A cancer diagnosis can be especially difficult when it comes during the exact years you were thinking about starting a family. You may have been excited about plans ahead of you, until cancer came and your timeline changed dramatically. With these concerns and the stress that comes with it all, it can be difficult to figure out how to even start talking to your care team about fertility.
Before beginning treatment, you may want to learn more about whether fertility preservation is right for you. The first step is understanding how your cancer treatment may affect your fertility. And if you are a candidate for fertility preservation, we have resources to help you navigate discussions with your care team about what choosing the right options for you.
How do I know if my treatment course will affect my fertility?
Because cancer treatments are designed to kill rapidly dividing cancer cells, they may also damage the cells of the ovaries (the organs that contain eggs and the cells that support their growth and release).
“The way I counsel patients is that they are going to be receiving treatments to cure their cancer, and that we are very thankful for the treatments for that reason,” says University of Colorado OBGYN and oncofertility expert Dr. Leslie Appiah. “However, these treatments have side effects, and part of the effects of the treatment are to injure some of the normal cells because normal cells are precursors to cancer cells. And the ovary is very sensitive.”
Treatments that can affect fertility:
Radiation, whether internal or external, that targets areas near the pelvis or abdomen may affect the ovaries and other reproductive organs, potentially affecting eggs and the ability to carry a fetus. Some radiation therapies targeting the brain may also impact fertility, as the brain is responsible for releasing hormone signals important for ovarian function.
Among chemotherapy treatments, there are some that are considered to pose a greater risk to fertility than others. Risk also depends on other factors like dosages and your age at treatment. The American Cancer Society provides a list of chemo medicines that are most likely to cause infertility here, but your doctor will know best about how your specific chemo course may affect your fertility based on those additional factors.
Surgical procedures that target the reproductive organs may also affect fertility and childbearing abilities.
Some hormonal treatments, like tamoxifen for breast cancer, involve the long-term suppression of ovarian hormone production. While it is not safe to get pregnant while on these drugs, you may be able to consult with your doctor and pause the treatment to try to conceive. (For information about treatment-induced menopause, read Jadey’s article here.)
Unfortunately, for immunotherapies and targeted therapies, less is known about how these treatments impact fertility. Doctors do know that some specific immunotherapies can interfere with ovarian function.
As always, it’s best to ask your physician about how your treatment will affect your fertility. Ask for a referral to a reproductive endocrinologist or OBGYN as part of your care team to address your questions and fertility preservation options. You may have the option to freeze eggs or embryos after the diagnosis but before treatment starts; this can keep the option of pregnancy available after treatment is complete.
Infertility risks from cancer treatment are different for each person, and your oncology and fertility specialists can best advise on the recommended course of action. Nearly three-fourths of young adult cancer patients (ages 15 to 39), mostly women, took some measures to preserve their fertility, a 2018 National Cancer Institute study found. Still, only about half of patients report talking with their healthcare team about fertility preservation.
“[Patients] should always ask, ‘Is there anything else I need to know?’ Because that question sometimes jogs the physician to think, ‘Okay, let's see. I talked about your heart, talked about your brain, talked about neuropathy. Oh, this can harm your fertility,’” Dr. Appiah says.
We know fertility may be just as important for you as any other part of your clinical care. It’s important to convey this to your care team. Understanding how your treatment path may affect this part of you is the first step towards making a fertility plan.
