this blog post) and she responded:

"Many women have healthy full term pregnancies after cancer treatment. However, some treatments have long lasting effects that can make it risky to become pregnant. It is important to speak with your oncologist about the particular treatments you received to see if this would be the case for you. For example, some chemotherapy drugs can affect the heart, lungs, or kidneys. The physical changes associated with pregnancy may stress the functioning of these organs. As another example, pelvic radiation may cause changes in the uterus, which may increase the risk of miscarriage and preterm labor. Maternal fetal medicine specialists are experts in high-risk pregnancies. If your oncologist clears you to attempt pregnancy, you could consider being evaluated by a maternal fetal medicine specialist before and during your pregnancy. For more information, go to: Society for Maternal-Fetal Medicine (www.smfm.org)."

She continues, "In regard to the risk of cancer recurrence associated with pregnancy, this varies based on the disease. Again it is important to speak with your oncologist about your risks. Women who are advised to avoid pregnancy can consider surrogacy with a gestational carrier. For more information, go to: RESOLVE The National Infertility Association (www.resolve.org) and Reproductive Facts from the American Society for Reproductive Medicine (www.reproductivefacts.org).

"Many men and women have healthy children after cancer treatment. Those who receive chemotherapy are generally recommended to wait at least one to two years before attempting pregnancy. This allows time for you to recover from treatment and for your body to clear any eggs or sperm that were exposed to chemotherapy and possibly damaged as they were maturing. In studies of children born of men and women who received chemotherapy in the past, no increased risk of birth defects was found. However, if the person’s cancer is associated with a specific genetic mutation, there is a risk of passing on that gene to a child, which could increase their risk of developing the same cancer. MSK’s Clinical Genetics Service offers hereditary cancer risk assessment and can discuss this further with you. For more information, go to: https://www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-…."

We hope this information is useful. Thank you for your comment.

Add new comment

Your email address is kept private and will not be shown publicly.